Winter Harvest


In a forthcoming book, “Final Exam: A Surgeon’s Reflections on Mortality,” Dr. Pauline W. Chen writes about the many operations she performed on brain-dead patients for the purpose of procuring, or “harvesting,” their organs for transplantation. “They all,” she writes, “seemed remarkably alive.”

This past fall, the prestigious journal Science published a report on a young woman who, after a devastating car accident, was declared vegetative. For five months, she showed no signs of awareness whatsoever. Scientists, though, decided to put her in a Functional Magnetic Resonance Imaging scanner, a machine that tracks blood flow to different parts of the brain and that was only developed a few years ago. When they asked her to imagine things like playing tennis and walking through her home, the scan lit up with telltale patterns of language, movement and navigation indistinguishable from those produced by the brains of healthy, conscious people. The report’s authors, while stressing that the patient may still be classified as “unconscious,” conclude nonetheless that she has a “rich mental life.”

Ten years earlier, a patient like the young woman would have been assumed, for all practical intents, to be – effectively, if perhaps not legally – lifeless. Only the development of a new diagnostic technology has now rendered her more obviously alive. It’s hard not to wonder what technologies might one day yet be developed – or what aspects of consciousness might forever elude scientific instrumentation.

The acronym DCD might be mistaken for some new medium of music reproduction but in fact refers to “donation after cardiac death” – the procurement of organs from people whose hearts have stopped, even if their brains may still be functioning. Such procedures have taken place in many countries, despite the fact that the cessation of heartbeat is not necessarily irreversible. Even some patients whose hearts did not respond to cardiac resuscitation, it is well documented, have “come back to life” – in one case after the lapse of a full seven minutes, certainly sufficient time to harvest a vital organ or two.

The driving force behind the scramble to define death “to the instant” is clearly the worldwide shortage of organs for transplant. This past summer, doctors at the World Transplant Congress in Boston were told how the pool of available organs in the United States could increase by up to 20% if DCD were adopted more widely.

What does Judaism have to say about all this? Saving a life is a most weighty imperative, to be sure, but Jewish religious law, or halacha, does not permit one life to be taken to save the life of another – no matter how diminished the “quality” of the life of the former, no matter how great the potential of the life of the latter.

Halacha requires that death be clearly established, and does not permit any action that might hasten the death of a person in extremis. Any harvesting of organs after cessation of heart function that might not be permanent would be forbidden.

Unrelated to DCD is “brain death” – a diagnosis of irreversible cessation of all brain function, which modern medicine and secular law consider sufficient to permit the “harvesting” of organs before removal of life-support. What does Jewish law have to say about “brain death”? Can a patient with no discernable brain activity but whose heart continues to beat be considered a corpse?

Some rabbis vote yea on that question. And a recent New York Times article about a conference organized by the “Halachic Organ Donor Society,” an organization advocating increased organ donation from halacha-observant Jews, referred to “near unanimity among rabbis on the criteria for organ donation” – presumably referring to the next paragraph’s citation of the chief Sephardic rabbi of the Israeli city of Tzfat, whose criterion is brain death.

But many, and considerably more prominent in the world of halachic discourse, are the rabbinical authorities who do not agree. They include the late Rabbi Shlomo Zalman Auerbach, who was renowned as one of our generation’s most authoritative halachic decisors, as well as Rabbi Yosef Elyashiv, considered by many Jews to be the most authoritative authority of Jewish law today. Some leading scholars at Yeshiva University too, like Rabbi Herschel Schachter and Rabbi J. David Bleich, concur.

In her book, Dr. Chen writes about her “83rd procurement” when the brain-dead body she sliced open for its organs was that of a young Asian-American woman like herself, who reminded her vividly, so to speak, of herself. She found herself hesitating during the procedure, but managed to complete it, although as she cut the vena cava and watched the patient’s blood drain into canisters, she felt “as if my own life force were draining away.”

Dr. Chen may intend her account to be simply what the title of her book promises, a reflection on mortality. But perhaps another thought for consideration lay there on the operating table, the idea that despite the inevitability of its end, life is holy – and we do well to tread carefully and slowly before considering it gone.

That might explain the feeling she writes she had at the end of that 83rd procurement, an exhaustion born not only of “sleep deprivation [and] overwork” but of “an unbearable grief.”

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Noam Stadlan
8 years 11 months ago

I must again point out that the “conclusion of the chapter” cited by Dr. Zacharowicz does not discuss patients who have been declared brain dead, only patients who have no brain function on physical examination. Dr. Zacharowicz now tells us that these findings are similar to ones cited by the Nishmat Avraham. I do not have my copy of Nishmat Avraham in front of me. However, no matter who cites this data and in what context, it is not relavent data in the discussion of brain death.

Let us use a different disease as an example.… Read more »

8 years 11 months ago

While respectful of the prestigious academic background of Dr. Zacharowicz, I cannot think of a reason that brain death cannot be debated in an intelligent, open, intellectually honest written debate. I fail to see why such issues need to be worked out in private, as that only adds more intrigue and lack of trust in the decision making process – especially when there are two viewpoints and one of them refuses to portray their view. If Dr. Zacharowicz can elaborate on his point that this is not an issue to be debated in public, I’d be most grateful.

Numerous articles… Read more »

Leon Zacharowicz
8 years 11 months ago

I again regret that my other obligations precluded a more prompt response.
To fully respond to the comments of my junior colleague, Dr Stadlan, I would have to discuss issues which are better discussed privately or offline. What I have cited was not a single study but a conclusion of a chapter on brain death determination, and these findings are similar to those cited by the Nishmat Avraham, Dr. Abraham S. Abraham, who recorded the rulings of Rav Shlomo Zalman Auerbach ztl and so many others in his magnum opus.
The secular legal definition of brain death varies from state… Read more »

Noam Stadlan
8 years 11 months ago

“There are data that indicate that 20% of cllnically brain dead patients [that is, individuals felt to be completely brain dead by physicians without the use of an ‘confirmatory’ tests—LZ] demonstrated residual EEG activity…The issue here is not one of prognosis. There is no doubt that the remaining cortical neurons [ie, living brain cells—LZ] supporting residual EEG activity and the hypothalamic
neurons supporting the regulation of water homeostasis eventually die in patients who meet the current criteria for brain death. The question is rather How should we define the set point at which the patient is dead?”
Switching from scientific knowledge to… Read more »

Dr. Leon Zacharowicz
8 years 11 months ago

I regret that my teaching (anatomy and physiology) and other commitments precluded an earlier response and prevent me from a more thorough reply to some of the interesting points made in this discussion.

Permit me to add a few facts and thoughts to the discussion:

1) There cannot be even a shadow of a doubt as to the final halachic position of Rav Shlomo Zalman Auerbach ztl in the matter of the brain death controversy: he required cardiac cessation. Although it is curiously not on the HODS website, his signed, written reply to Rabbi Moshe Tendler’s argument–in favor… Read more »

Michael Feldstein
8 years 11 months ago

An additional point that Rabbi Shafran failed to mention, and which Robby Berman referred to: The HOD Society has a unique organ donor card that allows one to choose their definition of halachic death according to their wishes and the rabbis that they follow: 1) brain stem death or 2) cessation of heartbeat. Many people don’t realize that kidneys and corneas can be recovered for transplantation for a short period of time, even after the heart stops beating. So one can still donate a limited number of organs — even if you hold by a stricter definition of… Read more »

Noam Stadlan
8 years 11 months ago

The Comments section of Cross Currents may not be the most appropriate place to discuss the technical anatamic and physiological details of brain death, but some of the points made by Dr. Zacharowicz need clarification.

1. There are many halachic decisors in the Orthodox community who believe that cessation of brain function(brain death) is a halachic form of death. One only needs to look at the HODS web cite and see. To say that ‘there is near-unanimity’ against it is to either ignore these rabbis(and many others), or ignore a large non-Chareidi segement of Orthodoxy(mainly… Read more »

Robert Berman
8 years 11 months ago

It is unfortunate that Rabbi Shafran feels it is necessary to resort to scare tactics in his choice of graphic words, such as in his title “Winter Harvest (italics mine)” and referring to a body being “sliced open for its organs (italics mine),” and by recounting stories of people thought to be dead by the medical establishment, he writes, but who were actually alive.

I imagine Rabbi Shafran is aware that with regards to organ donation, U.S. law and Israeli law agree with halacha in that is it illegal to remove organs from a person who is “unconscious,” in persistent vegetative… Read more »

Avi Shafran
8 years 11 months ago

While my essay most certainly was intended to counsel great caution and due consideration of all halachic opinions with regard to establishing the end of life for the purpose of procuring vital organs, I did not take a position on the halachic issues and neither does Agudath Israel of America.

I cited the school of halachic thought that sanctions harvesting organs after brain-death as well as the one that does not. That I consider certain rabbinic authorities to be more prominent in the halacha-respecting community is, admittedly, an opinion. But last I checked, I am entitled to one.

The reason… Read more »

8 years 11 months ago

I read the excerpt from Dr. Chen’s book that appeared in the New York Times magazine(I assume that is where R. Shafran also read it, unless he has an advance copy of the book). Dr. Chen writes eloquently about her feelings under very stressful circumstances, but that doesn’t mean that what she writes has halachic ramifications. I too have been present for organ procurement surgery, and indeed, there is little difference from surgery on living people- blood flows, the lungs move up and down, the tissues are pink and healthy- but that doesn’t change the fact… Read more »

Dr. L. Zacharowicz
8 years 11 months ago


Rabbi Shafran presents some uncomfortable truths. As a neurologist with first-hand experience, I am aware–perhaps to a greater degree than most–of the complexity of the brain death issue.
Here are just a few points:

1) Rabbi Shafran correctly presents the current situation, wherein there is near-unanimity amongst halachic authorities in all camps of orthodoxy, against accepting ‘brain death’ as equivalent to halachic death.

2) I have personally discussed the Chief Rabbinate’s decision with one of the former chief rabbis involved.
Anyone who reads the decision will quickly realize it was limited to accident victims in Israel (actually in Hadassah… Read more »

Dov Kay
8 years 11 months ago

How sad it is to see a complex halakhic issue simplified in this way.

The criterion for the time of death is a matter of dispute among the great poskim. As has already been pointed out by others, the Chief Rabbinate of Israel holds that brain death is death. Are they right? Ask you own local Orthodox Rabbi. That’s the way halakha works. Until we have a Sanhedrin, neither Rav Elyashiv’s nor any one else’s opinions are authoritative, except for those who seek them. Influential, yes; universally authoritative, no.

Rabbi Shafran’s insinuation of a… Read more »

8 years 11 months ago

Does anybody have any text that states R. Dovid Feinstein’s opinion? I have heard directly from RHS that R. Dovid had told him the exact opposite – that RMF did not approve of brain stem death as the halakhic criteria of death. I have seen one letter written by R. Dovid but that was regarding a responsum in YD 3, not in the letter to Dr. Bondi. I have heard that the letter to Dr. Bondi was perhaps a forgery. If anybody has any proof for R. Dovid’s opinion so that I can better understand it, I would greatly appreciate… Read more »

8 years 11 months ago

I also find fault with this article for being so one sided.

R’ Moshe Feinstein defined death as the cessation of breathing – even if the heart is pumping. He wrote a t’shuva to Dr. Bondi to that extent, and it has been clarified numerous times. His son R’ Dovid has been clear about this matter numerous times, and if that is the criteria, then brain death is considered death. For some reason, that opinion does not earn merit in the article.

Additionally, in 1986 the Chief Rabbis of Israel set up a committee to determine the halachic… Read more »

8 years 11 months ago

I’d like to point out a misrepresentation in this article.

Rav Shlomo Zalman Auerbach was not against brain death. He simply required criteria of total brain death, which is much harder to ascertain.

Please speak to Rabbi Prof. Avraham Steinberg who sat for many hours with Rav Auerbach regarding this issue.

I heartily recommend seeing the video interview with him on the Halachic Organ Donor Society Website – here (see the lengthy hebrew one):

For the record, I have filled out a donor card with the following box checked: “On the condition that a clergyman of my families choosing will permit the… Read more »

Steve Brizel
8 years 11 months ago

I applaud R Shafran for his mentioning RHS and R JD Bleich’s POVs on this issue. IMO, articles of this nature illustrate what we need more of-mutual appreciation of Gdolim.