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Israel - Health Ministry to Reexamine Problematic Brain-Death Law

Published on: April 25, 2010 09:02 PM
By:  Haaretz
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Israel - The Health Ministry intends to expand the number of medical examinations that are likely to determine with greater certainty whether a patient is brain dead. The move comes in response to the latest findings, which show a decrease of 40 percent in the ability of hospitals to declare an individual brain dead since a June 2009 law went into effect.

The wording of the legislation - formulated as a compromise between the Chief Rabbinate and the Israeli Medical Association - stipulates the conditions necessary in order to classify an ailing patient as brain dead.

It is only after doctors determine that a patient is in this state that they are permitted to request permission from family members to allow the organs of their loved one to be donated to needy recipients.

The original purpose of the 2009 law was to increase the number of organ donations by formally allowing the removal of organs from a deathly ill patient before his heart stops beating. It is essential for vital organs that are to be transplanted, such as the heart, lungs and liver, to be removed from a donor before his blood ceases to be pumped throughout the body.

Despite the original intent of the bill, it appears that abiding by the new criteria it sets out has led to a 40-percent drop in hospitals’ ability to determine whether a patient is indeed brain dead.

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A study initiated by the Israel Transplant Education Unit found that between January and March 2010, for example, there were only 25 cases out of a total of 46 potential cases, according to clinical examinations, in which a patient was determined to be legally brain dead under the criteria outlined in the 2009 law - a rate of just 54 percent.

Transplant experts say the low rate is due to technical problems related to the equipment used to verify cases of clinical brain death.

In Israel, half of all families refuse to donate organs, usually citing religious reasons. In 2009, officials did report a slight increase (54.3 percent) of those who agreed to donate the organs of a brain-dead relative.

In light of the findings, a panel of medical officials in the Health Ministry, which is tasked with monitoring the repercussions of the law concerning the diagnosis of brain death, resolved to update the criteria in order to increase the amount of organ donations.

By law, brain death can only be diagnosed and certified by two doctors who have undergone extensive training and are not involved in the care of the patient. Afterward, their clinical diagnosis must be verified by an examination using five different tools: the brainstem auditory evoked response test (BAER); transcranial doppler test (TCD); the somatosensory evoked potential test (SEP); and either a computed tomography (CT) exam or a magnetic resonance imaging (MRI), which examines the flow of blood in the brain.

In some instances, however, these examinations detect physiological processes still ongoing in patients who have been clinically declared brain dead.

The panel moved to add a procedure known as carotid angiogram, a test which looks for blockages in the neck arteries that supply blood to the brain. The test allows doctors to inject a certain substance which enables them to determine whether the lack of blood flow to the brain is acute enough to warrant a diagnosis of brain death.

The ministry will also allow doctors to use a single-photon emission computerized tomography (SPECT) scan, a method of nuclear imaging whereby a radioactive substance is injected into the blood so as to allow a three-dimensional mapping of the brain to determine its level of activity.



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Read Comments (10)  —  Post Yours »

1

 Apr 25, 2010 at 09:09 PM Anonymous Says:

They have made an already painful process even more difficult for the mishpacha. This needs to be objective process without interference from political or rabbincial influence. Let the professionals decide using objective and measureable criteria and then the family can make the decision and consider halacha to the degree they feel it is relevant and consistent with the wishes of the patient.

2

 Apr 25, 2010 at 09:42 PM Anonymous Says:

The halacha is not what the patient or family may wish. If someone has some brain activity and his heart is still beating, isn't the person alive?

3

 Apr 25, 2010 at 09:57 PM Anonymous Says:

Reply to #1  
Anonymous Says:

They have made an already painful process even more difficult for the mishpacha. This needs to be objective process without interference from political or rabbincial influence. Let the professionals decide using objective and measureable criteria and then the family can make the decision and consider halacha to the degree they feel it is relevant and consistent with the wishes of the patient.

B"H
instead of ur idea lets go with G-ds way.....

4

 Apr 25, 2010 at 10:02 PM Not just that... Says:

Reply to #1  
Anonymous Says:

They have made an already painful process even more difficult for the mishpacha. This needs to be objective process without interference from political or rabbincial influence. Let the professionals decide using objective and measureable criteria and then the family can make the decision and consider halacha to the degree they feel it is relevant and consistent with the wishes of the patient.

What are you talking about? Medicine is ALL about protocol. You're talking about letting every doctor decide for himself how to deal with this. In the past, this led to a lot of abuse, and created MORE pain for many mishpachos.

5

 Apr 25, 2010 at 10:18 PM Anonymous Says:

Reply to #4  
Not just that... Says:

What are you talking about? Medicine is ALL about protocol. You're talking about letting every doctor decide for himself how to deal with this. In the past, this led to a lot of abuse, and created MORE pain for many mishpachos.

Can't you read the post. No. 1 said that he/she favored using objective criteria to decide rather than letting every doctor use their own discretion. The point is that this should be a medical decision that can then be modified if the patient or the family is frum and wants the decision to be made in accordance with halacha. If the family wishes to rely upon an purely medical defintion of brain death, than they should be allowed to do so.

6

 Apr 25, 2010 at 10:31 PM Anonymous Says:

It seems that the doctors are trying to find a test which will show the results they want. So called "Brain death" evidently is quite arbritrary depending on the test and also on the test's interpretation. If stricter tests are reulting in less cases of brain death what does that tell us of the sinserity of the earlier criteria on determining true "brain death"?

7

 Apr 26, 2010 at 02:29 AM AuthenticSatmar Says:

So the tests are showing pshycological activity after their determination of brain death. So instead of realizing their determination is wrong, they will use other test to try to prove their point, and ignore the tests that show they are wrong. And how is this ethical??

8

 Apr 26, 2010 at 04:42 AM Yerushalmi Says:

Brain death has to be established before harvesting body organs for transplantation.

While chareidim are adamantly against the donation of body parts, here in EY they push and shove their way to the front of the queue when it comes to receiving body organs.

It seems that there are double standards at work amongst the chareidi community.

9

 Apr 26, 2010 at 08:05 AM Gkup Says:

Now we can understand why the gedolim in EY don't allow organ donation. They don't trust the doctors/officals in charge whose only mission is to increase the amount of ograns available. If they truly wanted to know if the patient was dead they would do whatever tests are possible unbiased with money/organ shortages. The fact that they now see some activity after the brain death shows you their motives all along.

10

 Apr 26, 2010 at 08:04 PM Daas Torah Says:

The issue of Defining death is what determines wether one's organs can or cannot be harvested.

In current medical literature Death is defined as 'Brain death' which means no higher cortical function, significant decrease or absence of cerebral blood flow/metabolism as detected by Transcranial doppler, cerebral angiography, etc. In this state, a patients heart can still be beating and some (cranial) reflexes are still present.

Most Poskim (not all) define Death as CARDIAC death- absence of cardiac activity (no heart beat). This obviously makes it difficult to harvest organs especially the heart. Kidneys and liver can survive 12-24 hours and 6 hours, repectively, without blood flow, but the heart dies(infarcts) in minutes.

The issue is that of brainSTEM death. Few Poskim hold that even if the heart is still beating, if there are no Cranial reflexes, the person may be declared Dead.

It seems however that The Rabbinate in eretz israel, presumably, to facilitate organ harvesting and donation (Pikuach Nefesh), have taken the definition of Brain /Brainstem death, and not one of cardiac death.

11

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