A Clash of Religion and Bioethics Complicates Organ Donation in Israel

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http://www.nytimes.com/2014/08/17/world/middleeast/a-clash-of-religion-and-bioethics-complicates-organ-donation-in-israel.html

By KEVIN SACK
AUG. 17, 2014


Tamir Cohen, second from left, a professional soccer player, with his teammates, attended the funeral of his father, Avi Cohen, near Tel Aviv. The elder Mr. Cohen had signed a card giving permission to donate his organs, but his family reversed the decision. Credit Getty Images.

JERUSALEM — In the Book of Genesis, it is written that when the great flood submerged the land it extinguished “all in whose nostrils was the breath of life.” Across nearly 2,000 years of Talmudic debate, Jewish scholars have returned to that verse in holding that life ends at the moment when breathing stops. One 19th-century code instructed that if a person appeared lifeless, a light feather was to be placed before his nose: “If it does not flutter,” the text advised, “he is certainly dead.”

The sages could not have anticipated that their writings would provide the underpinnings for cultural resistance to organ donation from the deceased in 21st-century Israel. But their definition of mortality, which can conflict with modern acceptance of brain death, is cited among several reasons Israel has among the lowest rates of deceased organ donation of any developed country.

The resulting five-year waits for a kidney from a cadaver help explain why this tiny nation has played an outsize role in the global organ trade, experts say.

Since 2000, one trafficking prosecution after the next has implicated Israelis in some way. Although recent legal changes have made it less enticing for Israelis to seek transplants overseas, they have contributed to longer wait lists at home. That has kept organ brokers in business.

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