Head to Head / What do you say to rabbis who oppose the practice?
An interview with organ donation advocate Ofer Gilor.
The death yesterday of former soccer star Avi Cohen has renewed public awareness of the lack of transplant organs in Israel. Cohen, 54, who was fatally injured in a traffic accident last week in Ramat Gan, was pronounced brain-dead by a medical committee at Ichilov Hospital in Tel Aviv on Tuesday. Yesterday morning Cohen's heart stopped beating and he was later laid to rest.
The hospital produced a death certificate and an organ transplant coordinator was dispatched to the family for their consent. The deceased had given his own permission and carried an ADI donor card from the National Transplant Center. But in the end, under pressure from rabbis, the family refused and Cohen's organs were not made available for transplant.
Two and a half years have passed since 12-year-old Omri Gilor's tragic death, after being trapped in a cave where he was playing on Moshav Kadima. After he was pronounced brain-dead at the Schneider Children's Medical Center, his parents decided to donate his organs.
Since then, his father Ofer Gilor has become active in projects encouraging organ donation in Israel. He is concerned that this week's developments threaten to set back several years worth of efforts to raise the number of organ donors here.
Ofer Gilor, what do you say to Israeli rabbis who oppose organ donation?
Many rabbis have issued statements recognizing brain death and the potential to save lives. The Chief Rabbi of Israel, Shlomo Amar, supported the donation of Avi Cohen's organs this week. But there are still rabbis in the ultra-Orthodox community who oppose organ donation, as well as some secular people, because no high-level Jewish religious authority has publicly issued a halakhic defense.
And so it happens that some completely secular families, who may be considering whether to donate their loved one's organs, are likely to refrain from doing so just because someone raises a rabbinical doubt.
Nonetheless, doctors have told me that they've never encountered anyone who has a problem with accepting organ donations. There's no problem in accepting them, only in giving.
What is your feeling on the Cohen family?
I don't know the family, so it's difficult to talk about them, but I can understand them and of course am very sorry for their loss.
When we were going through the most difficult situation in our lives, many people also came to us telling us we should do all kinds of things to increase the chances for a miracle, and that perhaps Omri would awaken. When a family is requested to donate organs, your world immediately turns upside down and you find yourself in a position where you never dreamed you'd end up.
There were people who prayed for Omri, and those who told us to go to a synagogue. During those moments, it was an embrace, despite the fact that prayer is not a part of our lives. But when it came time to consider organ donation, we kept this decision within the family.
It was a decision for a mother and a father to make, we did not even include grandparents. The more people the family includes in such a decision, the smaller the chances of a donation, because the person who says no is always more dominant.
What message would you like to send to the Cohen family?
I don't have a personal message for them, but I can say that if the family had donated organs, they would not only have saved lives but also advanced awareness of the issue - especially since we are talking about someone well-known, whom people admired and followed, an educational figure.
The family could have effected a significant change in the public, and in this case a turning point in saving lives through organ donation. It's sad, because now people are concerned that what happened this week will lead to a decrease in the percentage of donation agreements. Those who work in the field know how significant each donor is.
Two and a half years ago, when you were told that Omri was brain-dead, how did you come to the decision to donate his organs?
Omri was a charming boy who loved nature and sports. Nature was his second home. After [the accident], we had three days to say goodbye to him in the hospital. We agreed [to make the donation] after we asked ourselves what he would have wanted.
His twin brother Ohad said that Omri had seen an ADI donor card a few months earlier when we were sitting in a cafe, and even asked to add his name. This was characteristic of his sense of justice. He was like a gabai in a synagogue, collecting candies in his pocket for his friends.
His organs saved three children and two adults, including a heart transplant patient on the verge of death, and a girl who suffered from complications in her digestive system. She received his organs when an expert surgeon in the field happened to be visiting Israel. In addition, one of his corneas restored the vision of a boy from Haifa.
In principle, organ donation [from one person] can save the lives of up to six people - two kidneys, two lungs, a heart and a liver - and the vision of two more who receive the corneas.
Can you recall the moment when the subject arose for discussion?
The moment that brain death is pronounced - it's a disaster, and it cannot be taken for granted that people will agree. In times of great fear and sadness, when you understand that there is no more hope, when a parent loses a child, it's difficult to think about the happiness of someone else whose life is going to be saved.
For us personally, it was very hard for quite a while to keep in touch with those who had received his organs. We only recently met the person who received his heart, and soon we'll meet the girl who received his digestive system.
Has donating Omri's organs strengthened you in any way?
I personally did not see organ donation as a way to keep Omri's memory alive, because nothing will bring him back. I visit his grave every week, and I still feel sadness and loss and longing, and in this sense I don't know whether organ donation adds or subtracts anything. But the donation definitely strengthens values related to giving, mutual responsibility and saving lives.
What is the importance of a donor card if the family can later refuse to donate the organs of the loved one who signed it?
While the card has no legal standing, it still holds great importance in terms of the statement it makes, and in encouraging families to donate organs. The National Transplant Center is involved in education and awareness programs to increase the amount of cardholders, and I also devote some of my time to telling Omri's story to advance public awareness of transplants.
What else do you do to increase the number of donations?
Last September, symbols - an idea I thought of - were distributed to the families of donators as a means of raising awareness. The symbol was designed by Roee Shachnai, a Bezalel graduate and lecturer at the Shenkar College who is in my army reserve unit. In the shape of an offering hand, it bears the words "the gift of life" and is meant to be affixed to the graves of donors. It has become a national badge of esteem and educates people by marking the graves of those who, in their deaths, saved lives.
In your experience, how does the Israeli public regard organ donation?
There is an outrageous amount of ignorance among Israelis on this subject. It is important to understand that the diagnosis of brain death is based on research considered irreproachable by the medical community. There is not one documented case of error in such a diagnosis in Israel.
Still the public, due to lack of information or some idea they hold personally, are confused about what it means to be in a vegetative state - in which different sections of the brain have been injured, and a condition in which the body can be sustained on life support for a long time and some parts of the brain continue to operate internal organs - versus the state of brain death, for which no medical technology can prevent the heart from stopping within a few days.
When someone is diagnosed as brain-dead, the heart will stop within a few days - and in between there is a window of time to harvest organs for donation and save lives.
There is another argument stemming from ignorance, according to which some believe that doctors prefer not to provide treatment so they can remove organs from the patient - but this is completely ridiculous. First of all, doctors are obligated to save lives whenever there is a chance for recovery.
Beyond this, in order for a patient to become an organ donor after brain death, he must receive the best medical care for the internal organs to be preserved. In any case, doctors provide intensive medical care to patients who are in critical condition and unconscious.