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This from ABC News: Teen Survived Kalamazoo Shooting After Being Pronounced Brain Dead
The article goes on to relate how right before the 14 year old survivor was prepped for removal of her organs, she squeezed her mother’s hand, then again when prompted by her mom to prove she could hear her, followed by two thumbs up when asked to by her doctor.
Now this girl was declared brain dead shortly after arriving at the hospital and was literally about to be butchered alive. Unfortunately she’s still critical and most such patients don’t end up making it, but murder is murder.
Regardless of whether brain death really equals death, this is brutality according to all standards. We hear such stories every once in a while, but who knows how many more victims still feel fully and have brain function but can’t hear or respond or have no family member nearby and their organs are harvested while actually very much alive.
So I’m wondering, are medical staff truly clueless or are they simply blinded by the prospect of doing some transplants to save others, organ donor be damned?
And Tendler wants to change the Halacha to permit harvesting the organs of living people.
OOH we havent doen this in a while
I’m not sure what you mean by change halacha see Yoma 85a.
There are poskim who allowed brain death at least in theory if not practice.
As an aside does anybody know of a posek who doesn’t allow a person to receive a heart transplant?
Thanks
As to your question
“So I’m wondering, are medical staff truly clueless or are they simply blinded by the prospect of doing some transplants to save others, organ donor be damned?”
PArtly the former. Though the bigger problem is lack of understanding among laypeople regarding “brain death” which is often used interchangably with coma and persistive vegetative state. I dont know if this patient was actually declared brain dead or not media reports dont mean much though of course it is possible she was declared.
See for example a recent AMI piece on brain death where the author wrote “… Doctors where convinced that many of those who where breathing and whose blood was still circulating were really dead beacuse their brain function had ceased entirely.” and ” … patients who are brain-dead but whose circulatory and respiratory symptoms are still working.”
I assume this fellow researched his article yet he does not understand the abc’s of brain death. By definition a brain dead pateitn is not breathing rather a ventilator is breathing for him. By defintiion if he can breathe he isnt brain dead. Yet ths mistake is repeatedly made even by somehwat knowledgeable people.
Mistake? The hospital nearly murdered this girl!
Joseph
The “mistake” I was reffering to was calling anything besides brain death “brain death” This is a very common mistake often found in media (and even among medial people) and I provided a recent example of this mistake. I was not reffering to misdiagnoses by medical people
As for this case
Was she actually declared brain dead?
What do they mean by “prepped for removal of her organs” She was on the operating table and as the surgeon got ready to cut ” she squeezed her mother’s hand” or is the “prepped fort the removal of her organs” hyperbole to make the story more exciting?
The short of it is that physicians do their best to apply the Harvard criteria…most of the time. Some physicians are also more liberal with determining brain death. To be clear, brain death is not reversible. Search the medical annals, you wont find a case. However, what does happen though is that someone who is not actually brain dead is mistaken to be brain dead by misapplication of criteria.
As Ubiq mentioned, the media and other low-information folks confuse the terminology and think that brain dead patients are coming back to life. Not applying criteria strictly does lead to these crazy stories we keep hearing though!
Mamale
“what are the laws regarding when organs may be harvested from an accident / shooting victim?”
ALl 50 states recongnise brain death. Once dead, with the families permission, when a recipient is identified the organs are removed.
” How do they determine clinical death?”
The exact criteria vary slightly state to state and often hospital to hospital.
Basicly the sequence is as follows:
1)casue is identified to ensure there is no reversibility.
2) There are certain prerequesites such as normal temp and blood pressure
3)a neuro exam is performed to ensure absence of brain stem reflexes including lack of spontaneous respiration
some hospitals have guidelines as to who can perform the above: any physician, an intensivest, neurologist, many require two exms spaced a certain number of hours apart. But to the best of my knowledge no medical body makes these recommendations nor does any state specifically require them.
Some hospitals require anicallry testing such as EEG to look for brain waves of angiography for blood flow but these are not generally required nor done.
“Can she be breathing on her own and still be a donor of a vital organ?”
By definition, no. And I cant stess this enough because I see this mistake repeatedly. If someone is breathing then they are not brain dead. To be brain dead, by definition, the person cannot be spontaneously breathing.
” Are brain scans done and how reliable are they?”
They are generally not done and are have variable reliablility as both false positives and negatives are not uncommon. Brain death is a clinical diagnoses much like “regular” death.
Rabbi Tendler. Show some respect.
I support killing and harvesting organs from all who support organ donation from brain dead people.
I figure this should solve all the issues.
Rabbi Tendler. Show some respect.
no.
mamale I saw the story.
These stories come up from time to time. It is hard to determine what actually happened. Granted this is partly because the hospital is covering itself.
This line is telling “was pronounced brain dead shortly after arriving ” Brain death is never “shortly” pronounced it usually takes a day or more. Though Michigan may be different than NY
Keep in mind though if a brain stem death pt actually recovered it would make for an amazing case report. The fact that there are none is interesting.
(The hospital cant stop a physician from publishing a case report)
PBA
killing them when they are alive or brain dead?
Arguing shows respect.
And Tendler wants to change the Halacha to permit harvesting the organs of living people.
I assume you have a source or citation for this idea? I’m sure we’d all love to see it.
Mamale
“However, if medical personnel keep on making the same mistake, something is fishy”
There are no documented cases of a perosn being declared brain dead and “Waking up” There are severla reports in lay media (Zack dunlop, and Gloria Cruz come to mind) However as I said it is hard to know waht actually was “declared” Just last week I told a pateint’s family member that their loved one was in a cooma and unlikely to recover After discussing it extensivly and the family member seemed to have gotten it another family member later said “so you told my siter Dad is brain dead” He was not. IF the media where to ask what I said persumably she’d have said the same. Sadly the patient didnt recover but if He had this would be another “survival after brain death” when in fact the patient was NEVER declared brain dead.
If there where a documented case the Physician documenting it would achieve instant fame. Journals would fight over the case report it would be a landmark report. There is no reason if such a case existed it wouldne be published. outside of Tabaloids and news sources that generally repeat each other
“Here a diagnosis must be made within hours (or risk organ death which is the whole point)”
Many hospitals requitre repeat testing 24 hours apart (though this is becoming less common)
“Contrary to what you are saying, there was a documented case of organs being harvested …”
I dont have access. Though I think i have it saved at home. I dont rmeeber what it said. So i’ll have to get back on specifics.
However by definition, And again I cant repeat it enough since it is a mistake made by many including in halachic pieces on the subject. A brian dead person cant breathe
“It’s also troubling that they can react to the pain,”
I’m not sure why it is troubling. Have you seen a chicken after shechted it reacts to pain too yet is dead lekulay alma! (I dont chas veshalom mean to compare peopel tpo chickens, just give a real life physiologic example that you and others may be familiar with please dont misunderstand my comparison)
“(The logic is that if one’s brain stem controlling breathing etc. isn’t functioning the higher part of the brain surely isn’t, although prior studies have shown this to be wrong in a percentage of cases.)”
Do they cite any such studies?
“Finally each body’s organs can be valued at over $2 million,”
Thats an underestimate. Ask the recipents what they are worth to them…
BTW Mamale
Keep in mind I am not reffering to wrongful diagnoses of brain death. I.e say a person has cornela reflex or breathes/gasps during the apnea test yet is declared brain dead incorrectly either due to incompetnace or negligence on the declaring physician’s part.
while important, those limited cases are only tangentially related to the subject at hand.
I am reffering to when protocol IS followed and a patient is declared brain dead based on exisitng criteria/guidleines and subsequently recovers.
As another aside.
Dont forget people recover from “cardiac death” all the time.
In fact many teshuvas on the subject such as The Chasam Sofer’s are regarding the opposite situation. Where the in vogue thing was to wait a few days prior to burial since pt’s occasionaly awoke after being declared dead sometimes in a coffin or even underground (“saved by the bell”. governments wanted to ahve waiting periods of a few days to ensure the pt wouldnt recover from “cardiac death” To which the Chsam Sofer insisted if a person has a heart beat and/or bretahing he is alive otherwise dead and no need to wait
the mother was present as they were prepared to harvest her daughters organs?
When Is a Person? Pre-Persons and Former Persons:…
This book offers about 200 questions that can be asked by proxies
when discussing the level of personhood in anyone they know.
These questions are organized around 4 capacities that make us persons:
(1) consciousness, (2) memory, (3) language, & (4) autonomy.
Here are some things my mother did while she was a “former person”:
*She let me hold her hand knowing I may never do so again
*She listened to us tell her we loved her and were grateful for the life she gave us
*She allowed us to ask mechila with a whole heart
*She shed a tear as we said goodbye
*She brought to mind all the things I still “needed” her for, reminding me to have hakoras Hatov to those people in my life who deserve it
*She reminded us how precious life is even though it is fleeting
I am sure there is more. I am also sure that many “full persons” fail to impart such critical and deep seated lessons to their children and students. Perhaps their “personhood” is not so full after all.
thanks. i found that article fascinating. makes you wonder what kind of depth can be contained within someone who believes that what you provide is the basis of life.
“They were making preparations to harvest the organs according to the article. I don’t know exactly what the doctors were doing or at which point they give next of kin the boot.”
Why assume the doctors were doing anything? Perhaps they had discussed organ donation and were taking care of paperwork etc. and while they were discussing this the hand squeeze etc happened?
The impression you give is of a bunch of blood thirsty doctors, scalpels in hand, saliva drooling out of their mouth, just waiting for a chance to start yanking out those organs.
MAMAel lote of comments I’ll do my best.
However first and foremost, you amde the mistake many do and I reiterated several times not to make.
You said regarding the brain-dead individual “…and he is actually breathing, his heart still pumping — albeit assisted mechanically -…”
No ! while his heart is still pumping he is not still breathing. His chest may rise from the ventilator blowing in and out but so would a football if connected to a ventilator. I mentioned this a few times. A brain dead person, by definfiion is not breathing. This is key because according to R’ Moshe’s Family members including R’ Dovid, R’ Shabsi Rappaport and of course R’ Tendler this is why R’ Moshe recognised brain death as death.
Granted he heart is till beatig but there are cases with a heart beat where les man dipalug the person is dead eg decapitation. Which ARGUABLY can apply to a brain dead person. A body;s reaction to pain while [perhaps disconcerting is not an idicator of life even according to those who reject brain death.
“This is the part about higher brain activity after no basic heart stem functions:…”
Wny are brain waves a sign of life? A heart that stops is often declared dead even with an organized rhythm. It isnt like TV where pt flatlines. Quite often you wouldnt tell from the heart monitor that the heart stopped. The patient lacks a pulse and if DNR or after trying to revive but not succeeding the patient is declared dead with a heart rythm on the monitor.
“And this is the documented case I mentioned regarding spontaneous breathing, also from the same article:…The only possible caveat is that this author later went on to write a book about this subject, so some considered it a way to drum up business — although his evidence seems sound”
The caveat is sound. And the author left out a crucial part of the article. The article he cited is “A matter of life and death” and in that case “…upon subsequent review of the patient’s chart the anestesiologist had learned that the donor had gasped at the end of the apnea test…” The authro of the article left out the part that changed the entire story.!! There is still no documented case of someone actualy meeting criteria for brain death and recovering.
I skimmed your article by James Leonard PArk. You seem to be making a slippery slope arguemnt. Please correct me if I’m wrong. I’m not much a fan of slippery slope arguments. We are discussing brain death which some poskim say is dad either because like decapitated or because not breathing. Neither of those apply to Coma, PVS or Alzheimers. So bringing them up just confuses the issue there are alll sorts of nuts out there I dont think every meshugana opinion should be used to shape policy becasue of a slippery slope.
“our mention of the Chasam Sofer’s ruling about not waiting after death for burial was informative, but quite ironic”
Fair, though the bigger irony is he wanted death to be declared sooner than was in vogue now it used for the opposite. Also almost nobody says kavod hames is an issue. Most poskim allow transplants from a dead patient.
” don’t know exactly what the doctors were doing or at which point they give next of kin the boot. Most likely she was saying her goodbyes before traumatic aspects begin,”
More likely is, it is hyperbole to make the story more exciting. Do you believe the media doesnt do that?
Mamale
As mentioned, I have met more than one patient’s family member (most recently last week) who said they were told a patient was “brain dead” when nobody had told them that. And brain death is never “shortly declared” at least not in NY. Almost every hospital has a time period to allow for possible recovery prior to being delared brain death. (Though again, this may differ in Michigan, and I suppose “shortly” is relative)
Preparing organs for donation have nothing to do with removing organs, or even preparing to do so. The donor body must be kept in a proper state to ensure the organs remain viable, among other things it means ensuring the body is properly hydrated, is oxygenated and so on. (Medical info courtesy of what I understand my med school student neighbor explanation) The article is focusing on the fact that the doctors basically gave up hope and moved into preserve the cadaver for donation mode and that they were wrong in their prognosis. I hardly see any indication of an organ harvesting operation.
Well said APY
BTW from a NBC news story “Doctors first thought Abigail could become brain-dead and had started planning to harvest her organs for donation when she squeezed her mother’s hand. Her mother, Vicki Kopf, described the moment as “breathtaking.” “
Not quite the same as reported elsewhere
Mamale
“the hospital is now saying something else entirely, which is a little suspect. MLive quoting the medical director “…but said the nature of her injuries and the efforts to sustain her life, led doctors to discuss the possibility that she may become brain dead. But he said Abigail is not brain dead.” this while the mom is mentioning her daughter squeezing her hand as “breathtaking”. Go figure out whom to believe.”
Not suspect at all. It happens all the time. People often use “brain dead” to refer to any brain damage, coma, PVS etc although they are different. It is entirely plausible the mother was told “she is severly brain damaged and we will initiate testing to determine if she is dead” and interpreted that as she is brain dead” and that’s the story she shared with the media. I have seen similar occurrences many many times (minus the media part)
“My documented example was not to illustrate that true brain death is reversible, but that despite knowing the patient failed the breathing test”
The patient didn’t fail in that example! The neurosurgeon should be sued for malpractice and the surgeon tried for murder. That in no way affects the majority of patients who are correctly diagnosed as “brain dead” much like the few who are diagnosed as “regular dead” that are misdiagnioesd doesn’t lead to rejection of “cardiac death” So much so that the Chasam sofer doesn’t even require a waiting period even though misdiagnosed “cardiac death” was a very real concern in his day (more so than today)
“I don’t think he’s alone with his agenda, and it must be addressed and fought or life will indeed become dispensable and we’ll only have ourselves to blame.”
Agreed!
Mammale (and anyone else) I have a thought experiment for you
Imagine the following two scenarios:
1) Reuvein is quite sick and one by one his organs are failing. Luckily for him Shimon is compatible and Reuvein recieves Shimon’s pancreas, kidney, lung, intestine and heart (none of this is sience fiction, though all to one patient hasnt quite happned). Obviously Reuvein’s Posek recognises brin death otherwise he would be inconsitent if he allowed him to recieve the Heart. Well unfortunalty Reuvein gets badly burned and undergoes a face and hand transplant as well. (Still no science fiction) Reuvein now looks like Shimon, has Shimon’s fingerprints and the bulk of his internal organs where once Shimon’s. Who is Reuvein? Whose wife should eh go home too Mrs. Reuvein or Mrs. Shimon?
2) Instead of giving Reuvein all of Shimon’s organs. The Doctors figure lets just remove Reuvein’s functioning brain and put it in Shimon’s body (Now this is science fiction, but who knows…)”reuvein” now wakes up and he too has Shimon’s fingerprints and the bulk of his internal organs where once Shimon’s. Who is Reuvein? Whose wife should he go home too Mrs. Reuvein or Mrs. Shimon?
Now granted this doesnt prove anything. And all the “thought excercises” in the world are irrelevent to since only halacha matters.
But I think all would agree that the Brain is the seat of personhood and since Shimon’s brian was reomved in the second case although the rest of his organs including heart are still functioing. shimon has died and Mrs Reuvein Should get used to being married to a guy who looks like Shimon
thoughts?
Mammele -“My documented example was not to illustrate that true brain death is reversible, but that despite knowing the patient failed the breathing test, they still went ahead with harvesting his organs, because the doctor said the patient won’t recover.”
Search Lazarus phenomenon & you’ll see that it’s probably already happening!
“To be clear, brain death is not reversible. Search the medical annals, you wont find a case.”
A review of 1,311 first diagnoses of brain death in New York during 2007-2009 was published in the journal *Neurology* in 2011. They found that in no case did a second diagnosis, on average 19 hours later, differ from the first diagnosis.
“despite knowing the patient failed the breathing test”
The poskim who disagree with Rabbi Tendler mostly hold that cessation of breathing constitutes halachic death.
‘misdiagnosed “cardiac death” was a very real concern in his day’
Other poskim hold that cardiac death is the halachic definition of death. That is difficult, as blood circulation was not discovered until about years ago. Chazal would not have been able to create this definition.
“despite knowing the patient failed the breathing test”
The poskim who disagree with Rabbi Tendler seem to mostly hold that cessation of breathing constitutes halachic death.
‘misdiagnosed “cardiac death” was a very real concern in his day’
Other poskim hold that cardiac death is the halachic definition of death. That is difficult, as blood circulation was not discovered until about years ago. Chazal would not have created this definition.
“his heart still pumping — albeit assisted mechanically”
A heart transplant can only happen if the donor’s heart is beating and the donor’s lungs are breathing (possibly with mechanical assistance). If your halachic definition of death is anything other than brain death, then all heart transplants should be mamesh murder al pi halachah.
If you go to the heart transplant page at the web site of Montefiore Medical Center, you can see a video of an actual heart transplant.
The poskim who disagree with Rabbi Tendler mostly hold that cessation of breathing constitutes halachic death.
Charlie, earlier, ubiquitin wrote “By definition a brain dead pateitn is not breathing rather a ventilator is breathing for him.”
Is that incorrect?
charlie
The definition of death by chazal doesnt really matter.
The question is indicator. Namely does heartbeat signify life? Yoma 85a can be understood that way. Alternativly even the absence of breathing is only an indicator of death if he “mutal kaeven” (Rashi) i.e. obviously a polio sufferer in an iron lung isnt dead becasue of absence of spontaneus breathing. The question is if a heartbeat in someobody who is not breathing precludes him from being dead(as in a brain-dead patient) since he isnt “mutal kaeven” I beleive this was R’ Elyashiv’s main objection to brain-death.
The Chacham Tzvi has a teshuva that is quite relevent in which he clearly uses the heart as the main indicator of death. However as you point out, he is basing on the mistaken view that the heart is a respiratory organ that pumps air throughout the body. Even if a mistaken assumption however that doesnt neccesary matter (according to brain death opponeents).
what I do fintd surprising about brian -death opponents is how excited they get when somebody reportedly “recovers” from brain-death. As in this thread. Never mind the fact that these reports are never well documented and are allways based on hearsay, usually ciopy/pasted across various media outlets.
Even if it did happen once in a while (it hasnt ever, people survive cardiac-death literally daily. Even wihtough the “lazararus phenomenon” Health mentioned. Every cardiac arrest that survives CPR, every Heart transplant, and Every CABG all had a stopped heart which subsequently restarts.
Is Cardiac death then not death?
DY
It is accurate
From NYS dept of health website guidleines for determining brain death.
(i cut some parts to cut it for size and remove some of the technical details, for more details it is freely available on google and of course I would be happy to elaborate.)
Step 4: Apnea Test
Generally, the apnea test is the final step in the determination of brain death, and is performed after establishing the irreversibility and unresponsiveness of coma, and the absence of brainstem reflexes.
…
the physician should conduct the apnea test as follows:
?…
DY
From the American academy of neurology (a national as opposed to local source)
Evidence-based guideline update: Determining brain death in adults
Checklist for determination of brain death
Prerequisites (all must be checked)
? Coma, irreversible and cause known
? Neuroimaging explains coma
? CNS depressant drug effect absent (if indicated toxicology screen; if barbiturates given, serum level < 10 ?g/mL)
? No evidence of residual paralytics (electrical stimulation if paralytics used).
? Absence of severe acid-base, electrolyte, endocrine abnormality
? Systolic blood pressure ? 100 mm Hg
? NO SPONTANEOUS RESPIRATIONS [emphasis added)
[As for details:]
IX.Apnea.
?
Absence of a breathing drive.
Absence of a breathing drive is tested with a CO2 challenge. Documentation of an increase in Paco2 above normal levels is typical practice. It requires preparation before the test.
…
Procedure:
…
?
Preoxygenate for at least 10 minutes with 100% oxygen to a Pao2 >200 mm Hg.
…
?
Disconnect the patient from the ventilator.
?
Preserve oxygenation ….
?
…
?
If no respiratory drive is observed, repeat blood gas (Pao2, Paco2, pH, bicarbonate, base excess) after approximately 8 minutes.
?
If respiratory movements are absent and arterial Pco2 is ?60 mm Hg …the apnea test result is positive (i.e., supports the clinical diagnosis of brain death).
…
Mammele -“Terri Schiavo was proven to have been in a persistent vegetative state
when the autopsy was performed.”
And this was murder!
“But popular opinion before her feeding-tube was removed in 2005
came down heavily on the side
of believing that she was still ‘alive’ in some sense.”
She was alive!
“Thus, historically-speaking, it will be some decades
before PVS will routinely be recognized as equivalent to death.”
And this will be murder!
From Dr. Parnia in AOL’s newspaper:
“Neurologists have started to discover that contrary to the old dogma, supposedly vegetative patients may actually be conscious and aware of their surroundings and can carry out mental tasks on command.”
Health: I don’t think removing a ventilator would be murder. Gram Retzicha at worst and probably just an Issur of Lo Sa’amod Al Dam Reiacha.
Sam2,
I don’t think removing a ventilator would be murder.
In the case of Terri Schiavo, which Health was referring to, a ventilator wasn’t removed; rather, they removed a feeding tube.
Sam2 -“Health: I don’t think removing a ventilator would be murder. Gram Retzicha at worst and probably just an Issur of Lo Sa’amod Al Dam Reiacha”
It could very well be Retzicha! It depends who you hold like:
“The poskim who disagree mostly hold that cessation of breathing constitutes halachic death.
Other poskim hold that cardiac death is the halachic definition of death.”
I know nobody said otherwise, but to ensure no confusion please note that Terri Schiavo wasnt brain dead (neither were Karen Quinlan and Nancy Cruzan)
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