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An Issue That Can Try Body and Soul

Medicine: Religious attitudes toward organ donations vary. The Catholic Church and Islamic groups see such acts as charity. Among Jews, a debate rages.


For Los Angeles screenwriter Robert Avrech, it was a wrenching choice between two of his greatest loves: his Orthodox Jewish faith and the life of his only son.

His son, Ariel, is in critical need of a lung transplant. Avrech knew of a man who had just collapsed on a softball field and was in a coma. But Avrech, guided by his religious and moral compass, would not approach the family about a possible organ donation.

It seemed "ghoulish," he said. He saw a slippery slope that would turn the desire for healing and life into a morbid wish for death to harvest organs. Wouldn't that make him no better than a Nazi?

Even after the man eventually died, Avrech still declined to approach the family, for he says his Jewish values, particularly the need to show reverence to the body and respect for mourning, overrode even his own desperate desire to save his son's life.

"It's a difficult situation for me, because I want to save Ariel's life," Avrech said slowly, his voice weighted with emotion he does not try to hide. "But there are worse things than death, like leading an immoral life."

Avrech's case underscores the sometimes wrenching dilemmas--and vast divergence of belief--that occur in the religious world over the issue of organ donations.

All religions cherish the value of saving lives, but questions of when death begins and when donated organs may be used have raised a thicket of moral issues.

In Japan, for instance, an ancient religious belief that cutting a corpse defiles the individual's spirit has severely hampered organ donations. Not until 1997 did the nation recognize brain death as legal death, becoming the last advanced industrial nation to move away from the idea that death occurs only when the heart and lungs cease working. In part, the hesitation stemmed from beliefs among some Buddhist schools of thought that transplants from the brain-dead would deprive a soul of reincarnation.

The Roman Catholic Church, by contrast, has an "upbeat, positive attitude" toward organ donation, said James Walter, the O'Malley professor of bioethics at Loyola Marymount University in Los Angeles. At St. Francis Medical Center in Lynwood, he said, a pastoral care team broaches the subject of donations with families as early as the onset of brain death. As a result, the Roman Catholic hospital is one of the largest sources of organ donations in Los Angeles County, he said.

The positive Catholic tradition stems from the 1940s, when theologians began promoting organ donations as an act of charity, "the willingness to sacrifice for the sake of other people," Walter said.

Officials turned to the concept of charity to legitimize donations, because the church until then had frowned on mutilating the body except for the purpose of benefiting the greater whole--amputating a gangrenous limb, for instance. That "principle of totality," sacrificing a part for the whole, could not be used to justify donations lest it open the door for totalitarian societies, for instance, to claim ownership of people's organs. So a new principle--personal acts of voluntary charity--had to be established, Walter said.

Within Islam, organ donations are encouraged under the Koranic exhortation that "whoever gives life, it is like giving life to all human beings," said Maher Hathout, a retired Muslim physician and member of the Kuwait-based Islamic Medical Conference. The group affirmed organ donations as an act of charity several years ago, he said, stipulating that organs were not to be bought and sold and that living donors could not endanger themselves in offering organs. He added that Muslim scholars have also affirmed the use of organs from pigs--a growing supply source--despite prohibitions against eating pork.

In the Jewish world, debate rages between religious movements and even within them.

"To many people the issue of organ donations is very emotion-laden," said Rabbi Yitzchok Adlerstein, a professor of Jewish law at Loyola Law School in Los Angeles. "Unless you have a very, very definite cause, and usually an immediate need, Judaism attaches a high value on keeping the body intact."

Adlerstein said that entrenched value explains why crews in Israel can be seen gathering up the body pieces of a victim killed in terrorist blasts, for instance, to ensure a proper burial. There is also a folkloric belief that the body should be intact for resurrection after death, he and others say.

Those attitudes, however, appear to be changing in at least some sectors of Judaism. In 1995, legal scholars from the Conservative movement, the Jewish grouping with the highest number of U.S. synagogue members, approved a rabbinical ruling that not only declared organ donations permissible but said they were an obligation under Jewish law.

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