It’s important to discuss your preferences regarding posthumous organ donation with your healthcare proxy and loved ones. As with all end-of-life care decision making, it is extremely difficult for your family to make decisions for you at the moment of death. For your sake and the sake of those you love, take the time to share your values and preferences on these sensitive topics.

There are three critical steps toward making a decision about posthumous organ donation:

1. Educate yourself: Learn about the subject, talk to your rabbi and healthcare provider, and become an informed decision maker.
2. Express Your Preferences to Your Family: Let your proxy and loved ones know your feelings on the topic. The Ematai conversation primer helps you have those discussions and record your preferences.
3. Make a Legal Declaration:

There are two primary ways to make a legally-binding declaration regarding organ donation:

i. Sign up with your local organ donation registry.

Please note that this registration is a legally-binding directive. Once death has been declared, your choice to donate organs will be implemented without others having a say on the matter. This decision does not need to be approved or supervised by a family member, your doctor, or rabbi.

Some local registries include:

United States

Ontario

Quebec

• While most people register as organ donors in the Department of Motor Vehicles or the local equivalent, the official registry is now maintained online, where you can update your preferences.
• On many registration forms, there will also be an option to donate your body for research or educational purposes. Review these forms carefully. You can specify on the registration form (whether on paper or online) that you authorize your organs to be used for the purpose of transplantation only and not for research or education.

In the following countries, you can legally register as an organ donor for transplantation while choosing that you want a rabbi to supervise the process. We highly recommend this option where it is available:

Israel

England

South Africa

Australia (Coming Soon)

Wherever you are around the world, Ematai’s realtime consult hotline is always available for real-time consultation and to speak with the doctors and transplant specialists.

ii. Sign a legal advanced healthcare directive that includes a provision about organ donation.

(If you have separately signed up with the local organ donor registry, that registration might take precedence, especially if the organ donor registration is signed or formally updated after you have completed the advanced healthcare directive.)

There are many variations of these documents, including one created by Ematai. When properly drawn and signed, these are legally-binding documents.

Organ Donation Options on Ematai’s Healthcare Directive:

Ematai’s healthcare directive offers three options regarding posthumous organ donation with the following preamble:

This section is relevant only if death as defined by Jewish law and custom has been determined by my proxy in
consultation with my named rabbinic consultant. Please select from the options below.

1) I authorize my proxy to approve transplantation of any organs and tissues permissible under Jewish law and custom.

2) I do not wish to donate any of my organs or tissues.

3) I authorize my proxy to approve transplantation for only the following organs or tissues (specify):

We encourage people to sign up for option #1 for the following reasons:

1. It allows control of the final decision to remain in the hands of your proxy, which may also make some people more comfortable than signing up with a government registry.
2. It allows a person to remain committed to organ donation while leaving their preference of the legal criterion for death to a later time and after consultation with their rabbi.
3. As opposed to options # 2 or #3 on the directive, option #1 allows for promising medical technology to advance to a point at which organ retrieval may be possible following both of the major criteria of death. (See more below).

People with preferences regarding the Jewish legal criterion for death and/or organ donation may express that to their proxy and record their view in the accompanying conversation primer.

What Organs May Be Donated?

After Respiratory Brain-Death:

If one accepts the respiratory brain-death criteria adopted around the world and endorsed by Israel’s Chief Rabbinate (see here), then the list of organs and tissues available for posthumous donation include:

Heart

Lungs

Kidneys

Liver

Pancreas

Small Intestines

Cornea

Skin

Heart Valves

This broad range of options is generally only available when a person is declared dead in a hospital while under intensive care that includes the support of a mechanical ventilator.

After Cardiac Death:

• Historically, organ donation following the cessation of a heartbeat was much more limited (cornea, skin, and heart valves, for example). These options should not be belittled as they provide great life-enhancement for their recipients.
• New technologies offer some promise for increased organ donation after cardiac death, albeit with some important caveats. There are currently two types of scenarios for donation after cardiac death (DCD):

Controlled Donation after Cardiac Death (cDCD)

In this situation, a patient’s family and healthcare providers have:

• Determined that continued medical intervention is no longer appropriate, and
• Decided to withdraw care (such as ventilator support) that will lead to cardiac death.

In a carefully orchestrated process, the doctors withdraw treatment which allows for the patient to die and then allow the transplant team to retrieve the organs. cDCD is already implemented in many countries; in many places, this protocol provides ⅓ to ½ of all organs donated annually.

This process, however, runs into ethical questions of withdrawing care, as discussed here. For this reason and others, it is not performed in several countries, including Israel.

Uncontrolled Donation after Cardiac Death (uDCD)

In this situation, donation occurs from someone who dies following an unexpected and unsuccessfully resuscitated cardiac arrest. Normally, organ donation is not possible in such cases. In certain circumstances, when cardiac arrest takes place in limited locations (such as a specially-equipped ambulance or emergency room), it is sometimes possible to provide oxygen support that will maintain organ vitality and allow for organ retrieval.

This technique has not been fully developed around the world, but it is has been implemented in many countries (including Israel) to successfully retrieve critical organs like kidneys and lungs.

Despite the current significant limitations and barriers, both variations of donation after cardiac death may evolve into new possibilities in the future. In the coming years and decades, organ retrieval techniques will continue to develop and offer opportunities for organ donation in greater incidents of death. This is another reason why we encourage people signing the Ematai healthcare directive to select option #1 (“I authorize my proxy to approve transplantation of any organs and tissues permissible under Jewish law and custom”).