In life, football icon Avi Cohen inspired thousands of young Israelis, but his death last week proved divisive because of a deep rift in the Jewish state over life-saving organ donations.
Cohen, a former national team captain and the first Israeli to play professional football in England, was mortally injured in a Tel Aviv motorcycle accident and declared brain-dead several days later.
AdvertisementBut even though the 54-year-old Cohen had signed a donor card while still alive, when doctors asked his wife and family for permission to harvest his organs, they refused.
The news sparked a heated debate in Israel, which has a low rate of organ donation compared to Western nations, amid reports the family was pressured by a group of ultra-Orthodox rabbis who oppose the practice.
Supporters of organ donations have proposed a series of legal reforms to encourage the practice, including a controversial call to make donated organs available only to those who are themselves prepared to donate.
At the core of the ultra-Orthodox objections is the belief that a person is alive until their heart stops, and not when declared brain dead, said Daniel Sperling, an expert on medical ethics at Hebrew University's School of Public Policy.
But waiting until the heart stops renders the organs useless for transplant.
To overcome this, a law has been passed that legally defines death as when the brain no longer functions. But in order to win the support of rabbis, it heavily regulates the process of declaring a person brain dead.
"It has lots of limitations. Not any neurologist, only specially trained doctors, can declare someone brain dead and they have to have passed a special course by a team of 10 experts, including three rabbis," said Sperling.
Brain death must also be corroborated by expensive medical machines that are not available in most Israeli hospitals.
While some mainstream rabbis, including Israel's Sephardic Chief Rabbi Shlomo Amar, have supported the process, many other leading rabbis have refused.
As a result, Israel has low organ donation rates, with only about 10 percent of the population registered as organ donors -- and in many cases, families refuse to honour their wishes, Sperling said.
Critics say the rabbis who adhere to ancient law are out of touch with the advances of modern medicine and accuse them of negligence, noting that about 100 Israelis die each year waiting for transplants.
"Protecting the 'life' of a Jew with irreversible brain-stem damage has become more important for these irresponsible figures than saving the life of another human being, Jew or non-Jew," said an editorial in the Jerusalem Post.
"For these rabbis, removing organs before the heart stops, even if the brain-stem is dead, is tantamount to murder. Refraining from helping a terminally ill patient whose life can be saved by an organ donation is not."
Even Israel's Deputy Health Minister Yaacov Litzman, from the ultra-Orthodox United Torah Judaism Party, does not support Jews donating organs.
"It's no secret that there are different opinions regarding brain death," he told Israel's army radio, after being asked to explain why he had not signed a donor card.
"To each his own, if someone wants to donate that is good, if they don't, also fine," he said, adding that Israel managed to source many organs from overseas.
But critics say opponents of organ donation have no compunction about receiving organs. They want Israel to assume automatic consent for organ donation, requiring those opposed to "opt out."
"At the same time, should a person who has opted out of the programme need an organ transplant he will be told that due to his objection to organ harvesting he will not receive one," wrote commentator Jeff Barak in the Jerusalem Post.
While it seems unlikely Israel will adopt such a draconian method, it has implemented a controversial two-year trial programme that allows donor card holders to jump ahead on organ waiting lists.
The programme, which also offers donors free access to national parks and help covering funeral costs, seems to be boosting donor numbers, but is ethically problematic, says Sperling.
"It raises real problems because the general rule that guides dividing assets in the medical profession is that they should go to those who need them most."
Cohen's wife said she made her decision for private reasons. "The decision was mine, I wanted Avi whole," she said.
There have been calls to make signing an organ donation card binding, like a will, to prevent families from overturning the wishes of the deceased.
"We will never know what good his organs could have done. We do know that the ease with which his firm desire to do that good was disregarded is untenable," wrote the Jerusalem Post.
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