Religious Views on Organ Donation

The September, 2008 issue of The Philadelphia Jewish Voice posted an article by Gabrielle Loeb entitled Judaism’s perspectives on Organ Donation After Death. Its publication was highlighted by Professor Gerry Beyer on the Wills, Trusts & Estates Prof Blog on September 10, 2008.

Loeb's article is quite detailed. He introduces the subject as follows:

Although many Jews believe that Jewish law forbids organ donation, most rabbinical authorities not only permit it, but also encourage it.

In 1990, the Rabbinical Assembly of America approved a resolution to “encourage all Jews to become enrolled as organ and tissue donors by signing and carrying cards or driver’s licenses attesting to their commitment of such organs and tissues upon their deaths to those in need.” * * *

After investigating issues regarding already deceased donors, including Kavod Ha-met (honor of the dead) Nivul Ha-met (disgrace of the dead), and the definition of death, and raising newer concerns due to medical advancements that can prolong life, he concludes with this advice to Jews:

There are numerous reasons for Jews to become organ donors; most reasons against that choice are simply misconceptions. Jews should consult their own rabbi to discuss the issue of organ donation.

Most rabbis agree, however, that it is our responsibility as Jews to honor God’s name and to save lives by giving the gift of life even after are lives have terminated through the act of organ donation.

As Mishnah Sanhedrin 4:6 says, “Whoever saves one life, it is as if he saved the entire world.”

For a thoughtful, researched Christian view of issues involving organ donation, see: A Christian's Response to Organ Donation and Transplantation, by Brad Harrub, Ph.D., posted by Apologetics Press, which asks "Can faithful Christians take advantage of, and support, organ donation and/or transplants?"

[G]iven the successful heart, pancreas, pancreas islet cell, intestine, lung, liver, and heart-lung transplants[,] the question arises, “Is this new medical technology in compliance with God’s will?” What should Christians know about organ transplants, and can we support this ever-growing practice? * * *

Wikipedia, under its heading Organ Donation and its subheading Religious Scruples, summarizes various religious views on organ donation:

Most religions are in favor of organ donation as acts of charity and as a means of saving a life. Some impose certain restrictions. For example, Jehovah's Witnesses require that organs be drained of any blood, and Muslims require that the donor have provided written consent in advance.

A few, such as certain branches of Orthodox Judaism consider it obligatory.

However, a few groups disfavor organ transplantation or donation; notably, these include Shinto and those who follow the folk customs of the Gypsies. * * *

This summary appears drawn from a short-form analysis of religious beliefs towards organ donation, with a lineage dating back to 1979, now widely posted on the Internet.

That analysis attempted to answer a basic question, answered differently for individual donors with differing religious viewpoints, who consider organ donation:

A common question that arises when people are considering organ and tissue donation is, "Does my religion approve of organ donation and transplantation?"

Surveys find that few individuals are aware of their own religion's doctrines regarding organ and tissue donation.

In fact, most major religions encourage organ and tissue donation, and many of them at the very least allow their followers to make a personal decision in this regard.

Such materials were posted in chart form by the U.S. Department of Health and Human Services, Health Resources & Service Administration on its webpage, Religious Views on Donation.

The government website's version of the materials was adapted from Organ and Tissue Donation: A Reference Guide for Clergy, 1995." For a more comprehensive guide incorporating those principles, see: Organ and Tissue Donation Reference Guide (2004; PDF, 46 pages), prepared & posted by the Wisconsin Donor Network.

Versions of that material summarizing religious viewpoints on organ donation were posted by many reputable organizations, including:

• American Red Cross' Tissue Donation -- Statements from Various Religions
  
• Gift of a Lifetime's Religion and Organ and Tissue Donation
• National Kidney Foundation's What Does My Religion Think of Donation?"
• New York Organ Donor Network's Religious Viewpoints
• One Legacy's Religious Views of Donation

In Pennsylvania, the Donate Life program, co-sponsored by the PA Department of Health, offers resources to explain and encourage organ donation. The Health Department also posts Organ and Tissue Donation Links for education and support. See also: PA EE&F Law Blog posting Organ Donation in Pennsylvania (06/14/07).

The PA Department of Transportation now provides an online organ donation registration for Pennsylvania residents who desire to make such a designation. The effect of, and process for, such a designation is explained by Penn DOT on its webpage entitled Organ Donation.

According to an article entitled Producing Organ Donors, by David H. Howard, published in the Journal of Economic Perspectives (Vol. 21, No. 3, Summer 2007, pages 25–36; PDF), the problem now is not the technology, but is the availability of transplantable organs:

"Organ transplantation is one of the greatest technological achievements of modern medicine, but the ability of patients to benefit from transplantation is limited by shortages of transplantable organs. * * *

As a result of the growth in the demand for organs, many observers have questioned whether the current system is capable of providing enough transplantable organs.

Transplant physicians and policymakers are seriously debating proposals to pay donors and their families and to change the legal regime governing the process of obtaining consent to donation. * * *

According to OrganDonor.gov from January to June of this year, 13,812 organ transplants occurred, due to the selflessness of 6,987 donors and their families.

Yet, as of September 8, 2008, the waiting list of organ transfer candidates remains at 99,435 hopeful recipients.

Reduced Rates for PA Senior Drivers

Do you recognize this woman driver from the mid-80s?

On April 14, 2008, Tyrone-PA online posted an article entitled "New PA law says only ‘refresher’ course needed for previous Seniors for Safe Driving participants", by Amanda Golden. She highlighted recent changes in Pennsylvania law regarding "Senior Driver Improvement Classes" that result in a mandatory 5% reduction in driver insurance rates for three years.

The Pennsylvania Department of Transportation has maintained a web page explaining the special rules for "mature" or "older" drivers -- those over the age of 55 -- entitled "Older Driver Info Center", which offers these further links:

• Retired Status Registration
• Talking with Older Drivers
• Mature Driver Improvement Courses
• Forms, Facts and FAQs
• Physician Reporting

On November 30, 2008, PennDOT issued a Press Release, entitled "PennDOT Approves 4-Hour Mature Drive Improvement Course", which announced changes in its senior driver improvement refresher courses to qualify over-55 drivers for discounts in vehicle insurance rates.

The Pennsylvania Department of Transportation has approved a 4-hour Mature Driver Improvement Refresher Course, which will allow drivers 55 and older the opportunity to hone their driving skills and continue to qualify for discounted vehicle insurance.

The refresher course will be offered to individuals who have completed the PennDOT approved, 8-hour Mature Driver Improvement Basic Course within the last three years. Currently, individuals are required to complete this course every three years to continue to qualify for discounted vehicle insurance.

Under Pennsylvania law, drivers 55 and older are eligible to receive a five percent discount on their vehicle insurance by completing the basic course. The requirements for receiving this discount are that each individual named on the policy must be 55 years of age or older and must have completed the course within the past three years. Individuals should check with their insurance carrier for specifics of their program.

“PennDOT is pleased to authorize a refresher course for Pennsylvania’s mature driving population,” said PennDOT Secretary Allen D. Biehler, P.E.

“The basic and refresher courses help mature drivers understand how aging affects driving abilities. They also provide insights about driving on today’s roadways, including recently enacted laws that affect all motorists.” * * *

The Press Release noted the "four state-approved organizations that conduct courses across the commonwealth" addressing the specific safety needs of the mature driver. These courses do not involve any tests on knowledge or driving skills.

PennDOT refers further inquiries to those approved organizations:

• AAA (Check local offices for availability)

• AARP (1-888-227-7669)

• National Safety Council (1-800-459-2556)
  

• Seniors for Safe Driving (1-800-559-4880)

The recent article by Amanda Golden reflected implementation of the revised training program in one community -- Tyrone, a borough in Blair County, PA, located 15 miles northeast of Altoona, on the Little Juniata River.

The two-day courses have been offered many times in Tyrone, with one class being held recently at Epworth Manor.

With the change in Pennsylvania law, individuals over 55 years of age who have successfully completed a Senior Education Program in the past, now only have to attend a one day refresher course to renew their insurance discount, as opposed to taking the two-day course again. The one-day course lasts a total of three and a half hours.

Seniors who have never participated in a Senior Driver Improvement Program in the past, must still attend a two-day seminar to earn the automobile insurance discount. The two-day course is a total of seven hours, broken down to three and a half hours each day.

The course covers a variety of topics and is designed to help participants do a better job:

• understanding the element of risk;
• managing the area around your vehicle with good visual techniques;
• sharing the highway with other drivers;
• managing vehicle speed;
• managing vehicle space as you share the road with others;
• handling driving emergencies;
• understanding and compensating for visual changes;
• understanding techniques for improving night vision and safety;
• understanding anti-lock braking systems;
• understanding supplemental inflatable restraint systems;
• understanding children and air bags -- why they're a dangerous combination;
• understanding Pennsylvania's road signs;
• understanding seniors and prescription drug problems;
• understanding why expressway driving is a problem; and
  
• understanding road rage related problems.

The course is presented in a non-threatening environment. The class is informative, entertaining, and there is no testing. There is no on the road driving. The course is strictly classroom theory. A nominal tuition fee is charged. * * *

If you recognize the lady driving the car in the photo above, then you may already have qualified to take such a refresher course.

"Where's the Beef?"
-- Clara Peller (1984) in a Burger King Ad

Organ Donation in Pennsylvania

Several years ago, I promised Peter C. Wolk, Esq. -- a brilliant & patient man -- that I would try to arrange posting of his excellent article entitled "How Lawyers Can Assist Their Clients with Respect to Organ Donation" on the website of the Pennsylvania Bar Association.

Unfortunately, that never happened; but I post it now on this Blog to fulfill my promise.

His article was printed in the Winter, 2005 issue of the Newsletter of the PBA's Real Property, Probate & Trust Law Section. And forms of his article were posted on the websites of other bar associations, such as the Washington State Bar Association, through its Real Property, Probate & Trust Law Section, as indicated here:

We have posted a short article on How to Become an Organ and Tissue Donor in Washington that provides useful information for both attorneys and their clients. This article contains links to form donor cards, information on the types of tissue and organs that can be donated, and other sites on the internet that provide useful information on organ donations.

A second piece, How Lawyers Can Assist Their Clients with Respect to Organ Donation provides practitioners with three simple questions we can ask our clients to see if they would like to participate in an organ donation program.

At the time of our discussions, Peter had graduated cum laude from American University Law School, held a Masters Degree from Harvard University, and was a Phi Beta Kappa graduate of Trinity College (CT); and he had embarked on a lawyer education outreach project for the U.S. Division of Transplantation about organ donation.

Since then (according to a presentation announcement dated September, 2006), it appears that Peter founded, and now serves as the Executive Director of, the National Center for Nonprofit Law, in Washington, D.C., and authored a book, The Art of Creating Nonprofit Organizations.

Organ donation remains an important topic for Pennsylvanians. Lawyers have a role in raising the topic with clients during discussions on personal & estate planning matters. And the public deserves simple answers to questions about organ donation.

So, I provide needed information, and I fulfill my promise (in a fashion), by posting his article here, updated by me with current links to resources. Its copyright remains in Mr. Wolk.

How Lawyers Can Assist Their Clients with Respect to Organ Donation

A major cause of the shortage of organs is that regardless of a decedent's wishes, virtually no surgeon will take organs or tissue without permission from the family. Regrettably, family members often withhold authorization because they are unaware the decedent wished to donate organs and tissues, thereby frustrating organ donors' wishes.

In fact, a national study conducted by Gallup indicates that when family members know of their loved one's wishes, 94% will honor the request. But, when family members do not know, only 54% will donate the relative's organs. Indeed, of all the causes for organs being unavailable from people who wanted to be donors, 37% are lost due to the family's refusal to consent. Those lost organs (from people who wanted to be organ donors!) could save many lives.

Attorneys are uniquely positioned to help by asking clients during estate planning and Will intake sessions if they want to be organ donors and if they have told their family. (Whether someone decides to be or not to be an organ donor is a personal decision that is respected; the purpose here is to ensure that people who want to make anatomical gifts do not have their wishes thwarted.) Sharing the decision to be an organ donor also has the effect of sparing surviving family members from the difficulty of having to make a burdensome, personal decision at an emotional time.

The American Bar Association supports more client education about organ donation issues:

RESOLVED, That the American Bar Association urges all attorneys to raise with their clients, when appropriate, the topic of organ and tissue donations and to provide donation forms to those clients who indicate an interest in making a donation.

See: Summary of Action of the House of Delegates, American Bar Association 1992 Mid-Year Meeting, Dallas, Texas, p. 30 (February 3-4, 1992). (Full text of the Resolutions and additional organ donor information is printed in the ABA pamphlet: "A Legacy for Life" (free on the ABA website; $12/100 pamphlets in print). [See: Reposting of this pamphlet on the ACTEC website here.]

As a lawyer, you can help by asking your clients the following questions during Will intake interviews:

1. Do you wish to be an organ and tissue donor?

Self -------> Yes ____ No ____

Spouse --> Yes ____ No ____

2. If yes, have you signed an organ donor card or indicated on your driver's license your intent to be an organ and tissue donor?

Self -------> Yes ____ No ____

Spouse --> Yes ____ No ____

3. Have you told your family about your intention to be an organ and tissue donor?

Self -------> Yes ____ No ____

Spouse --> Yes ____ No ____

What People Should Know About Organ and Tissue Donation in Pennsylvania

If you wish to be an organ and tissue donor, all you have to do is say yes to organ and tissue donation on your donor card and/or driver's license and discuss your decision with your family.

Nationally, about 63 people receive an organ transplant every day, but another 15 people on the waiting list die because not enough organs are available. In Pennsylvania alone, 478 people died [in 2003] waiting for an organ donation and 6,185 people are currently awaiting organ and tissue transplants.

One part of the problem is that some people who sign donation cards are not treated as donors.

Even if you've signed something, your family will likely be asked to give consent before donation can occur. Make sure that you talk to your family members about organ and tissue donation so they know your wishes!

One individual organ donor can save or improve the quality of life for more than 50 people who suffer from organ failure, congenital defects, bone cancer, orthopedic injuries, burns or blindness.

Who can become a donor?

All individuals can indicate their intent to donate (persons under 18 years of age must have parent's or guardian's consent). Medical suitability for donation is determined at the time of death. Are there age limits for donors?

There are no age limitations on who can donate. The deciding factor on whether a person can donate is the person’s physical condition, not the person’s age. Newborns as well as senior citizens have been organ donors. Persons under 18 years of age must have parent's or guardian's consent.

How do I express my wishes to become an organ and tissue donor?

1. Indicate your intent to be an organ and tissue donor on your driver’s license.
2. Carry an organ donor card.
3. Most important, DISCUSS YOUR DECISION WITH FAMILY MEMBERS AND LOVED ONES.

If I sign a donor card or indicate my donation preferences on my driver’s license, will my wishes be carried out?

Even if you sign a donor card it is ESSENTIAL THAT YOUR FAMILY KNOWS your wishes. Your family may be asked to sign a consent form in order for your donation to occur.

If you wish to learn how organ donation preferences are documented and honored where you live, contact your local organ procurement organization (OPO). The OPO can advise you of specific local procedures, such as joining donor registries, that are available to residents in your area.

What can be donated?

• Organs: heart, kidneys, pancreas, lungs, liver, and intestines
• Tissue: cornea, skin, bone marrow, heart valves, and connective tissue
• Bone marrow

If I sign a donor card, will it affect the quality of medical care I receive at the hospital?

No! Every effort is made to save your life before donation is considered.

Will donation disfigure my body? Can there be an open casket funeral?

Donation does not disfigure the body and does not interfere with having a funeral, including open casket services.

Why should minorities be particularly concerned about organ donation?

Some diseases of the kidney, heart, lung, pancreas and liver are found more frequently in racial and ethnic minority populations than in the general population. Successful transplantation often is enhanced by the matching of organs between members of the same ethnic and racial group.

Are there any costs to my family for donation?

The donor’s family does NOT pay for the cost of the organ donation. All costs related to donation of organs and tissues are paid by the recipient, usually through insurance, Medicare or Medicaid.

Can I sell my organs?

No! The National Organ Transplant Act (Public Law 98-507) makes it ILLEGAL to sell human organs and tissues. Violators are subject to fines and imprisonment. Among the reasons for this rule is the concern of Congress that buying and selling of organs might lead to inequitable access to donor organs with the wealthy having an unfair advantage.

How are organs distributed?

Patients are matched to organs based on a number of factors including blood and tissue typing, medical urgency, time on the waiting list, and geographical location.

How many people are currently waiting for each organ to become available so they can have a transplant?

Click here for the most current data -> United Network for Organ Sharing.

Can I be an organ and tissue donor and also donate my body to medical science?

Total body donation is an option, but not if you choose to be an organ and tissue donor.

If you wish to donate your entire body, you should directly contact the facility of your choice to make arrangements. Medical schools, research facilities and other agencies need to study bodies to gain greater understanding of disease mechanisms in humans. This research is vital to saving and improving lives.

Where can I get additional information about organ and tissue donation?

• Statistics and additional information about organ and tissue donation are available at: United Network for Organ Sharing, and the Division of Transplantation, U.S. Department of Health and Human Services.
• Information on minorities and organ donation and transplantation is available at the website of the Minority Organ Tissue Transplantation Education Program.
• Information about the American Bar Association’s efforts with regard to organ donation, and the ABA pamphlet entitled “A Legacy for Life” may be found here.
• Information about local Organ Procurement Organizations and local activities and facts about organ donation may be found at: Organ Procurement Organizations (Organ procurement organizations coordinate activities relating to organ procurement in a designated service area. They evaluate potential donors, discuss donation with family members, and arrange for the surgical removal of donated organs. OPOs also are responsible for preserving organs and arranging for their distribution according to national organ sharing policies. There are currently 59 organ procurement organizations throughout the U.S.). The Association of Organ Procurement Organizations (AOPO) is a private, nonprofit organization recognized as a national representative of organ procurement organizations.
• Information about the Uniform Health- Care Decisions Act (UHCDA) (approved by the Uniform Law Commissioners in 1993) is available here.

Pennsylvania Organ Procurement Organizations

Pennsylvania Department of Health
1-800-PA HEALTH.

The Center for Organ Recovery & Education
(Western Pennsylvania)
204 Sigma Drive
Pittsburgh, PA 15238
Phone: (412) 963-3550 / (800) 366-6777

Gift of Life Donor Program
(Eastern Pennsylvania)
2000 Hamilton Street, Suite 201
Philadelphia, PA 19130-3813
Phone: (215) 557-8090 (610) 543-6391

Update: 06/20/07:

For a discussion about a revision to the underlying law previously enacted in Pennsylvania governing organ donations, see: PA EE&F Law Blog posting "Uniform Anatomical Gift Act in PA Someday?" (06/20/07).

Update: 09/11/08:

For consideration of organ donation from the viewpoints of various religions, see: PA EE&F Law Blog posting "Religious Views on Organ Donation" (09/11/08).

"Steer Clear"; Steer Clearly, Too

On September 8, 2006, Pennsylvania's new "Steer Clear" driving law took effect. Generally, motorists now must change lanes or slow down when they approach emergency workers, police, or tow trucks on the road. Senior drivers (anyone over the age of 45, according to standards of a driver review program established by the Pennsylvania Department of Transportation) should be aware of the new law and its ramifications if violated.

Troop "F" of the Pennsylvania State Police summarizes the change in law, as follows:

Effective September 8, 2006, [Pennsylvania] motor vehicle law now requires drivers to move into a "nonadjacent lane" when approaching an emergency scene, police stop or a tow truck picking up a disabled vehicle along a highway.

If an adjacent lane is unavailable, illegal, or unsafe, drivers must pass the emergency response area at a careful and prudent reduced speed.

Drivers cited under the new law would face a fine of up to $250 and could have their operating privileges suspended. * * *

That summary, as well as the statutory amendment in its entirety, are found online here in a revised Section 3327 of Chapter 33 of the Vehicle Code ("Rules of the Road - In General").

The aim and implementation of this new driving law is discussed in an article, dated September 25, 2006, entitled "'Steer clear' law aims to prevent accidents", by Catherine Rodriguez, published in the Pocono Record Writer, found here:

Three Pennsylvania State Troopers have been killed since 1999 after being struck by drivers passing by traffic stops or accident scenes. And amazingly, between January 2005 and March 2006, 38 police cruisers were hit by passing cars, despite their flashing emergency lights. ***

Chief of the Coolbaugh Township Volunteer Fire Company Bernie Harrison said the law is a good thing. "It's for the safety of our personnel as well as for the drivers. Everyone's preoccupied with their CD player, cell phone, their friends. People aren't paying attention to their driving. It will require an effort to educate people but I think it will definitely be beneficial." ***

"No matter what the situation is on the road, we are at the mercy of a distracted or inattentive driver," said Harrison.

The law adds an usual reporting procedure by an "emergency service responder" who observes a violation of the new law. In a written, signed report delivered to police within 48 hours of an incident, an observing responder may indicate that a violation has occurred at a particular place & time, and provide information about the alleged violator and also about the vehicle's type, license number, & color. A police officer then can issue a citation, which would result in a summons.

PennDOT issued a press release on September 19, 2006 (found here & here) recognizing implementation of the new law.

Why is the new "Steer Clear" driving law important to seniors?

First, because it is a change in law altering driving habits in this state and increasing penalties for violation. Second, because a summary violation of the "Steer Clear" law (which could be difficult to defend if reported by a witnessing responder making a later report) could have a grave impact on a senior's future ability to drive at all.

PennDOT notes on a web page entitled "Mature Drivers", as follows:

There are nearly 1.4 million licensed drivers aged 65 and older in the Commonwealth, making up 16.7% of Pennsylvania's driving population. Pennsylvania is the fourth largest state in terms of population that is 65 or older. State Data Center statistics indicate that the number of Pennsylvanians 65 and older will increase 21% by the year 2020.

With Pennsylvania being a state with a very rural population, it is difficult for people to function without transportation. The loss of mobility can be devastating to the lives of older Pennsylvanians. Many older people are capable of driving safely, and have a lifetime of valuable driving experience to draw upon. PennDOT has created this page to provide access to information of interest to mature drivers and their families.

PennDOT provides links to information, including a 2-page "Fact Sheet" and also a 14-page pamphlet (Publication 345) entitled "Talking with Older Drivers". In its "Question & Answer" format, the pamphlet discusses many issues involving older drivers, including license retesting and revocation based not only on violations, but also on capability to operate a motor vehicle:

Q: How does PennDOT determine when an older person needs a physical, vision or driver’s exam in order to have a license renewed?

A: There are several ways PennDOT determines when a driver should be tested:

1) Medically incapacitated drivers of all ages may be identified by doctors. By law, all physicians, and others authorized to diagnose and treat disorders and disabilities, must report to PennDOT every person diagnosed as having a condition that could impair his ability to safely operate a motor vehicle.

2) Police and accident reports on drivers of all ages also help PennDOT determine who should be evaluated, and PennDOT may request medical or driver’s exams for those reported. Also, PennDOT receives letters from concerned family members and others. Drivers identified through these letters may be asked to complete an examination.

3) Each month, 1,650 drivers over the age of 45 are chosen at random for retesting at the time of license renewal and required to undergo vision and physical exams by doctors of their own choice. If the results of those exams suggest a need, the driver will also be required to take a driver’s examination. PennDOT has found that less than 1 percent of the selected drivers need to take the driver’s exam.

Q: What are some of the reasons for denying a license renewal or recalling a license?

A: When PennDOT receives medical information from a doctor, it starts an evaluation process. Based on the information submitted, one or more of the following may occur:

1) Restrictions to the person’s driving privilege may be added or deleted;
2) The person’s license may be recalled or restored;
3) The person may be asked to provide more specific medical information;
4) The person may be asked to complete a driver’s examination; or
5) No action may be taken.

The Pennsylvania Department of Transportation, not the physician, makes the license determination.

To avoid intervention by PennDOT in driving privileges, "Steer Clear" near others' accidents, and always "Steer Clearly" to avoid your own accident.

* * *

Update: 02/03/07:

Another new PA law will affect all drivers -- the windshield wipers & lights law. See: Pa.'s bright idea: Lights in the rain, by Lini S. Kadabar, in the Philadelphia Inquirer on January 28, 2007.

Basically, if your windshield wipers are on, your headlights must be on too. The new law took effect in Pennsylvania on January 29, 2007.

Starting this week, when the wipers on the car go swish, swish, swish, the car's headlights better go shine, shine, shine, or else.

A new Pennsylvania law, effective tomorrow, requires motorists to turn on their headlights whenever they run the windshield wipers, even intermittently, due to rain, snow, sleet, mist, or other inclement weather.

Violators can be pulled over and fined $25.

* * *