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Are there authorities who hold that a stopped heart constitutes halachic death, but yet permit heart transplants? Stopping and taking out the recipient's heart would seem to be technically considered as causing halachic death (i.e. murder). The fact that it ultimately leads to healing or prolonging the life of the recipient (at time T2) should seemingly have no bearing on the prohibition of murder (which occurs at time T1 < T2).

[While there's a precept of violating Shabbos for someone so that he can keep more of them in the future, an analogous "kill someone so that he can live longer" principle doesn't seem to exist.]

So according to these authorities (if there are any), what is their halachic reasoning to permit stopping a recipient's heart?

user9806
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  • Wouldn't most open heart surgeries be the same issue? I don't think anyone holds that they are assur. Based on the Gemara shabbos about a person under a fallen wall, the Chacham Zvi says that death can be determined by heartbeat only if there's no breathing as well. Perhaps that's why nobody says great surgery is assur, and by extension, it wouldn't be the issue of transplants either. Reb Moshe says it was assur for other reasons – Chatzkel Jul 25 '21 at 22:20
  • If he's halachakly dead, so his children would inherit him. Maybe his wife is also freed from marraige. Bunch of other shailos would come up. – Shlomy Jul 25 '21 at 22:24
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    Open heart surgery has an artificial heart lung machine running while the bad heart is removed. Thus, he is still alive even halachically. A person whose heart has stopped and is revived by CPR is not considered halachically dead. – sabbahillel Jul 25 '21 at 23:42
  • @Chatzkel Fair point, this question could've also been about open heart surgery. But what happens if there's no breathing also - but only artificial blood oxygenation (or maybe CPR as sabbahilel said). Why should that not be halachic death? – user9806 Jul 26 '21 at 00:24
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    Jewish Virtual Library points out that part of the definition is irreversible cessation. Similarly, a person on a ventilator (which is artificial oxygenation) cannot be disconnected. Thus someone on a heart lung machine is treated as still alive and must be kept on until the operation is completed and the heart and lungs functional. – sabbahillel Jul 26 '21 at 00:32
  • @sabbahillel Interesting. The addition of reversibility as a criterion can make things complicated - how does one ever truly know/determine something is no longer reversible? That could be a function of technology available and circumstance - for example, if someone stops breathing near a hospital that might be reversible, but if the same happens on a hike far away from civilization then it's most likely not. Does that mean death can be declared sooner in the latter instance but not the former? – user9806 Jul 26 '21 at 01:39
  • I have no idea. It may that it is a matter of the time required to get the person to the hospital. Then again, it may be required to get to a doctor to make an official declaration. – sabbahillel Jul 26 '21 at 17:41
  • @shlomy just recalled the story with reb chatzkel roth who did a second kiddushin after he left the hospital from a respirator. See this link for fascinating sources on the topic, including this story. https://www.sefaria.org/sheets/175696?lang=bi – Chatzkel Jul 26 '21 at 22:18
  • Does it matter that the persons heart is indeed permanently stopped (non beating)? The essence of a heart transplant is that we have the intent to permanently and irreversibly stop the living persons own heart beating. The fact a second heart beats in its place is presumably irrelevant, if "heartbeat" is the definition of "being alive". (If it isnt the definition of being alive then we dont have any issue with transplants other than those applicable to surgery in general). So it seems this should be an insurmountable obstacle? – Stilez Jul 29 '21 at 19:43
  • @Stilez I would think that if it's really "heartbeat" that's the definition of "being alive", then it shouldn't matter much which heart does the beating (or if it's even a heart, or a mechanical pump) – user9806 Jul 30 '21 at 20:46
  • But it should. If the halachic standard of death is permanent cessation of ones heart, then that's the standard, and it cant be conveniently ignored that you plan for it to be permanently ceased. The fact you intend to start a second, different heart, shouldnt change that, because you arent keeping a person alive - not if the beat of ones own heart has been stipulated as the actual definition of "alive" in the first place. (Consider the implication of the alternative: if you permanently stop someones heart but start another in a lab somewhere, you could equally well claim nobody died) – Stilez Jul 30 '21 at 21:00
  • What I'm saying (and I could be wrong) is that it's probably not "the permanent cessation of one's heart" that's the halachic standard, but rather the permanent cessation of a heartbeat (as in, cessation of blood flow through the body). – user9806 Jul 30 '21 at 21:07
  • A related but perhaps more serious question is in regards to organ donations and whether a Jew can be an organ donor or a receive an organ bc of when the organ is taken and was this person dead yet – Dude Dec 23 '21 at 15:11

1 Answers1

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As stated above -- halachic death would be when there's irreversible heart cessation.

However, your intuition is somewhat correct. See this related question. Once the patient's heart is removed, there is no longer a chezkas chai -- presumption of living -- and thus the odds of success have to exceed fifty percent to allow heart transplants. (Rabbi Unterman addressed them before they had met this threshold, and from what I understand they fortunately later did.) As heard in a lecture from Dr. Fred Rosner.

Shalom
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