After removing her liver, doctors said Nosatzki would not have lived more than two weeks.
By SARAH HERSHENSONliver trans feat 88 298(photo credit: Courtesy of Israel Liver Transplantees Association)
Merri Ahava Nosatzki is a cute, petite eight-year-old whose eyes are the color of the sea on a summer's day. She likes to draw pictures with bold strokes and bright colors, and, if you wish, will deftly paint your fingernails complete with fancy designs.
"Oh, I had a great deal of experience painting fingernails at Schneider Children's Hospital in Petah Tikva," she answers carefully. "They sell the designs at the gift shop, and my mom would buy them for me - sometimes every day."
Merri spent many days in the Schneider hospital. On June 25, 2004, she became sick with an illness that attacked her liver and did not respond to treatment with drugs. Nine months passed, her condition worsened, and in March 2005 she was placed on the waiting list to receive a liver transplant.
"This list is compiled according to need, and Merri's name was number one. However, donations in Israel are few and far between," recounts Merri's mother, Holly Nosatzki, who grew up in the Greater New York area and made aliya after graduating from college. "Even though we hoped that a transplant would become available, we also knew that Merri was really sick at this point, and as an alternative, my husband Ze'ev - whose blood type is compatible - was supposed to undergo an operation and donate a piece of his liver with hopes that it would regenerate."
At this time, the Nosatzki family found a support system called the Israel Liver Transplantees Association (www.livertrans.org.il). "This organization offers support, information and understanding to people of all ages and their families who have someone involved in liver transplants," explains Mrs. Nosatzki. "We needed to meet other people who have undergone liver transplants, as well as their family members. My husband and I felt that participation in this kind of organization would give us both strength and knowledge as to how to cope with possible challenges in the future. We found that this organization - and its president, Sara Wechsler-Shoumovitz - is always there for us. Moreover, it has given us the chance to meet other transplantees and see how they are coping with the challenges."
On June 5, 2005, the unexpected happened: They were notified of a donation of a whole liver that would be a possible gift of life for Merri, although a tragedy for another family. This family from the Modi'in region had a little girl, named Natalie, who was three-and-a-half years old. She had undergone an operation to correct her crossed eyes, but during the operation something went terribly wrong. She did not regain consciousness, and, after undergoing many tests, was diagnosed by a doctor as being brain dead. The stem of her brain was dead and this is the prognosis when a person has no chance of recovery, and is kept 'alive' solely by artificial means.
Natalie's family was approached by the transplant coordinator at the hospital on a Sunday morning to ask their permission to donate their child's organs, and they said 'yes.' Time was given to the family to grieve before the machines were disconnected and the organs removed. Four children's lives were saved - two of whom were on the cusp of death.
"In the worst moment of their entire lives," relates Holly Nosatzki, "Natalie's parents were able to say, 'Let's do something good with this.' When Merri's liver was taken out, the doctors said that Merri would not have lived more than two weeks."
Nevertheless, there are pros and cons to organ transplants. When Merri's parents made the decision to accept the liver transplant, they knew that she was exchanging one illness for another chronic condition. Merri would need medicine every day of her life, checkups every three months, and exposure to certain germs and illnesses would put her life at risk.
"This is the heavy part of it," says her mother. "We kept her alive to live as a transplantee. Merri's liver transplant was a success but there are no guarantees. We view every day as a gift."
"So, what are we supposed to do with this gift?" she asks. "We decided to go public and talk about the idea of organ donations and stimulate dialogue. We believe that a dialogue will prompt people to look at sources of knowledge. Only then can they make an educated decision about organ donations. Truthfully, if someone had asked me before Merri's illness if I would sign a donor card, I would have said 'no' because I did not know enough about the issue. We have learned first-hand of its importance and therefore I now carry registration forms for ADI (the health ministry's organization dedicated to increasing awareness about organ donation) and transplant information wherever I go."
ADI was established by the family of Ehud (whose nickname was Adi) Ben-Dror, who died while waiting for a kidney transplant. ADI is part of the Israel Transplant Center in Tel Aviv, and the department that manages a computerized database of all Israeli residents who have declared their willingness to donate organs after death. Approximately 300,000 Israeli citizens - only four percent of the population, compared with 15-35% in most western countries - carry an organ donor card, obtained by calling 1-800-609-610 or visiting the ADI website at www.health.gov.il/transplantt.
According to Tamar Ashkenazi, Director of the Israel Transplant Center, the answer to finding additional potential organ donors lies in education. She points out that all organ transplants are carried out in Israel legally, through a system that is just. There is no buying or selling of organs, and the recipients are chosen on the basis of need and medical compatibility. Doctors do not rush to perform transplants or declare someone brain dead.
If there is a situation of a potential organ donation, certain things have had to occur before a specially trained nurse - the transplant coordinator - approaches the family for permission.
"Not every doctor can declare a brain death, a factor that is unique in Israel," points out Ashkenazi. "Regardless of the fact that there is a 24 hour window of opportunity to take organs, if there is any question about whether the person is or is not brain dead, the medical staff must wait six hours before performing another check - and if need be, wait another six hours and do a second check."
Only if there is agreement on all sides does Ashkenazi authorize a data base search for a suitable recipient or recipients. Exact time management issues such as transportation, preparation and operating room schedules have to be coordinated.
Throughout this dramatic situation, the transplant coordinator nurse is at all times with the donor family. Afterwards, the donor's family is invited to the transplant center, which runs workshops for companion and professional support. Each year these families are given recognition and invited to a ceremony at the President's house in Jerusalem. The families of donors are also invited to memorialize their loved ones on a special website managed by the transplant center, www.health.gov.il/yourdear.
Nevertheless, even thinking about death and what to do with the organs once it occurs, is a difficult issue for many people and one of the reasons they hesitate to sign up. Furthermore, Ashkenazi explains that many Israelis, both religious and secular, have another cause for negating the donation of organs. They believe that organ donation is against the teachings of Judaism.
This is not true, according to the Chief Rabbinate of Israel, whose rulings encourage organ donation. The Chief Rabbinate recognizes brain-stem death as Halachic death, based on the writings of Rabbi Moshe Feinstein, z"l. Moreover, they state that donating one's organs is a mitzvah because it saves another person's life.
However, there is discrepancy among rabbis as to the exact moment of death and when organs can be taken. Rabbi Moshe Tendler, a professor of Talmud at Yeshiva University who also has a PhD in Biology and is the son-in-law of the late Rabbi Feinstein, is a leader in recognizing brain stem death as Halachic death. He explains that his and his father-in law's decision is based on an interpretation of the Mishna Ohalot, and states: "After it has been determined that no blood is flowing into the brain, and the brain stem is not functioning and has no control or relation to the rest of the body, the person is considered more dead than alive."
Other rabbis follow the opinions of noted authorities such as the late Rabbi Aaron Soloveichik, who stated that cessation of the three important body functions - cardiac, respiration, and brain activity - has been the halachic definition of death throughout the ages. A third viewpoint in halachic thought, brought forward by Rabbi J. David Bleich of Yeshiva University and Cardoza School of Law, states that death occurs when cardiac and respiratory functions cease completely, even if there is still brain activity. Cessation of brain activity, according to this point of view, would be a valid criterion of death only if the brain tissue were completely destroyed or liquefied.
In order to address these questions and raise the awareness of organ donations, The Halachic Organ Donor (HOD) Society was established in 1995 after the tragic death of American Alisa Flatow, 20, who was killed in a terrorist attack in Israel. Faced with her death, her parents consulted with Rabbi Tendler and afterwards made the decision to donate her organs. Realizing the importance of this issue, they then directed their efforts to the establishment of the HOD Society to serve as an aid to people in making an educated decision, under Jewish law, concerning organ donations. The organization's internet site can be visited at www.HODS.org and provides educational materials and rabbinical opinions about the medical and halachic issues concerning organ donation. It also supplies its members with a unique organ donor card that offers different donor options, so that people may donate according to their particular halachic belief.
The HOD Society's brochure points out that out of the 1,100 people in Israel who are waiting for organs, 750 await kidneys. The kidney is an organ that, in certain situations, is now medically possible to recover for up to 40 minutes after the heart has stopped beating. People who believe that brainstem death must be followed by cessation of heartbeat can now also be organ donors.
In June this year, the Nosatzki family held a Se'udat Hodaya - a meal of thanksgiving to G-d - for Merri's year of recovery. They invited the hundreds of friends and family who helped them cook meals, with transportation to medical centers, by staying in touch with the family and the other children during Merri's stays in the hospital, and visiting Merri during her recuperation at home.
In Holly and Ze'ev Nosatzki's words, these were true friends who gave a listening ear. At the Seudat Hodaya, they remarked that they gave thanks to God and his miracles, for in September 2006, Merri started first grade with children of her age.
She is a busy little girl who still paints fingernails on her front steps - but only in her spare time.
