Parshat Balak tells a pretty wild story: Balaam, a Moabite prophet hired by the Moabite king to curse Israel, is prevented from doing so by God, who uses a talking donkey to insure that Balaam cannot fulfill his mission, which originally God had enjoined him to reject and subsequently gave him permission to pursue, at least somewhat. Is your head spinning yet?
We all
get caught up in the talking donkey, which is arguably the most intriguing
animal in the Bible. But I have always wondered: Does Torah believe that Balaam
has the power to curse Israel in such a way that Israel’s fortunes and future
are determined, or even influenced, by his utterances? Given that Balaam’s
intended curse is antithetical to God’s desire, how could his curse — or for
that matter, his blessing — make a difference?
Upon
meeting King Balak, Balaam tells him:
How can I damn whom God has
not damned,
How doom when Adonai has not
doomed? (Numbers 23:8)
It
appears that the Torah believes Balaam to have life and death power, which is
why God is so interested in telling him what he may, and may not, say.
As I
write this, 10-year-old Sara Murnaghan survives only thanks to a
respirator in Children’s Hospital of Philadelphia (affectionately known as
CHOP). She suffers from cystic fibrosis,
an autosomal recessive genetic disorder that has so severely damaged her lungs
that Sara cannot breath without the ventilator. She has been on a transplant
list for 18 months. Well, sort of.
The Organ Procurement and
Transplantation Network (OPTN), established by Congress in 1984, maintains the
national waiting list. The United Network for Organ Sharing (UNOS) is a non-profit organization that does
the administrative work of the OPTN, determining who receives the drastically
inadequate supply of lungs available for transplant in the United States — that
is, for people 12 years old and up. Sara, you’ll recall, is 10. The system does
not cover her.
In short, the two primary factors
under consideration are how long the patient is expected to live without a transplant, and how long the
patient is expected to live if given the transplant. Calculating these
probabilities is not simple. Among the many factors are age, body mass, blood
type, and geographic location, because in general the transplant must take
place within two to four hours of removal from the donor. The new technique of
“ex vivo” for assessing, storing, and reconditioning damaged lungs may extend
this deadline considerably.
A computer program makes the calculations according to the criteria and scoring
people have devised, and patients are placed on a waiting list accordingly. The
computer also makes the shidduch
(match) when donor lungs become available. The computer program is, in a
strange way, the purveyor of blessings and curses: its programming makes life
and death decisions.
The current system was set into
motion in 2005, replacing a previous first-come first-served system; it has significantly
decreased mortality on the waiting list. (Here is an excellent explanation of
how the system works.)
Many people poured countless hours into creating the current system, and we
have reason to be grateful to them for the vast improvement they put in place
in 2005. There is also good reason to re-examine the current criteria and formula
for assigning donor lungs. There are 50 times as many people on the waiting
list as there are lungs to transplant. Therefore, there is good reason to ask
whether 12 years old is a medically sound, or somewhat arbitrary, cut-off. If a
10-year-old is large enough to accommodate adult size lungs (which no doubt
come in a range of sizes, as do 10-year-olds), why exclude Sara from the
waiting list? The claim has been made that there is insufficient data on
children to include them in the program. The problem with that approach is that
children are far more likely to be consigned to death if they don’t have a
chance at the national supply of donor lungs. Moreover, perhaps the data is
lacking because children so rarely receive lungs; we then have a vicious circle
going. Certainly, we might say that living with cystic fibrosis is a curse. But
we might also say that children under 12 are cursed in the pursuit of lungs for
transplantation by the current system.
Sara secured a spot on the list on
June 5th because her parents sued Health and Human Services, and a U.S.
District Court Judge Michael Baylson ordered HHS Secretary Kathleen Sebelius to
suspend the 12-year-old cutoff rule and include Sara on the list. Almost
immediately, the mother of Javier Acosta initiated a lawsuit, as well. Javier
is 11 years old; his older brother died of cystic fibrosis in 2009.
The system for determining who
receives donor lungs will now be revisited, as it should be. Together with
improved technology (and “ex vivo” research does indeed look promising) I hope
and pray that many more children and adults will receive the transplants they
so desperately need to live and enjoy the blessings of life.
As Balaam looked up and saw Israel encamped tribe by tribe, the
spirit of God came upon him. Taking up his theme, he said…
How fair are your tents, O Jacob,
Your dwellings, O Israel!
Like palm-groves that stretch out,
Like gardens beside a river,
Like aloes planted by the Lord,
Like cedars beside the water… (Numbers 245-6)
May all those in need receive the supreme
blessing of life-saving organs; may they stretch out like palm trees, aloes,
and cedars beside the river, enjoying a full and meaningful life.
© Rabbi Amy Scheinerman
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