Israel Medical Association Journal

Background: Changes accommodating requirements of religious authorities in Israel resulted in the Brain and Respiratory Death Determination Law (BRDDL), which came into effect in 2009. These included considering patient wishes regarding the brain respiratory death determination (BRDD), mandatory performance of apnea and ancillary testing, establishment of an accreditation committee, and accreditation required for physicians performing BRDD.

Objectives: To assess the impact of the legislation from 2010–2019.

Methods: Data collected included the number of formal BRDDs and accredited physicians. Obstacles to declaring brain death and interventions applied were identified.

Results: Obstacles included lack of trained physicians to perform BRDD and interpret ancillary test results, inability to perform apnea or ancillary testing, and non-approach to next-of-kin objecting to BRDD. Interventions included physician training courses, additional ancillary test options, and legal interpretation of patient wishes for non-determination of BRD. As a result, the number of non-determinations related to next-of-kin objecting decreased (26 in 2010 to 5 in 2019), inability to perform apnea or ancillary testing decreased (33 in 2010 to 2 in 2019), and number of physicians receiving accreditation increased (210 in 2010 to 456 in 2019). Last, the consent rate for organ donation increased from 49% to 60% in 2019.

Conclusions: The initial decrease in BRDDs has reversed, thus enabling more approaches for organ donation. The increased consent rate may reflect in part the support of the rabbinate and confidence of the general public that BRDD is performed and monitored according to strict criteria.

Background: With smoking on the rise among teenagers, the United States has recently implemented anti-smoking legislation, though with questionable success.

Objectives: To examine the attitudes in Israel to such legislation.

Methods: An interviewer-administered questionnaire was completed by 505 adults: 217 undergoing general employment checkups and 288 amateur athletes requiring medical testing for certification. Smoking habits and attitudes toward anti-smoking legislation were examined.

Results: The overall rate of smoking was 25.3%, with a male:female ratio of 1:24 (P=0.232). Most smokers (65.6%) started smoking before the age of 20, and only 47.7% tried to quit at least once. Both the smokers and the non-smokers who were interviewed were in favor of legislation that recognized cigarettes as an addictive substance, restricted the sale of cigarettes to people aged 18 and older, and banned cigarette advertisements.

Conclusions: Anti-smoking legislation is looked upon favorably by Israelis, though the true benefit of such measures is questionable. Priority must be given to primary prevention through education and empowering youth to choose not to smoke.