By Rabbi Yair Hoffman for the Five Towns Jewish Times

It is perhaps one of the most remarkable innovations in the history of fetal medicine. It is called the “BioBag” and for all practical purposes, it acts like an artificial replacement womb. It is predicted that this device, already successful with sheep, could in a few short years, bring premature human babies to term outside of the uterus.

This innovation is significant because extremely premature babies have very difficult and dismal outcomes. Prematurity is the leading cause of death for newborns. In the United States, ten percent of babies are born before they reach 37 weeks. Six percent are born at or before they reach 28 weeks.

Those that are extremely premature, in order to survive, require mechanical ventilation. They need medications and intravenous nutrition as well as fluids. Their organs are not fully developed, or they are stunted in their growth, and between one fifth and one half of them still suffer from very serious health issues. This BioBag will soon change all of that.

THE HALACHIC ANGLE

This is a remarkable development that we can all welcome. Our question, however is: What are the implications of this device on halacha? More specifically, would a child born of an artificial womb still require a Pidyon HaBen? If so, would the pidyon haben be held thirty days after the baby (or fetus) came out of the mother’s real womb, or would it be held thirty days after it emerged from the artificial womb?

Believe it or not, the answer to this critical question may lie in a Tosfos in Kesuvos (folio 4b, “Ad”).

WHAT IT IS ALL ABOUT

Before we get to the actual discussion of the halacha and its sources, let’s get a view of what the artificial womb is all about.

It looks like one of those oversized zip-lock bag that Glad (a registered trademark) manufactures. There are tubes of blood and fluid that go in and out of the bag. Indeed, in the experiment that was discussed in this week’s Nature Communications Journal, eight fetal lambs developed within the BioBag.

For a period of four weeks, the lungs and brains of these eight lambs actually grew. The fetal lambs sprouted wool. They opened their eyes. They wiggled. They learned to swallow within the artificial womb, or the Glad bags, whatever one wishes to call these devices. And what they are called may be a critical point in the eyes of halacha. Are they actually a womb? Or are they a glorified incubator or a Glad bag?

The lead author of the article is a fetal surgeon at the Children’s Hospital of Philadelphia, Dr. Alan Flake.

He says “the point of developing an external womb is to give infants born months too early a more natural, uterus-like environment to continue developing in.”
Does the BioBag’s appearance look like a womb, a rechem, in halachic terminology?

No, it does not. However, perhaps critically, it contains the same key parts. The womb is a protective sac that protects the developing fetus from the outside world. And so does the artificial womb. The womb has amniotic fluid. The Glad bag, or artificial womb has an electrolyte solution that bathes the fetal lamb in a manner that is almost identical to the amniotic fluid. It also allows the fetus to circulate its blood and exchange carbon dioxide for oxygen.

The Gemorah actually discusses a second womb, and its halachic implications.

The issue of how one views an incubator was once brought up to Rav Elyashiv zatzal by his son-in-law Rav Yitzchok Zilberstein, ylct. Rav Elyashiv answered that an incubator would not be considered equivalent to a second womb, but is rather looked upon as a machine that aids the fetus in his recovery (See Chashukei Chemed, Bechoros 49a).

BIO-BAG IS DIFFERENT

But this Bio-bag would seem to be very different than an incubator. Here is why:

This device actually mimics the circulatory system that connects the mother to the fetus. Here, the carbon dioxide that is produced by the fetus is exchanged for oxygen – just like the mother does for the baby. The blood flows with just the right amount of pressure as well.

If an external pump would have been used, it could overload the baby’s delicate system. Dr. Flake and his colleagues created a pumpless circulatory system which allows the baby’s blood to flow without another pump.

In an incubator system used in a hospital’s NICU (neonatal intensive care unit), which was what Rav Elyashiv zt”l was asked about, the incubator is open air.
This system is different. The bag and the artificial amniotic fluid protect the fetus from infection. Fluids flow in and out of the bag just like in the mother’s womb. It removes waste and keeps the fetus’s developing lungs bathed with fluid.

RAV FEINSTEIN’S VIEW

Rav Moshe Feinstein zt”l was asked once about artificial hearts, and he explained that the devices are considered as actually part of the person. The halachic significance of which is that they need to be buried along with body of the deceased upon his death. It can thus be argued that according to Rav Feinstein zt”l – something that takes the place of a womb may also be considered to be a womb from a halachic perspective. One Posaik had informed me that Rav Feinstein’s view was that the heart-lung machine is also considered a halachic heart and would, technically speaking, also require Kevurah. It is just that others would need it as well.

PRESSING ISSUE

The author of the study, Dr. Flake, predicts that in three years’ time they will be ready to test the device on human beings. That being the case, the issue should be presented to leading contemporary Poskim as to what to do, because this may soon become normative medicine.

SOURCES

The Gemorah in Chulin 70a discusses the law of a firstborn animal. It states as follows:

What is the law if a person joined up two wombs [of two different animals] to each other and the fetus went from one womb and entered the other? Do we say that it exempts only its own [from the law of Bechor] but it does not exempt that of another [animal] or perhaps it exempts also that of another animal?

The Gemorah concludes that these questions remain undecided.

While some might say that the Gemorah’s case may be different since although the fetus is taken out of the first womb and placed in a second womb, at least the second womb is a womb. Here the “second womb” is a plastic bag.

It can, however, reasonably be argued that the second womb, vis a vis the animal, is not substantially different than the BioBag under discussion. Since the Gemorah concludes that the issue is undecided – it would seem that, if our Poskim would consider this a Safaik – we should, in fact, either perform two Pidyon HaBen ceremonies – one thirty days after it emerges from womb #1 and the second one after it emerges from the BioBag. Or perhaps we can just do one Pidyon HaBen after “the second birth.”

IS THE BABY EXEMPT ON THE FIRST BIRTH?

The Gemorah in Bava Kamma (11b) explains that if the firstborn is born as a treifa – it will not live – it is exempt from the need to redeem it. One could conjecture that an extremely premature baby should therefore be exempt from Pidyon HaBen altogether. However, Rav Yitzchok Zilberstein Shlita in his Chashuchei Chemed there explains that when the doctors state that the baby can live – even on account of technology, we do perform a Pidyon HaBen.

CONCLUSIONS

It is this author’s view that the BioBag might very well be substantially different than the case of the incubator presented to Rav Elyashiv, and thus may be considered the second womb of the baby as in the Gemorah in Chullin. The Pidyon HaBen should therefore be performed 30 days after it emerges from the BioBag.

One last thought. The aforementioned Tosfos in Kesuvos states that the case of putting one womb next to the other and transferring from to the other was just theoretical and was discussed “lehagdil Torah ulehadira.” Perhaps another interpretation of this concept is that Chazal were very much aware of future technological achievements and breakthroughs. This discussion, as we now see, is very pertinent.

The author can be reached at [email protected]