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HODS Race 2014

Issues

1.  Is Needing a Kidney a Case of Pikuach Nefesh?

2.  Brain-Stem Death

3.  Taking Organs but Not Giving Organs

4.  Cornea Donation

5.  Donating to Non-Jews

6.  Evil Eye

7.  Gosses

8.  Health Care Abuse

9.  Is Organ Donation a Mitzva?

10. Israel Situation

11. Paying for Organs

12. Resurrection of the Dead

13. Should I Donate?

14. Who's Who?

15. Other Religions

Is Needing a Kidney a Case of Pikuach Nefesh?

Yes.  Research shows that people who receive a kidney transplant live for approximately 14 more years after the transplant.   Had they been exclusively on dialysis, however, their life expectancy would have been only 4.8 more years for people 60-64 years-old.

Nephrologist Dr. Benjamin Hippen noted in the scientific journal New Atlantis, Fall 2006, "Life on dialysis is a fragile, vulnerable existence."   Far too often, things do not go well, and people on dialysis are unable to work, experience multiple complications and die within a short period of time. 

The most recent United States renal dialysis statistics show that people ages 60-64 are likely to live 5 more years on dialysis versus 13 more years after receiving a kidney transplant. In other words, receiving a kidney transplant will give someone an extra 8 years to live. For people ages 45-50 years-old, the benefit is 14 more years after receiving kidney transplant than on dialysis.   (See the Full Report)

Brain-Stem Death

Rabbis who object to organ donation do not do so because a body must be buried whole. They object because organs are usually taken from a person who is brain-stem dead but whose  heart is still beating with the help of a ventilator. These Rabbis consider a beating heart to be a sign of human life and therefore donating organs at this point would be killing the donor. The question is whether or not a brain-stem dead person is alive or dead. Other rabbis who view brain-stem death as death view the organism is dead while the organs remain alive with the mechanical artificial help of a ventilator supplying the organs with oxygen.

The organ donor card of the Halachic Organ Donor (HOD) Society is unique because it allows donors to choose to donate their organs at brain-stem death or after cardiac death.

Many halachic authorities accept brain-stem death as death and support organ donation even though the heart is still beating. Some of them are listed below.  [Please note Rabbi Sternbuch does not rely on secular doctors to diagnose brain death,  and Rabbi Aeurbach requires all cells of the brain to be dead, so while they accept brain death as halachic death, they would not support turning off the ventilator on a brain dead patient.] 

Chief Rabbi of Israel Ovadiah Yosef

1973-1983



Chief Rabbi of Israel

Mordechai Eliyahu
1983-1993

Chief Rabbi of Israel

Avraham Shapiro z"l

1983-1993

Chief Rabbi of Israel
Shlomo Amar


Rabbi Yechiel Halevy

Secretary General Chief Rabbinate



Rabbi Gedaliah Rabinowitz

Rosh Kollel, Jerusalem

Rabbi Moshe Sternbuch
Av Bet Din,

Eidah Charedis


hods

Chief Rabbi of Netanya Dovid Shlush





Dayan, Chief Rabbinate

Shaul Yisrael z"l
1965-1990

Chief Rabbi of Israel

Shlomo Goren

1973-1983

Rabbi Dr. Moshe Tendler Yeshiva University




Rabbi Zion Boaron, Dayan, High Court of Chief Rabbinate of Israel

Rabbi Zalman Nechemia Goldberg

Rabbi Moshe Feinstein


Rabbi Shlomo Zalman

Auerbach

 

hods

Rabbi Adin Steinsaltz 

Rabbi Shlomo Aviner

Rabbi Yosef Carmel

Rabbi Yigal Shafran

Rabbi Shabtai Rappaport Amanuensis for Rav Moshe

Rabbi Dr. Avraham Steinberg

Rabbi Mordechai Halperin

RABBI MOSHE FEINSTEIN

Rabbi Moshe Feinstein also accepted brain-stem death as halachic death even though the person's heart was still beating.  Another way to phrase his position is unconsciousness coupled with irreversable cessation of respiration (as confirmed by the death of the brain-stem) is death.  He wrote his position in Iggrot Moshe, in a letter to Dr. Bundy and in his letter to Dr. Frank Veith (JAMA article, page 1654).  Some have claimed his rulings in Igrot Moshe do not support brain death. Yet, in addition to his writings, every person who ever spoke with Rav Moshe Feinstein about this issue confirmed he accepted brain-stem death as death.

No one who has ever claimed to have spoken with Rav Moshe Feinstein about this issue reported that Rav Moshe rejected brain-stem death.  All the doubts concerning his position were raised only after he died.

People who spoke with Rav Moshe Feinstein about this topic and who testified that he confirmed brain-stem death was death according to halacha and did not view a beating heart as a sign of life are his son Rabbi Dovid Feinstein, his grandson Rabbi Shabtai Rapport, his son-in-law Rabbi Moshe Tendler, his grandson Rabbi Mordechai Tendler, Dr. Frank Veith, Dr. Ira Greifer, Dr.Arthur Eidelman, and Dr. Sam Koontz.

It is important to become very familiar with the debate surrounding brain-stem death because critical organs such as the heart and lungs can only be recovered at brain-stem death and the recovery of all organs is more medically challenging after cardiac death.


Many terms are used by physicians and laymen that are not well understood: Death of a Person, Death of an Organ, Brain Death, Brain-stem Death (BSD), Coma, Deep Coma, Persistent Vegetative State (PVS), and Clinical Death. Below is a brief primer on some of these terms.

 

Death of a Person: The central question in this debate is 'When is a person dead?' Is a person dead when the soul leaves the body, when the body disintegrates, when the heart stops beating, when respiration irreversibly ends? An organism -- that is, a human being -- can be dead, but the organism's heart, kidneys, liver and other organs can remain alive for some time. At what point would you consider the organism 'dead?'

Death of an Organ: An organ can cease to function, but it's cells can remain alive and slowly die at some point later in time.  At what point would you consider an organ to be 'dead?'

Brain Death: The brain mainly consists of the cortex (the larger part of the brain) and the brain-stem. Brain death is sometimes used too broadly.  A person is brain dead when the cortex and the brain-stem cease to function.

Brain-Stem Death: This occurs when the brain-stem is dead, and by implication, the cortex as well. According to the laws of the United States and Israel, organs are only recovered from people who are deceased as defined by brain-stem death. This means that their brain no longer functions, that they are unconscious and inanimate.

The brain-stem controls respiration, and therefore the supply of oxygen to the body. Without oxygen, the heart can continue to beat only with the aid of a mechanical respirator that pumps blood throughout the body. The blood carries oxygen, essential to keep individual organs 'alive' even though the brain-stem is dead. (Inevitably, even with the use of a ventilator, the heart will shut down.) Brain-stem death (BSD) is examined in more detail below, from a medical, halachic and legal standpoint.

Coma, Deep Coma, Persistent Vegetative State (PVS): These terms imply the cortex is not functioning even if the brain-stem is, and the patient might be able to breathe on his or her own. Deep coma and PVS typically mean that this condition is irreversible. People often confuse PVS with brain-stem death, but they are not the same. Organs are never recovered from patients who are in coma or PVS.

Clinical Death: A term typically used to describe someone whose heart has stopped beating but who can be resuscitated. We sometimes hear stories of people who were 'clinically' dead but were revived.

 

A Closer Look at Brain-Stem Death

Medical Status: The brain-stem controls a number of neurological functions, the most important one being breathing. A person who suffers a severe head trauma typically has swelling of the brain. Because of increased internal pressure within the skull, blood flow into the cranium is blocked, resulting in oxygen deprivation. Brain cells, extremely sensitive to oxygen loss, begin to die. Once the brain is dead, the patient stop breathing, and he or she will die.

For thousands of years, a non-functioning brain-stem meant the death of the body and its organs because the heart stops pumping once it is deprived of the oxygen. With the invention of the mechanical respirator, however, it has become possible to keep blood oxygenated and to keep the heart and other organs alive for a few days or even weeks.

No one has ever "woken up" from brain-stem death. It is irreversible. Even with the use of a ventilator, the heart eventually stops beating resulting in complete systemic failure. BSD is irreversible because from the onset of brain-stem death, the brain begins to liquefy (lyses). Click here to learn more about the medical aspects of brain-stem death.

Legal and Medical Status: The majority of the countries in the world, and all 50 U.S. states, accept the 1968 Harvard University Medical School criteria of brain-stem death as the definitive moment of death.

Halachic Status: The central Halachic question is whether or not Jewish law considers a brain-stem dead patient (or corpse), whose heart continues to beat with the help of a ventilator, dead or alive. If halacha considers this person to be ‘alive,’ then removal of organs would be forbidden because you would be 'killing’ the donor.

There are those Rabbinic authorities who claim that only when a person’s heart has irreversibly stopped beating is he or she dead. From a medical viewpoint, this makes it difficult to transplant organs because once the heart stops pumping oxygenated blood to other organs, they begin to deteriorate and die. These organs are typically no longer viable for transplant. What most people don't know, however, is that in certain situations it is possible for a donor whose heart has stopped beating to donate their kidneys or liver for up to 40 minutes after cessation of heart beat. (Kidneys and liver are more resilient to oxygen deprivation than other organs.) The ramifications are enormous because of the 80,000 Americans waiting for organs, 50,000 are waiting for kidneys.

Breathing vs. Beating
There is a Rabbinic debate in the Talmud concerning the definition of death. One opinion is that death is indicated by the irreversible cessation of breathing. The other opinion is that death is indicated by the irreversible cessation of the heartbeat. [Tractate Yoma, page 85, side A.]

Textual Variant
Before we discuss the actual debate it is important to note that this text is a Talmudic textual variant.


The basis for the BSD debate is the nose vs. heart debate in the Babylonian Talmud in Tractate Yoma (85a). The older Yerushalmi Talmud records the word navel instead of heart (i.e. that irreversible cessation of respiration was indeed the sole criterion of death and the debate was as to whether the nose or the moving diaphragm was the best diagnostic tool). This alternative reading is not limited to the Yerushalmi Talmud.

The Babylonian Talmud in possession of Rabbinic authorities such as the Rosh, the Rif, the Ramban, the Yalkut Shimoni (and many other manuscripts found in museums in London and Germany) records the word navel and not heart in the debate. It seems only Rashi’s manuscript had the word “heart” and the printer replaced the word “navel” with the word “heart” in order to fit Rashi’s commentary. (This is indicated by the fact that the divrei hamatchil of Rashi, Rashi's citation of his Talmud, is out of order with our Talmudic text.)

Moreover, one can see from the flow of logic of the Talmud that links this debate to a parallel debate as to whether the formation of a fetus begins at the head or the navel. It would most likely make sense that the original text for determining death should be between nose and navel and not nose and heart. Regardless if there are any halachic ramifications concerning this fact (the Chazon Ish says variant texts play no role because the almighty intended us to have the text that we have and the GRA held differently), the HOD Society has engaged a Professor of Talmudic manuscripts at Hebrew University to research this issue and we will post it as soon as it is complete.

The Debate
The Rabbis of the Talmud contemplate a situation where a person is buried by a collapsed building on the Sabbath. Typically one is not allowed to dig on the Sabbath but of course, if life is at risk, not only is one allowed to dig, one is obligated to do so. If the person is found unconscious, lying inanimate, one must determine if he is dead or alive. If alive, continue digging to free him. If dead, leave him be and stop digging and recover the body only after the Sabbath. There is a debate as to whether or not a beating heart or respiration is a sign of life. The Talmud seems to say that lack of breathing in an unconscious inanimate person is death. The Shulchan Aruch, the book of Jewish Law, and Maimonides rule that way as well. But, there are those Rabbis that interpret the Talmud differently, and insist that a beating heart is clearly an indication of life.

Prior to addressing the subject of brain death, Rabbi Slifkin, in Rationalist Judaism,  briefly summarizes the methodology of halachic decisions based on the Talmud utilizing inference and analogy.  This is the responsibility of the posek, the halachic decisor, since most of the decisions concern situations that didn’t exist at the time of the redaction of the Talmud (Gemara) about 1500 years ago.  Regarding brain death in particular, the Gemara does not address brain death since at the time little was known of the physiology of organ function. Therefore halachic decisions concerning brain death and respiration which cite the Gemara in Yoma and the Mishna,  reflect the opinion of the posek who infers and makes analogies to the Talmud  while employing  much non-Talmudic information in halachic decisions concerning brain death. Rabbi Slifkin concludes that the latter part - the non-Talmudic information -is crucial to demonstrating the relevance of the Talmud.

  • Breathing
  • There are two methods to determine if cessation of breathing is irreversible. If after attempting CPR and all other life saving measures, breathing is not observed for a period of time it is considered irreversible. In addition, modern medicine has established that the brain-stem controls respiration, and if the brain-stem is not functioning and it dies, a person can never breathe again on his or her own. [People can wake up from a coma because comatose people have a functioning brain stem and are breathing on their own. Never in the history of modern medicine has there ever been a case of a brain-stem dead person ‘waking up.’ ]

    Some of the Rabbis who believe that irreversible cessation of autonomous respiration is death, even though there is a beating heart are: Rabbi Moshe Feinstein; Rabbi Dovid Feinstein; Rabbi Moshe Tendler; Rabbi Gedaliah Scwhartz, Av Bet Din of the Rabbinical Council of America (RCA) and Rabbi Yosef Dov Soleveitchik [There is some dispute about the Rav's position. Some students and family members claim he did not accept BSD. It seems, however, that they are testifying that they never heard the Rav accept BSD, and not that they heard him explicitly reject it. Also, since the RCA had a policy of accepting Rav Soloveitchik rulings, Rabbi Binyamin Walfish, former Executive Director of the RCA, testified that he asked the Rav about BSD and that he heard Rav Soloveitchik explicitly accept it. This concurrence was the basis of the RCA resolution of 1991 accepting BSD and adopting the RCA Living Will.]; Rabbi Dr. Avraham Steinberg; Rabbi Shlomo Zalman Auerbach [some doubt that this was the position of Rav Auerbach, but Rabbi Avraham Steinberg testifies that he personally heard this position from Rav Auerbach after the sheep experiment, and transcribed his psak for him]; Rabbi Shlomo Aviner, Chief Rabbi of Bet El; Rabbi Shaul Israeli, former member dayan of the Supreme Rabbinical Court of Jerusalem; former Chief Sephardic Rabbi of Israel Rav Moredechai Eliyahu; former Chief Ashkenazi Rabbi of Israel Avraham Schapiro; Rabbi Yaacov Yosef, son of the former Chief Sephardic Rabbi Ovadiah Yosef; Rabbi Moshe Sternbuch, the Av Bet Din (RAVAD) of the Eida Charedit in Jerusalem (BADAZ) who is considered one of the most important poskim of the Charedi world; Rav Zalman Nechemia Goldberg; and the complete halachic committee of the Chief Rabbinate of Israel in 1986, Chief Rabbinate Ruling on Moment of Death in 1986.

  • Beating

    There are those Rabbinic authorities who claim that only when a person’s heart has irreversibly stopped beating is he or she dead. From a medical viewpoint, this makes it difficult to transplant organs because once the heart stops pumping oxygenated blood to other organs, they begin to deteriorate and die. These organs are typically no longer viable for transplant.

    What most people don't know, however, is that in certain situations it is possible for a donor whose heart has stopped beating to donate their kidneys or liver for up to 40 minutes after cessation of heart beat. (Kidneys and liver are more resilient to oxygen deprivation then other organs.) The ramifications are enormous because of the 80,000 Americans waiting for organs, 50,000 are waiting for kidneys.

    Some Rabbis who believe that a person is still alive as long as the heart is beating are Rav Yosef Shalom Elyashiv; Rabbi Elazar Shach, Rabbi J.D. Bleich, Rabbi Mordechai Willig, Rabbi Herschel Schachter , Rabbi Dr. Avraham Avraham (author of Nishmat Avraham), Rabbi Aharon Soloveitchik, Rabbi Eliezer Waldenburg (author of Tziz Eliezer), Rabbi Yitzchok Wiess, Rabbi Nissan Karelitz, Rabbi Shmuel Wozner, Rabbi Yitzchak Kolitz, Rabbi Nosen Gestetner, Rabbi Aharon Kahn, and Rabbi Mayer Scheinberg.

    According to Rabbi J.D. Bleich and Rabbi Herschel Schachter, even a decapitated body that had the arteries and veins sewn together at the neck, whose heart is still beating, is alive.

Determining the moment of death is the main Halachic debate concerning organ donation. There is more information in the Articles section.

The organ donor card of the Halachic Organ Donor (HOD) Society is unique because it allows donors to choose to donate their organs at brain-stem death or only after cardiac death.

The HOD Society suggests that you consult with your Rabbi as you decide what kind of organ donor to become.  


Taking Organs but Not Giving Organs

Most rabbis who prohibit donating organs do so because they think a brain-stem dead patient is alive and believe that by donating the organs you are killing the patient.  Is such a person who holds such a belief then halachicly allowed to receive organs from a brain-stem dead patient? Obviously not. That would be akin to asking the doctors to murder someone for your benefit.

That is why Rav Yosef Shalom Elyashiv forbade Jews from going to China to get an organ because there they execute prisoners just to remove the organ.  Rav Elyashiv does not allow people to claim the doctor is doing the killing so the recipient shares no guilt, or that the Chinese are going to remove the organ anyway so “why shouldn't I benefit?”  And that is why Rav Chaim Kaniefsky recently publicly announced that Jews are forbidden to receive organs from a brain-stem dead patient.

Jewish law (Mishnah Torah, Hilchot Gneivah, 5:1) prohibits Jews from buying stolen goods because it helps create a market.  The parallel here is obvious.   You become an accomplice in a forbidden act - murder.  The Talmud (Bava Kama 118b) says that even purchasing milk, wool, or calves from a shepherd is not permitted since he may have stolen these items from the cattle under his care.

The claim that organs are being “taken out anyway” is simply not true.  First, besides cornea and skin, there are no banks for organs: no heart, liver, or kidney banks.  Organs have limited viability outside the human body (4-36 hours depending on the organ).   Organs have to be designated for a specific person where testing (such as tissue typing, blood typing, size compatibility, etc) has to be done before transplantation to make sure there is a match between the organ and the specific patient.  Sometimes, even though there is a great need for organs, organs are not removed from a brain-stem dead patient because the transplant society can't find an appropriate recipient.  When you put yourself on the transplant list you are asking the doctors to remove vital organs for you in particular.  If you believe that the potential donor is alive, you are in effect asking the doctor (whom you may think does not know any better) to murder someone on your behalf. This is clearly morally reprehensible and halachicly forbidden.

While there is a talmudic concept that one is not culpable for telling, asking, or hiring someone to do something illegal and immoral (ein shaliach li-dvar aveirah) this exculpation from guilt would not apply to murder (Kiddushin 43a; Rambam Rotzeach 2:2-4). Hiring an assassin makes you guilty (chayav mitah bi-dei shamayaim) and the Rambam calls you a murderer (shofech damim, 2:2 and a rotzeach, 2:4). There is a debate if one needs to actually pay the assassin to be guilty or if verbal command is sufficient (see Mishneh Le-Melekh). This debate is irrelevant, however, in the case of transplants since the recipient or his insurance is paying the doctor/hospital.  


Cornea Donation

Since the Talmud (Nedarim 64b) declares suma kamet (a blind person is akin to a dead person), Rabbi Israel Unterman, former Chief Rabbi of Israel, and other Rabbinic authorities have ruled that in saving someone from blindness it is as if you were actually saving someone from a life-threatening disease. Accordingly, Rabbi Unterman ruled that donating corneas to give a person sight is halachicly considered saving a life. In addition, the surroundings of a blind person are dangerous and may possibly cause death. There have been several studies that document the association between blindness and early mortality (Study 1, Study 2). 


Donating to Non-Jews

"Are Jews allowed to donate organs to save non-Jews?"
It is important for the person asking the question to clarify for him or herself if he or she is asking for Halachic interpretation, based on nationalistic reasons (“All Arabs are our enemy”) or based on simple racism. If the questions stems from non-halachic issues, then he or she should not hide behind the skirt of halacha by claiming that halacha prohibits organ donation to non Jews. “Do not use the Torah as a spade to dig with.”

1. Image of God
The above question presupposes that the Torah indicates that while saving the life of a Jew would be permitted, the same act to save a non-Jew would be forbidden. In other words, the Torah considers the life of a non-Jew to be less valuable than that of a Jew. This assumption could be challenged on the Torah basis that “all of mankind was created in the image of God.” Since Judaism believes that every human being is created in the image of God, donating an organ to a non-Jew affirms that the person has the potential to walk in the path of God: Abram, the father of Judaism, was not Jewish before he became Abraham.

2. Different Halachic definition of non-Jew
It is true, that in certain cases the Talmud distinguishes between Jew and non-Jew concerning the permissibility of violating commandments to save a life. Some Rabbis, however, believe that although the halacha of 2000 years ago would distinguish between Jew and non-Jew that is because the non-Jew of yesteryear was a pagan, that sacrificed their children to the fire god, Molech. The non-Jew of today, certainly not monotheistic non-Jews, would not fall into such a category.  

Even if one were to accept today the ancient halachic distinction between Jew and non-Jew, it appears that there are a number of other halachic factors that compel a Jew to donate organs to a non-Jew, like Eiva.

3. Enmity (Eiva)

The Talmud states that although one might think it is forbidden to violate the laws of the Torah, such as Sabbath laws, to save the life of a non-Jew, we are supposed to do so out of fear that not doing so might cause enmity between non-Jews and Jews. That reasoning seems to apply here.


Rav Moshe Feinstein wrote in Iggrot Moshe that Jewish doctors should violate the Sabbath to save the life of a non-Jew to prevent enmity -- in its simplist form a feeling of hostility, in its worst, hatred.

The Crown Heights riots in New York in 1991 is a case in point. One of the things that inflamed the Brooklyn neighborhood was the fact that the Jewish ambulance corps, Hazalah, came to a car accident scene and took the Jewish driver to the hospital and not an African-American child. Although there was no racial or religous motivation -- the police had instructed Hazalah to do so because the African-American boy was already declared dead and the driver was injured -- there was a perception of preference by the Jewish ambulance technicians for the Jewish driver. Rioting among African-Americans and Jews took place for 3 days and 3 nights, and several Jews were chased and beaten. Yankel Rosenbaum, a chassidic Jew, was stabbed and killed.

Enmity, whether based on religious favoritism or merely the perception of it, is a real concern in today's world.

There is plenty of anecdotal evidence in transplant centers about how the medical establishment is angry that Jews don’t donate organs but are willing to receive organs. Again, halachic reasoning suggests that Jews should donate organs not only to Jews but to non-Jews as well, to prevent enmity. 

4. The organ recipient might be a Jew

(This reasoning is based on the ancient idea that one should make a distinction between pagan and Jew). According to U.S. and Israeli law a donor family is prevented from knowing the religion of a potential recipient. As a result, there is a chance that the recipient might be a Jew.

The Talmud Tractate Yoma clearly states that when it comes to saving lives we don't follow the majority. This means that even if the majority of the 85,000 Americans waiting for organs are non-Jews, we don’t assume a chazaka, that the recipient is a non-Jew. Even if there is a fraction of one percent of a chance that you can save a (Jewish) life, you should violate 610 laws of the Torah (out of 613). 

5. Every act of organ donation brings a Jew closer to the top of the list.

Assuming your understanding of Jewish law was focused on saving Jews, even if all of your eight critical life-saving organs were given to eight non-Jews, by removing those recipients from the list you are directly causing a Jewish person on the list to move up, where they might be matched with a life-saving organ.

A Nationalistic Perspective
The question of donating organs to non-Jews often comes up in Israel where potential recipients are Israeli Arabs, who are viewed by some Israelis as ‘the enemy.’ (It should be noted that Israel is not responsible for organ donations to Palestinians. Israeli organs only go to Israeli citizens, whether they are Jews, Muslims or Christians.)

  • Arab Donors – Many Arabs donate organs that save Jewish lives. If discrimination were allowed, Jewish recipients would suffer.

  • Justice - Consider God’s response to the angel in the story of Yishmael (Breshit, Vayereh). Rashi comments that the angels asked God to let the boy Yishmael die of thirst in the desert because his offspring will kill Jews in the future. Rashi quotes the Talmud (Rosh Hashana 16b) and says that the boy needs to be judged for whom he is now, and not what he, or his descendents, will do in the future.

  • Goodwill - There can be no better way to build bridges between Arabs and Jews than by having reciprocal life-saving organ donation.   

Evil Eye

Some people believe that signing a donor card will invite ‘the evil eye’ to cause the card holder to have a deadly accident. This is an irrational belief, which is disproved on its face by the fact that there are millions of donor card holders worldwide who are alive and thriving.

The evil eye in Jewish literature can be understood to refer to the concept of jealousy. Do not do something that will cause other people to be jealous of you (i.e. to look at you with an evil eye) and possibly cause you harm.  The same term is used in Jewish literature when you are told to give charity with a good eye (generously) and not with an evil eye (grudgingly).

If it were true that a supernatural force or evil eye would cause a person harm for signing an organ donor card, then he or she should also refrain from buying health insurance, car insurance, fire insurance, theft insurance and flood insurance. The same principle would apply. 


Gosses

Gosses is a status in Jewish Law ascribed to a person who is deathly ill, and who will most likely die within three days. Halacha, Jewish Law, dictates that a Gosses must not be touched for fear that any sudden or traumatic movement will accelerate the person’s death. The analogy is given that a Gosses is akin to a flickering candle and any slight movement might extinguish this last spark of life. Doctors can test for brain-stem death without causing an invasive or traumatic injury that might accelerate death and violate the prohibition of Gosses. 

Rabbi Shlomo Zalman Auerbach said the prohibition of gosses is that one is not allowed to move a gosses for reasons other than the patient's benefit. But Rabbi Auerbach ruled one is allowed to touch a gosses even if not for the patient's benefit. 


Health Care Abuse

Some people believe that if doctors know you have a donor card they will prematurely declare you dead in order to harvest your organs.  First, it is difficult to imagine that a doctor in good conscience would kill one patient in order to save another.  Such action is unethical. It is also illegal and would expose the physician and the hospital to criminal and civil liability. Second, most hospitals have a protocol that demands evaluation by a separate medical team -- a team that was not involved in the patient's care and is ignorant of a patient's status as a potential donor -- to determine whether or not he or she is brain-stem dead. 


Is Organ Donation a Mitzva (a good deed or obligation)?

As with most halachic questions, it depends on whom you ask. This website is not meant to give Halachic rulings on organ donation, but rather to educate the public about some of the different medical and halachic issues concerning organ donation.

Jewish law (Halacha) is clear that saving a life (pikuach nefesh) is of the utmost importance and overrides just about every prohibition and commandment in Judaism (with the exceptions of murder, illicit sexual relations and idol worship).

There are three biblical prohibitions concerning a cadaver that would, at first blush, seem to indicate that organ donation should be forbidden. They are:

  • Nivul Hamet, a biblical prohibition that forbids the needless mutilation of a cadaver. This prohibition is the basis for why autopsies are generally forbidden. But Jewish law does permit autopsies when the results of the autopsy have a real and immediate chance to save lives (Rabbi Yechezkel Landau, the former Chief Rabbi of Prague, in his Noda Beyehuda). Most Rabbis agree that Pikuach Nefesh, saving a life, is more important than the prohibition of Nivul Hamet. Organ transplant saves lives.

  • Halanat Hamet, Deuteronomy 21:23, a biblical prohibition that forbids delaying burial of a body. All Rabbis agree that Pikuach Nefesh, saving a life, is more important than expedient burial. Organ transplant saves lives.

  • Hana’at Hamet is a prohibition (some say biblical others say rabbinical) that forbids one from deriving any benefit from a dead body, such as selling it for medical research. All Rabbis agree that Pikuach Nefesh, saving a life, is more important than this prohibition. Organ transplant saves lives.

The above prohibitions afford respect and dignity to cadavers, for they once hosted life itself. In this context, it makes sense that all Rabbis agree that saving a life outweighs observing prohibitions concerning a cadaver because by saving a life one is giving utmost respect and dignity to the human body. As it is written in Jewish Law, "Save one life and it is as if you have saved the entire world," Sanhedrin 4:5. 

Pikuach Nefesh Overrides Most Commandments


Israel


Although the Chief Rabbinate of Israel ruled that brain-death fits the definition of halachic death, there remains a widespread misconception in Israel that Jewish law categorically prohibits organ donation. Even though most Israelis are secular, when it comes to issues of death they adopt a more ‘religious’ perspective and don’t donate organs.

As a result, Jews have the lowest percentage, among all other ethnic groups worldwide, of signing organ-donor cards. So while most western countries achieve organ-donor membership of up to 30% of their population, Israel -– a predominately Jewish country -– remains at 3%. Israel was recently expelled from the European Union Organ Donor Network because, year after year, they accepted organs but didn’t donate organs.

Death in Israel because of a lack of transplant organs is unnecessary. In 2001, there were 200 people in Israel who died in such a way that made them viable donors. None of these brain-stem dead patients had signed donor cards but each of their families were approached by transplant coordinators and asked to donate organs. Seventy families, out of 200, agreed to donate. [This 35% acceptance rate is also the lowest in the world.] That means that 130 people were buried with perfectly good organs to donate. The tragedy is that in that same year, 114 Israelis died waiting for organs that never came. The 130 viable donors could have easily donated their organs to the 114 people and others, but did not.  


Paying for Organs

Most countries prohibit the buying and selling of human organs (excluding China, Iran and the Philippines.) The United States enacted the National Organ Transplant Act (NOTA) in 1984, making such activity a federal crime punishable by $50,000 and/or 5 years in prison. As such, the Halachic Organ Donor Society does not buy or sell, or facilitate the buying or selling of, organs. While this activity is illegal, there has been great debate about whether or not it is immoral. Articles on both side of the debate may be found on our Articles page and our Press page


Resurrection of the Dead


The belief that a person must be buried with his or her organs in order to be resurrected from the dead has no basis in classical Jewish sources.  The fact is that upon death all organs, tissue and muscles quickly decompose as all organic material succumbs to degradation by microorganisms.  The book of Ezekiel (Chapter 37), for example, recounts a resurrection of dry bones as dry bones are all that remain.  Ultimately, however, even bones disintegrate.

In fact, classical Jewish sources confirm organs decompose.  The Mishna and Talmud report that deceased family members were traditionally placed in a niche inside a family burial cave.  After a few months, when the organs decomposed, the family then performed “likut atzamot” where they gathered the bones from the niche and placed them into a pit in the cave that contained all the bones of previous ancestors, thus the Hebrew euphemism for death, ‘To be gathered unto his fathers.’ 

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                                                         Caves/  Bones
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                                                  cave  cave  cave  cave  bones

                                                                          Photos Courtesy of Israel Antiquities Authority


                                            
During the Second Temple period, however, Jews in Israel adopted the Greek custom and placed the bones into an ossuary, a small stone-hewn chest, and sometimes inscribed the family member’s names on it.

 
 

    Ossuaries
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    ossuary  ossuary  ossuary  ossuary 

    ossuary  bones  ossuary  ossuary


    bones
      cave  bones  ossuary

                                                                  Photos Courtesy of Israel Antiquities Authority



Rabbi Elazar ben Zadok described how he dutifully carried out his late father's instructions to collect his bones and place them in an ossuary. He voiced his satisfaction at having maintained continuity from generation to generation: "Just as he attended his father, so have I attended him." Thousands of ossuaries and family burial caves containing human bones have been found throughout Israel, including those of a Cohen Gadol, a high priest who served in the Temple.  

All organs disintegrate. There is one text, in Bereishit Rabah of Parashat Noah, that refers to resurrection being dependant on a vertebrate called the Luz bone (some think this might be the last vertebrate in the spine known as the coccyx.) If the Almighty decides to resurrect a dead person, the Lord will assuredly have the power to do so regardless of the state of the body.

(Sources: Mishna Moed Katan 1:5; Mishna Ohalot 9:15; Mishna Sanhedrin 6:6; Talmud Pesachim 92a; Talmud Zevahim 100b; Talmud Moed Katan 8a; Mishna Baba Batra 6:8; Talmud Smachot 12:6,7,8,9; etc.) 

 

Should I Donate?
If you or someone you know has questions about the moral, medical or halachic issues surrounding organ donation, consult with a Rabbi who has halachic knowledge as it relates to death and medicine, and medical knowledge in his own right. Having doubts and questions should not become a cause for paralysis or procrastination.  


Who's Who ?

Nancy Cruzan was a prominent figure in the right-to-die movement. After years of being in a Persistent Vegetative State as result of an auto accident, her family fought to have her feeding tube removed. The family’s request to remove the feeding tube was eventually granted, and Nancy died 11 days after the tube was removed.

Alisa Flatow was a 19 year-old American student living in Israel where she was killed in a terrorist attack in 1995. She was one of the first high profile cases where an Orthodox Jewish family agreed to donate organs. Some of her organs went to Israeli Arabs.

Rabbi Isser Yehuda Unterman was the Chief Rabbi of Israel (1964 to 1973). He supported organ donation and ruled that donating a cornea to a blind person was considered as if one was saving the blind person from a life-threatening disease. He based his ruling on the Talmud Nedarim 63b which says a blind person is akin to a dead person (suma kamet.)

Rav Moshe Feinstein's writing on the issue of brain-stem death has been under debate on account of different interpretations. However, all witnesses who spoke with Rabbi Moshe Feinstein on this issue testified that they personally heard him tell them that brain-stem death is halachic death and organs should be donated at that point. Seven of these witnesses included Rabbi Dovid Feinstein (his son), Rabbi Moshe Tendler (his son-in-law), Rabbi Mordechai Tendler (his grandson), Rabbi Shabtai Rappaport (his grandson), Dr Ira Greifer (Nephrologist and former medical director of the National Kidney Foundation in New York and a professor of medicine at Albert Einstein College of Medicine in the Bronx),  Dr. Sam Koontz (Vascular surgeon in San Francisco) and Dr. Frank Veith (vascular surgeon at Montefoire Hospital.)

Rabbi Dovid Feinstein, son of the late Rav Moshe Feinstein, is the Rosh Yeshiva (dean) of the Mesivtha Tifereth Jerusalem, a yeshiva elementary, high school and kollel. He inherited the position after the passing of his father in 1986. He testified that he heard that his father say that a beating heart is not a sign of life. If a person is unconscious and has irreversible cessation of respiration, that person is dead and all life-saving organs, including the heart, should be donated.

 

Rabbi Moshe Tendler is a senior Rosh Yeshiva at Yeshiva University's RIETS    and the Rabbi Isaac and Bella Tendler Professor of Jewish Medical Ethics and Professor of Biology at Yeshiva College. He has a Ph.D. in Microbiology and is one of the world's leading experts on Halacha (Jewish law) and Jewish medical ethics. He accepts brain-stem death as halachic death and has been a staunch supporter of organ donation together with his father-in-law, Rav Moshe Feinstein.

 

Rabbi Shabtai Rappaport was an amanuensis for Rav Moshe Feinstein recording many of his responsa in support of organ donation and acceptance of brain death.  Rabbi Shabtai Rappaport, a noted halachic expert in the areas of medicine and organ transplant, accepts brain-stem death as death.

 

 

Rabbi Dr. Avraham Steinberg is a pediatric neurologist at Shaarei Zedek hospital in Jerusalem and a recipient of the Israel Prize for writing his magnum opus, "The Encyclopedia of Halacha and Medicine." Rabbi Steinberg accepts brain-stem as death and supports organ donation. He led the Chief Rabbinates medical committee in 1986 when they unanimously accepted brain-stem death as halachic death and supported organ donation.

 

 

Terri Schiavo suffered severe trauma to her brain after cardiac and respiratory arrest in 1990. She entered in to a Persisten Vegetative State. In 1998, her husband and guardian, saying she would not want to be kept alive in such condition, petitioned the courts to have her feeding tube removed. After a long legal battle, the tube was removed on March 18, 2005. She died 13 days later.

The issue in the Terry Schiavo case was not brain-stem death and no judge ever ruled that she was brain dead nor did the doctors who testified say that she was brain dead.  The issue was persistent vegetative state (PVS) which is a different syndrome.  It would be illegal to harvest organs from those with PVS, and, indeed, Ms. Schiavo's organs were not harvested.  Thus, the Terry Schiavo case, whatever it merits or lack thereof is not relevant to any discussion about brain death and organ transplants.

 

Rabbi Yechezkel Landau lived in 18th-century Prague: His ruling in the Noda Biyhudah (Volume II, Yoreh Deah 210) ruled that Jews can allow autopsies to be done if the information learned might save the life of someone in immediate danger (but not for the purpose of gleaning general medical knowledge that might help someone in the future).

 

 

Rabbi Yehuda Meshi Zahav is the founder and chairman of the Israeli organization, Zaka (Disaster Victim Identification). Zaka is an organization which deals with collecting body parts in the aftermath of an accident or terrorist attack, in order to maintain the respect of the dead. He carries an organ donor card and accepts brain-stem death as death.

 

 

Rabbi Dovid Shloush is the chief rabbi of Netanya. He was part of the Chief Rabbinate Medical Committee in 1986 that ruled that brain-stem death was Halachic death and organs should be donated.

 

 

 

Rabbi Mordechai Eliyahu was the former Sephardic chief rabbi of Israel in 1986, when the Chief Rabbinate unanimously ruled that brain-stem death was Halachic death and organs should donated.

 

 

 

Rabbi Binyamin Walfish is the former director of the Rabbinical Council of America and one of the architects of the RCA’s donor/transplant guidelines back in the early 1990s. He testified that Rav Yosef Dov Solovetchik told him that he accepted brain-stem death as death.

 

 

Rabbi Gedalia SchwartzRabbi Gedalia Schwartz is the Av Bet Din, the Chief Presiding Judge, of the National Bet Din of the Rabbinical Council of America (RCA).  Rabbi Schwartz believes that irreversible cessation of autonomous respiration is death, even though there is a beating heart.

 

 

 

Rabbi Avraham Kahane ShapiroRabbi Avraham Kahane Shapiro was the Rosh Yeshiva of Mercaz Ha-Rav Kook Yeshiva, one of Israel’s largest talumudic academies, as well as a former Ashkenazi Chief Rabbi of Israel.  He accepted brain-stem death as death and supported organ donation even though the heart is still beating.

 

 


Other Religions


Most other religions either support organ donation or consider it to be an individual choice.  Below is a sampling of the views of other religions on organ donation. 

The National Health Service of the United Kingdom has worked closely with religious leaders of Buddhism, Christianity, Hinduism, Islam, Judaism and Sikhism to research and produce a series of leaflets explaining organ donation and religious viewpoints and principles.   Click on each religion listed in this paragraph to view and/or download the relating leaflet.

Ame & Ame Zion (African Methodist Episcopal)
Organ and tissue donation is viewed as an act of neighborly love and charity by these denominations. They encourage all members to support donation as a way of helping others.

Amish
Approved if there is a definite indication that the health of the recipient would improve, but reluctant if the outcome is questionable.

Baptist
Donation is supported as an act of charity and the church leaves the decision to donate up to the individual.

Buddhism
Donation is a matter of conscience.

Catholicism
Transplants are acceptable to the Vatican and donation is encouraged as an act of charity. Here is a link to an address by Pope John Paul II to the 18th International Congress of the Transplantation Society.

Christian Science
No position; decision about donation is left to the individual.

Episcopal
The Episcopal Church passed a resolution in 1982 that recognizes the life-giving benefits of organ, blood, and tissue donation. All Christians are encouraged to become organ, blood, and tissue donors "as part of their ministry to others in the name of Christ, who gave his life that we may have life in its fullness."

Greek Orthodox
No objection to procedures that contribute to restoration of health, but donation of the entire body for experimentation or research is not consistent with tradition.

Hinduism
Donation of organs is an individual decision.

Independent Conservative Evangelical
Generally, Evangelicals have no opposition on organ and tissue donation. Each church is autonomous and leaves the decision to donate up to the individual.

Islam
The religion of Islam strongly believes in the principle of saving human lives. According to A. Sachedina in his Transplantation Proceedings article, Islamic Views on Organ Transplantation, "The majority of Muslim scholars belonging to various schools of Islamic law have invoked the principle of priority of saving human life and have permitted the organ transplant as a necessity to procure that noble end."

Jehovah's Witness

Jehovah's Witnesses refuse medical and surgical treatment using blood products.

Lutheran
In 1984, the Lutheran Church in America passed a resolution stating that donation contributes to the well-being of humanity and can be "an expression of sacrificial love for a neighbor in need." They call on "members to consider donating organs and to make any necessary family and legal arrangements, including the use of a signed donor card."

Mennonite
Mennonites have no formal position on donation, but are not opposed to it. They believe the decision to donate is up to the individual and his or her family.

Mormon
The Morman Church believes that the decision to donate is an individual one made in conjunction with family, medical personnel, and prayer. They do not oppose donation.

Pentecostal
Pentecostals believe that the decision to donate should be left up to the individual.

Presbyterian
Presbyterians encourage and support donation. They respect a person’s right to make decisions regarding their own body.

Protestantism
Encourages and endorses organ donation.

Quaker
Donation of transplant organs is an individual decision.

Seventh-Day Adventist
Donation and transplantation are strongly encouraged by Seventh-day Adventists. They have many transplant hospitals, including Loma Linda in California. Loma Linda specializes in pediatric heart transplantation.

Shinto
In Shinto, the dead body is considered to be impure and dangerous, and thus quite powerful. "In folk belief context, injuring a dead body is a serious crime. . .", according to E. Narnihira in his article, "Shinto Concept Concerning the Dead Human Body." "To this day it is difficult to obtain consent from bereaved families for organ donation or dissection for medical education or pathological anatomy . . . the Japanese regard them all in the sense of injuring a dead body." Families are concerned that they not injure the "itai" -- the relationship between the dead person and the bereaved.

Society of Friends (Quakers)
Organ and tissue donation is believed to be an individual decision. The Society of Friends does not have an official position on donation.

Unitarian Universalist

Organ and tissue donation is widely supported by Unitarian Universalists. They view it as an act of love and selfless giving.

United Methodist
The United Methodist Church issued a policy statement in regards to organ and tissue donation. In it, they state "The United Methodist Church recognizes the life-giving benefits of organ and tissue transplant."