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1. Is it a Mitzva?
2. Brain-Stem Death
3. Superstitions
4. Israel
5. To donate or not?
6. Donating to non-Jews
As with most Halachic questions, it depends on who you ask.
This website is not meant to give a Halachic ruling on organ
donation, but rather to inform the public as to some of the
different medical issues and some of the general trends of rabbinic
rulings involved with organ donation.
All rabbis agree that pikuach nefesh, saving a life, is of
primary importance and overrides all other Halachic considerations
except for murder, illicit sexual relations and idolatry.
- "Don’t stand idly by the blood of your neighbor!"
Rashi, the famous bible commentator, explains this to mean
"don’t watch him die when you can save him." The
Choshen Mishpat elaborates that "even if there is a danger
to your life in saving the other person, you should not be
overly concerned with your own safety." [Leviticus 19:16]
This commandment indicates that it is appropriate to save
another life by donating organs.
There are biblical commandments, however, concerning the handling
of a cadaver that might indicate that organ donation should be
forbidden. But pikuach nefesh, saving a life, supercedes them. They
are:
- Nivul Hamet is a biblical
prohibition that forbids the needless mutilation of a cadaver.
This prohibition is the basis why autopsies are generally
forbidden. But Rabbis do permit autopsies when they are needed
to determine the cause of death, where the results might save
lives. Therefore, all Rabbis agree that saving lives, pikuach
nefesh, is more important than the prohibition of Nivul Hamet.
Organ transplants save lives.
- Halanat Hamet is a biblical
prohibition that forbids delaying the burial of a body. All
Rabbis agree that Pikuach Nefesh, saving lives, is more
important than this prohibition. Organ transplants save lives.
[Deuteronomy 21:23]
- Hana’at Hamet is a
prohibition, some say biblical others say rabbinical, that
forbids one from getting 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 transplants save 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.
Most Rabbis who don’t support organ donation, do so on the basis
that the organs are mainly taken from a brain-stem dead person who
is, in their opinion, halachickly alive. Organ donation would be
forbidden because taking essential organs from a live person is, in
effect, killing them.
Medical Description: A person who
suffers a sever head trauma, and whose brain-stem does not function,
cannot breath on his own. Brain-stem death is irreversible, and
within 10 minutes the heart will stop pumping because it is deprived
of oxygen. With the invention of the respirator, however, it became
possible to artificially keep blood oxygenated thus allowing the
heart and other organs to continue functioning.
From the onset of brain-death, however, the brain begins to
liquefy and as a result, even on a respiratory, all organs and
systems shut down in a matter of days. Concerning the legal and
medical status of brain-stem death: the majority of the countries in
the world, and 44 US States, accept the 1968 Harvard 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 person, whose heart continues to beat only as result
of the artificial help of a respirator, 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.
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 heart beat.
[Tractate Yuma, page 85, side A.]
- 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, it dies, and a person can never
breathe again on his own. Never in the history of modern
medicine has there ever been a case of a brain-stem dead person
‘waking up.’ [Parenthetically, people can wake up from a
coma because comatose people have a functioning brain stem and
are breathing on their own.]
- BEATING
There are those Rabbinic authorities who claim that only when a
person’s heart has irreversibly stopped beating is he dead. On
a practical level, this makes it difficult to transplant organs
because once the heart stops sending oxygenated blood to other
organs they begin to deteriorate and shut down. The organs then
are no longer viable transplants.
What most people don’t know, however, is that in certain
situations it is possible for a non-heart beating donor to
donate kidney and cornea for up to 40 minutes after cessation of
heart beat. [Kidney and cornea are more resilient to oxygen
deprivation then other organs.] The ramifications are enormous
because out of 80,000 Americans waiting for organs, 50,000 are
waiting for kidneys.
In a nutshell this is the main Halachic debate concerning organ
donation. For more information please see the Resources link on this
website. For deciding what to do concerning organ donation please
see the ‘To Donate or Not’ link on this website.
- The Evil Eye: Some people
believe that signing a donor card will invite ‘the evil eye’
and cause the card holder to have a deadly accident. Besides
this belief being totally irrational and unproven it is, in
fact, disproven: there are millions of donor card holders
worldwide and nothing has happened to them. Indeed, if that were
the case there would be an adequate supply of organs and no need
for organ donor education.
- Resurrection of the Dead: Some
people believe that organs should be kept in the cadaver because
they are necessary in order to be resurrected from the dead.
This is pure fantasy because immediately upon death, organs
begin to rapidly disintegrate and after a few weeks have
dissolved. Indeed, even if one were to believe that resurrection
is dependent on the bodily state of the cadaver, the only Jewish
source which mentions such a thing refers to luz bone, a
vertebrate of the spine, as the point from where resurrection
stems from. In addition, if the Almighty Lord decides to
resurrect a dead person, he assuredly will have the power to
supply missing parts. It is difficult to imagine that the many
Israeli soldiers who died defending the State of Israel and the
people of Israel might not be resurrected because he lost an
organ in battle.
- Health Care Abuse: Some people
believe that if doctors know you have a donor card they will
prematurely declare you dead before you really are dead in order
to get 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 and illegal, exposing the
physician and the hospital to criminal and civil liability.
Second, most hospitals have established protocol that demands a
separate medical team – a team that was not taking care of the
patient and is unaware that the patient is a potential donor –
to determine if the patient is brain-stem dead or not.
- Corneas Do Not Save Lives: Rabbi
Unterman, one of the Chief Rabbis of Israel, Rabbi Tuvia
Friedman, and Rabbinic authorities consider blindness to be a
life threatening illness, where one’s surrounding are
dangerous and may possibly causes death. They have ruled that
donating corneas to give a person sight is halachickly ‘saving
a life.’
Although the Chief Rabbinate of Israel ruled that brain-death fits
the definition of Halachic death, there remains a widespread
misperception in Israel that Jewish law categorically prohibits
organ donation. 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. Even though most Israelis are
secular, when it comes to issues of death they adopt a more ‘religious’
perspective and don’t donate organs.
Death in Israel due to a dearth of 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 all their families were approached by
transplant coordinators and asked to donate organs. 70 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 but didn’t. 114 people died unnecessarily.
Other Issues
Gossess: Gossess is a Halachic
category ascribed to a person who is deathly ill, and who will most
likely die in three days. Halacha dictates that a Gosses must not be
touched for fear that any sudden or traumatic movement will
accelerate the person’s death. According to some Rabbis, such as
Rabbi Moshe Tendler, it is medically possible to check a person for
brain-stem death without causing invasive or traumatic injury that
might accelerate death and violate the prohibition of gosses.
If a person is unclear how to act, he or she should consult
with a knowledgeable Rabbi who has medical knowledge. But confusion
or the effort involved in asking a Rabbi should not become paralysis
or procrastination.
"Are
Jews allowed to donate organs to save non-Jews?"
Before answering this question it
is important for the person asking the question
to clarify for him or herself if this questioned
is being asked out of Halachic concern or rather
based on nationalistic reasons (“All Arabs are
our enemy”), or based on simple racism. If the
questions stems from non-halachic forces, 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 is affirming that the person has
the potential to walk in the path of God just as
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, see
below.
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 by not doing so it might cause enmity
between non-Jews and Jews. That reasoning seems
to apply here.
Rav Moshe wrote in Iggrot Moshe that Jewish
doctors should violate the Sabbath to save the
life of a non-Jew because of enmity. In fact,
one of the things that inflamed the Crown
Heights riots started in 1991 was the fact that
the Jewish ambulance corp., Hazalah,
took the Jewish driver to the hospital and not
the black child. Rioting ensued for 3 days and 3
nights where Jews were chased and beaten and the
Chasid was killed. Enmity is a real concern in
our day.
There is plenty of anecdotal evidence in
transplant centers how the medical establishment
is angry that Jews don’t donate organs but are
willing to receive organs. Imagine how much more
angry the non-Jews would become if they were
told that Jews will donate organs only to Jews
but not to non-Jews.
4. The organ recipient
might be a Jew – (This reason assumes one
should make a distinction between pagan and
Jew). According to US 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 go after the
majority.
Meaning 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. Organ donation bumps
a Jews closer to the top of the list. – Even
if all of your 8 critical organs were given to a
non-Jew, by removing those recipients off the
list you are directly causing a Jewish person on
the list to be moved closer to the top where
they have a better chance of being selected to
receive organs.
Nationalistic
Perspective
The question of donating organs to
non-Jews often comes up in Israel where
potential recipients are Israeli Arabs and they
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 – it
would go both ways.
-
Suicide Bombers -
An Arab who can’t get an organ and has a
limited time to live, is the best candidate to
be recruited to become a suicide bomber. He
has nothing to lose.
-
Justice -
Consider God’s response to the angel in the
story of Yishmael. (Breshit, Vayere) 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.
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