Jewish Perspective on Organ Donation

For the NJ Sharing Network 10/10/12.  In the spring of 1995, Alisa Flatow of West Orange was a junior at Brandeis University, age 20, studying for a year in Jerusalem, when she got on a bus one beautiful spring day.  A short while later, a terrorist drove a van filled with explosives into the bus.  Shrapnel from the explosive entered Alisa’s head, leaving her unconscious.  Upon hearing the news, her father got on the first available plane to confirm her identity and to make any subsequent medical decisions.

Alisa would never regain consciousness and she was declared brain dead.  Then her family did something incredibly courageous.  They decided to donate her viable organs to six different people in Israel.  Out of her death, six people lived – among the recipients were Palestinian Arabs.  At the time, PM Yitzhak Rabin said:  “Alisa Flatow’s heart beats in Jerusalem.”

But, wait a minute – you might say – isn’t organ donation somehow inconsistent with Jewish law?  After all, how else can one explain the historically low rate of consent for organ donation among Jews?  How could an orthodox family allow the body of their daughter to be torn apart in this way?  Perhaps they were responding to an educational effort on the part of rabbis of all denominations beginning in the late 80’s and early 90’s.

In truth, organ donation has never been against Jewish law.  It took some time for rabbis to deal appropriately with this medical breakthrough.  Rabbis had many questions to ask.  However, the idea that organ donation is forbidden by Jewish law is a huge misunderstanding on the part of Jews and non-Jews alike.  When organ transplantation was first introduced, it was met with both theological and practical objections in the Jewish community.  Specifically:

(1) Some argued that the Jewish law of “K’vod Ha-Met – Dignity for the Deceased”, which forbids an autopsy, makes organ donation prohibited.  (2) Others suggested that Jews would need their bodies intact for bodily resurrection in the world to come.  (3) Still others reasoned that it would be one thing to save a life by donating an organ, but it would be against Jewish law to “bank” an organ.  (4) A final objection was raised regarding the low success rates of the first transplants: if the recipient’s life would not be saved, why bother risking the donor’s place in the world to come?

On the flip side however, some have argued that God actually performed the very first organ transplantation.  In Genesis 2:21-22, we read, “So, the Lord God cast a deep sleep upon the man; and while he slept, God took one of his ribs and closed up the flesh at that spot.  The Lord built the rib – which Adonai had taken from the man – into a woman and brought her to the man.”  God gave Eve life from Adam’s body.  So, we are merely following God’s example.  However, even if we don’t choose to read the Torah that literally, we can come to the same conclusion.

Let us look more carefully at the four objections enumerated above that have been raised in the Jewish community over the years, and how they have been refuted.

1. K’vod Ha-Met

Jews believe in a concept ‘K’vod Ha-Met’ –showing proper respect the body of the deceased.  We try to avoid autopsies when possible.  (However, there are exceptions!)  We keep the body under watch until the burial, which is supposed to take place within 24 hours of death.  We do not allow the body to be put on display.  Only men may prepare men for burial; only women may prepare women for burial.  We take this concept of honoring the body very seriously – not necessarily because we will need the body again in the World-to-Come, but because we view the body as a loan from God, and we must return it in the best possible condition.

However, we also have a legal concept ‘Pikuah Nefesh’– saving a life.  The Talmud (BT Yoma 82a) teaches: “Preservation of life overrides all other considerations.”  The rabbis interpreted this to mean that a Jew may transgress any Jewish law – except three – to save a human life.  The three things we may not do are: kill, illicit sexual act, worship another deity.  Since organ donation does not fall under any of these three categories, we may set aside the rules of ‘K’vod Ha-Met’ in order to save a life.

Rabbi Elliot Dorff, the Rector of the University of Judaism takes it one step further, writing the following: “The overriding principles of honoring the dead – K’vod  ha-Met – and saving lives – Pikuah Nefesh – work in tandem.  That is, saving a person’s life is so sacred a value in Judaism that if a person’s organ can be used to save someone else’s life, it is actually an honor to the deceased.”

2. BODILY RESURRECTION.

Three times each day, a traditional Jew chants the following words:  “Who is like you, Lord of power?  Who is like you, O Sovereign?  You bring death and restore life, and cause salvation to flourish.  You are faithful to revive the dead.  Praised are You, Lord, who gives life to the dead.”

One of the earliest mysteries which humanity tried to solve is what happens after our time on this planet is over?  Every religious tradition wrestles with this issue.  Unfortunately, no one has ever left this world and found a way to come back and tell us.  (And even if they did, we would write them off as crazy!)  In Judaism there are two major responses to this question.  The first is bodily resurrection.  God will somehow enable us to come back to life in a physical form.  A major proponent of this view was Saadia Gaon, a 10th Century Jewish philosopher).  The second answer is known as the immortality of the soul. Only our souls will continue to live when our time on this earth is over.  A major proponent of this view was Yehudah Halevy a 12th Century Jewish thinker.

Moses Maimonides – a rabbi AND a physician in the 12th/13th Century – followed in the intellectual footsteps of Yehudah Halevy.  He argued that in the world to come, our immortal souls would be liberated from our bodies, and that we would have no future need for them.  If one agrees with Halevy and Maimonides, then there is no intellectual or philosophical barrier to donating one’s organs in order to save a life.

But, even if we do believe in some sort of bodily resurrection – a concept which has deep roots in the Jewish tradition – I have to believe that if God can resurrect our bodies, decide what age we’ll be when resurrected, deal with auto accident victims and war casualties, then God can certainly figure out what to do with transplanted organs which saved the lives of other human beings.

3. BANKING.

From a Jewish legal perspective, in order to permit the harvesting of organs, one must prove that the purpose is to save an actual life.  It is not sufficient to save a potential life or a hypothetical life.  Thus, it is not permitted to bank organs for some future need.  However, I need not share the statistics with you.  Each day, about 74 people receive organ transplants. However, 18 people die each day waiting for transplants that can’t take place because of the shortage of donated organs.

There is no banking of vital organs.  It just doesn’t happen.  Recipients are prepped for surgery at the same time as the organs are being harvested.

So, this objection is moot.

4. SUCCESS RATES.

Back in the 1950’s and 1960’s when this was really experimental medicine, one could make the argument that a donor was not actually saving a life.  The odds of success were quite low.  However, with the development of powerful immunosuppressive drugs in the 1970’s, all that changed.

Today, an organ donor (whether living or post-mortem) is truly giving life.  Generally, success rates for single-organ transplants average 80% or higher.

As of May 4, 2009, the percentage of recipients who were still living 5-years after their transplant is noted below for kidney, heart, liver, and lung.

  • Kidney: 69.3%
  • Heart: 74.9%
  • Liver: 73.8%
  • Lung: 54.4%

So, it is clear, that when one donates organs for transplantation, the odds are quite good that one is saving a life.

 

SUPPORTING TEXTS:

If we agree, therefore, that organ donation does, in fact, save lives, then the Jewish tradition is quite clear.  In Leviticus 19:16:  “You shall not stand idly by the blood of your neighbor.”  In his commentary on this verse, Maimonides wrote:“Anyone who is able to save a life but fails to do so violates this mitzvah.” In the Talmudic commentary of Rabbi Shlomo Yitzhaki – a/k/a Rashi of the 11th Century – (on BT Sanhedrin 73a, he wrote:  “’You shall not stand idly by the blood of your neighbor’ means ‘You shall not rely on yourself alone.’   Rather, your must turn to all available resources so that your neighbor’s blood will not be lost.”  The only obvious conclusion one can draw is that organ donation is not simply permitted or okay.  It is a mitzvah – a sacred obligation.

Rabbi David Golinkin, the former Dean of the RabbinicalSchool at the Schechter Institute in Jerusalem (and a fabulous teacher!) wrote:  “It is not merely permissible for a Jew to bequeath his organs for transplantation following death; it is a mitzvah (sacred obligation) to do so in order to save one life or several lives.”  It is the moral, ethical response to the needs of our fellow human beings.

Each of the major movements has responded by advocating for organ donation.

The Conservative movement’s Rabbinical Assembly Resolution of 1990 states:  “The Rabbinical Assembly affirms the life-giving benefits of organ and tissue donation, and thereby encourages all Conservative Jews to become enrolled as organ and tissue donors.”

Reform statement of 1997: “The Union of American Hebrew Congregations (since renamed: Union for Reform Judaism) is committed to the concept of Organ Donation and Transplantation as a positive example of the traditional Jewish value of saving a life.”

The Orthodox Rabbinical Council of America statement of 1991:  “Since organs that can be life-saving may be donated, the family is urged to do so.  When human life can be saved, it must be saved.  The halachah (Jewish Law) therefore looks with great favor on those who facilitate the procurement of life-saving organ donations.”

Thanks to the educational efforts of ALL the major branches of Judaism over the past 15-20 years, we’ve begun to see an increase in organ donation in the Jewish community.  In fact, in a study done in Israel at 22 hospitals over 3 years, nearly half the families of terror victims requested that their loved ones’ organs only be given to other Jews.  When told that they could not make such a request, all of them chose to donate the organs anyway.  We ARE making progress.

The truth is that most people who die are not viable organ donors.  It takes a particular set of circumstances to allow the transplantation of the major organs.  However, the Jewish tradition asks us to give consent in the event that one day through our deaths, we can give life as Alisa Flatow was able to do some 12 years ago in the Land of Israel.

 

Shalom,

RAF

SOURCES:

Leviticus 19:16: “You shall not stand idly by the blood of your neighbor.”

Rabbi Shlomo Yitzhaki (Rashi), Commentary on Babylonian Talmud Sanhedrin 73a: “’You shall not stand idly by the blood of your neighbor’ means ‘You shall not rely on yourself alone.’   Rather, your must turn to all available resources so that your neighbor’s blood will not be lost.”

Moses Maimonides, Laws of Murder & Guarding Life 1:14: “Anyone who is able to save a life, but fails to do so, violates ‘You shall not stand idly by the blood of your neighbor.’”

Babylonian Talmud Yoma 82a: “Preservation of life overrides all other considerations.”

Rabbi Theodore Friedman, CJLS Responsum, 1953: “Greater is saving a life than the dignity of the dead – k’vod ha-met.” 

Rabbi Isaac Klein, A Guide to Jewish Religious Practice, 1979:  “There is no greater k’vod ha-met than to bring healing to the living.”

Rabbi Moshe Tendler, on behalf of the Chief Rabbinate of Israel, 1994:  “All rabbinic authorities agree that the classic definition of death in Judaism is the absence of spontaneous respiration in a patient with no other signs of life….  Brain death is a criterion for confirming death in a patient who already has irreversible absence of spontaneous respiration.” 

Rabbi David Golinkin, Responsa of the Va’ad ha-Halachah of the Israeli RA, 1994:  “It is not merely permissible for a Jew to bequeath his organs for transplantation following his death, it is a mitzvah for him to do so, in order to save one life or several lives.”

The Conservative Movement’s Rabbinical Assembly Resolution of 1990:  “The Rabbinical Assembly affirms the life-giving benefits of organ and tissue donation, and thereby encourages all Conservative Jews to become enrolled as organ and tissue donors.”

Reform Movement statement of 1997: “The Union of American Hebrew Congregations (since renamed: Union for Reform Judaism) is committed to the concept of Organ Donation and Transplantation as a positive example of the traditional Jewish value of saving a life.”

The Orthodox Rabbinical Council of America statement of 1991:  “Since organs that can be life-saving may be donated, the family is urged to do so.  When human life can be saved, it must be saved.  The halachah (Jewish Law) therefore looks with great favor on those who facilitate the procurement of life-saving organ donations.”

Resources

Halachic Organ Donor Society – www.hods.org/

Union for Reform Judaism – http://urj.org/jfc/bioethics/donor/index.cfm/

United Synagogue of Conservative Judaism –

http://uscj.org/The_Mitzvah_of_Organ5455.html

Rabbinical Council of America – http://www.rabbis.org/pdfs/hcpi.pdf

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About Rabbi Avi Friedman

I am the rabbi of Congregation Ohr Shalom - SJCC, a progressive Conservative and traditional congregation. I am also husband to Jodi as well as father to Gabi, Jonah, Jessica and Ilana. I have been a part of the Summit community since 2005.
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