Organ donation in Jewish law
Certain fundamental Jewish law questions arise in all organ donation issues. Rabbinic rulings and opinions represent different assessments of how to balance Judaism’s duties to preserve one’s own life and to help others live. Overall, according to many Halachic rulers, there are no Jewish laws that state you can't donate organs, and usually it is pikuach nefesh (probability of saving the recipient’s life in the process) that gives people permission to donate. The probability of saving the recipient’s life must be substantially greater than the risk to the donor’s life or health. However, it is always advised to consult with a rabbi before making a decision.
Under Jewish law, organ donation raises some questions, and has traditionally been met with some skepticism. However, it has met increasing acceptance as medical transplantation methods have improved. In both Orthodox Judaism and non-Orthodox Judaism, the majority view holds that organ donation is permitted in the case of irreversible cardiac rhythm cessation. Some say there is an obligation to donate an organ, while a minority opinion considers any donation of a live organ as forbidden.
In most cases, rabbinic authorities believe that while one is not obligated to donate an organ, it is an obviously praiseworthy deed.
- 1 Relevant principles of Jewish Law
- 2 Types of Organ Transplants and Jewish law
- 3 Ultra-orthodox opposition
- 4 See also
- 5 Sources
- 6 References
- 7 External links
Relevant principles of Jewish Law
In judging cases for organ donation, rabbis apply a range of Jewish principles and consider precedents concerning the donor. These Jewish principles include mutilation of the body, the risk of the medical operation, delaying the burial of the dead, the determination of death, and the duty to preserve or save life. Removing an organ from a body (live or dead) violates several Torah prohibitions. However, as a general rule in Jewish law, virtually all prohibitions are overridden (with the exception of murder, sexual morality and idolatry) if there’s the potential of immediately saving someone’s life. The conditions that need to be met to override prohibitions are: the recipient is at hand and his/her life is in danger, and the donor consented to organ donation during his lifetime.
Preservation of life
In favor of organ donation, all authorities rely on the overarching principle (pikuach nefesh) that requires extraordinary actions to preserve or save life. However, the application of that law to specific situations has not been settled.
Another issue is Jews donating organs to non-Jews. "Pikuach nefesh" does compel a Jew to save the life of a non-Jew, but may be limited to cases where no violation of Jewish law is involved. Since Jewish law requires intact preservation of a body, pikuach nefesh may override that transgression only to save a Jewish life. Others argue that the degree of transgression here is smaller than the degree of transgresson involved in allowing a person to die, regardless of their religious status, because every man is created in the image of God.
There is a fear of enmity between Jews and non-Jews. An argument has been made that pikuach nefesh has to apply to non-Jews, because there is already a complaint in the medical world about Jews being willing to receive organs but not give organs, thus jeopardizing the status of Jews waiting to receive a transplant - itself an paplication of Pikuach Nefesh. There are several counter-arguments, including the fact that organ transfer protocols explicitly preclude judgement on the basis of race, religion, or politics
In addition, by putting yourself on an organ list there is a possibility that a Jew on the list will be bumped up if a non-Jew is given your organ. This argument is also controversial, since it is only provides a small chance of pikuach nefesh involving Jewish life.
Overall, there is no consensus on this subject. According to some Halachic rulers, there is no Halacha that says you can't donate organs, and usually it is pikuach nefesh that gives people permission to donate. Due to there being many dissenting Halachic rulers, it is advised to consult with a rabbi before making a decision.
Living Jewish donor
In all cases of living donors, there are Rabbis who believe that one cannot be coerced or obligated under Jewish law to donate an organ, and there are some rabbinical opinions who believe it is an act of piety, while others' opinions rule that organ donation is obligated if the outcome could be saving the recipient’s life, which is a major principle in Judaism.
Risk to donor's life
The main concern of organ transplants in Jewish law for a living Jewish donor is whether or not a person is permitted to endanger his own life or health in order to save a life of another. The decision is based upon the success rate of the transplantation procedure and recovery period.
Non-living Jewish donor
Jewish principles that are considered when transplanting organs from a dead person.
Mutilation and undue benefit of a dead body
Jewish interests in avoiding mutilation and desecration of a living and non-living body has been considered a factor in gauging the permissibility of organ donation. The basic Jewish principles involved in organ donation cases are:
- nivul hamet – which forbids the needless mutilation of a body. This raises an issue in Jewish law when surgically cutting the body for organ transplants. If organ transplantation was allowed to be performed, the incision to remove an organ must be limited to the necessary minimum to remove the organ to save the recipient's life.
- halanat hamet – which forbids delaying the burial process of a body. Organ transplants procedures require adequate preparation and time. Preparing a body of a Jewish donor for transplants delays the burial process and paying respect to the deceased.
- hana'at hamet – which forbids gaining benefit from a dead body. Taking organs from a dead body to use for beneficial purposes is not permissible.
- Jews are obligated under Jewish law to bury a person whole with all their body parts. If organ transplantation was allowed to be performed, all organs and tissue not transplanted from the donor must remain with the cadaver for appropriate and prompt burial.
Determination of death
Another major debate around organ donation concerns with the definition of death. Because if the accepted definition if death is "incorrect," removing a heart from a donor who was established dead under the "wrong" criteria is tantamount to murder. With life-support and cardiopulmonary resuscitative technology, establishing the moment of death becomes more complicated and opinionated.
According to Jewish law a person is defined dead in a state of complete and irreversible cessation of cardiorespiratory function and a minimum of 5 minutes was waited (period of time depends on custom). After 5 minutes blood flow to organs have ceased, at which time it removal of organs to save a life is permitted according to some rabbinical opinions. Some opinions define death as solely the irreversible cessation of breathing, and some define death as the irreversible cessation of the heartbeat—which is the majority, long standing accepted opinion.
In 1968, a Harvard committee decided on a set of criteria for irreversible coma, or brain stem death. Regarding the point at which a person is considered dead in the case of brain-stem death with a ventilator machine causing heartbeat, a definitive consensus from halachic authorities has not been reached as of today. If brain death is accepted according to Jewish ruling, surgeons will be permitted to take full advantage of modern medical technology and perhaps save a life. However, the Harvard protocol has been demonstrated recently to have possibly fatal flaws, and support for its use in determining death has been waning in the rabbinic community.
Another issue of organ donation concerning the donor is the prohibition against touching a goses. A goses is a halachic category ascribed to people who are critically ill and expected to die within a brief period, typically three days. Jewish law forbids touching the body of a goses for fear that any sudden movement may accelerate the time of death. For this reason, there may be reluctance to medically intervene (preparing patient for organ donation) with an imminently dying patient solely for the purpose of preparing them for organ donation. Therefore, heart transplants raise a controversial question of when does one determine the patient donor dead to be able to begin the transplant procedure and remove the heart.
Types of Organ Transplants and Jewish law
Transplants with artificial organs do not pose any problems in Jewish law (with the exception of artificial heart transplants), as long as the prospects for success are greater than the risks. Therefore, there is no conflict with Jewish law against artificial heart valves, bone parts, joints, and use of dialysis. Artificial heart transplants are not permissible according to Jewish law due to low success rates and the serious medical complications involved. Medical science has not reached the point of being able to use artificial organs or animal organs as protocol for transplantation.
Blood and bone marrow
According to Jewish law application, it is permissible to donate blood and bone marrow tissue because there is almost no danger or risk to the donor, and these tissues regenerate quickly.
For successful heart and liver transplants the donor's heart must still be beating. There is the important issue of determining the moment of death to permit heart transplantation. Some rabbis prohibit removal of an organ from a brain-dead patient, making it impossible to perform heart transplants. Other rabbis accept the criterion for brain stem death and allow organ transplantation to immediately save a life.
After kidney donation, the donor lives with one kidney and there is a small risk associated with the surgery. Whether a person is obligated to endanger his own life to any degree to save another person's life who is critically ill is a critical question in Jewish rulings. Therefore there are some rabbinical opinions that prohibit kidney donation from live donors. Other rabbis allow it as an act of piety, and others believe it is an obligation not to violate a precept, "Thou shall not stand idly by the blood of thy fellow man."
The lobe of lung transplantation is not common from living donors because the mobility and mortality to the donor is felt to be excessive. Non-living lung donations are more commonly used.
Many Rabbis who allow organ donation for life-saving organs extend this to allow preserving human skin from cadavers in skin banks for future use for burn victims.
Some ultra-orthodox Jews (haredim) are vehemently opposed to organ donation. Haredim in Israel have recently issued an anti-organ-donor or "life" card which is intended to ensure that organs are not removed from the bearer after brain death or brain stem death. It states: "I do not give my permission to take from me, not in life or in death, any organ or part of my body for any purpose."
- Elliot N. Dorff. Matters of Life and Death:A Jewish Approach to Modern Medical Ethics. Philadelphia and Jerusalem: Jewish Publication Society 1998. Pp. xix, 476. ISBN 0-8276-0647-8
- Jakobovits, Immanuel. 1959. Jewish Medical Ethics. New York: Bloch Publishing. pp. 285–291
- Lau, Y. "The sale of organs for transplantation" (Hebrew), Tehumin 18:125–136, 1998
- Joseph Prouser. "Organ and Tissue Donation Card" in Mackler, Aaron L., ed. 2000. Life & Death Responsibilities in Jewish Biomedical Ethics. JTS.
- Ramirez, Anthony. "Medicine Meets Religion In Organ Donation Debate." New York Times, 18 November 2006, Vol. 156 Issue 53767, p. B2, (AN 23283799)
- Sinclair, Daniel. Jewish Biomedical Law. Oxford Univ. Press, 2003 (Chapter 6)
- Twersky, Abraham, Michael Gold, and Walter Jacob. 1991. "Jewish Perspectives." pp. 187–98 in New Harvest: Transplanting the Body and Reaping the Benefits, edited by C. Don Keyes and Walter E. Wiest. Clifton, NJ: Hurnana Press.
- Stephen J. Werber. "Ancient Answers to Modern Questions: Death, Dying, and Organ Transplants – A Jewish Law Perspective," Cleveland State University Journal of Law and Health, 1996 / 1997, v.11
- Cohen, Alfred. "Sale or donation of human organs." Journal of Halacha and Contemporary Society, 2006.
- Fink, Reuven. "Halachic Aspects of Organ Transplantation." Journal of Halacha and Contemporary Society, 1983.
- Steinberg, Avraham (2003). Encyclopedia of Jewish Medical Ethics. Jerusalem. New York.: Feldheim Publishers.
- Sinclair 2003, p.242
- Rabbi Shaul Israeli (January 1997). "Organ Transplants: Responsa". ASSIA - Jewish Medical Ethics III (I): 14–17.
- http://www.chabad.org/library/article_cdo/aid/635401/jewish/Organ-Donation.htm. Missing or empty
- Werber, Stephen, J. "Ancient answers to modern questions: death, dying and organ transplants" a Jewish law perspective". Journal of Law and Health.
- "Haredim issue anti-organ-donor cards". Haaretz. 2008-09-01.