Monday, 1 December 2014

Organ Donation in Halakha

Can/should I donate organs when I am alive? E.g. donating a kidney or bone marrow or donating blood? The Torah tells us not to stand idly by the blood of your neighbor (Vayikra 19:16). But can we risk our own lives to save others? The answer lies in the risk level. If the donor would be high risk most halakhic decisors would rule the act forbidden but if the risk is relatively low halakhic decisors generally permit and could even mandate it. 

Rabbi Joshua Flug writes "donating a kidney entails a certain degree of risk. In a survey of over 10,000 kidney donations, two donor deaths were reported. If we assume that one must undertake a certain degree of risk in order to save a life, one cannot absolve himself from the obligation to donate a kidney based on the risks associated with donating a kidney."

Rav Moshe Feinstein writes (Igrot Moshe, Yoreh De'ah 2:174) that a person is not obligated to donate an organ to save another person. However, he considers the act meritorious. Rav Ovadiah Yosef ( Yehave Daat 3:84) hints that not only is it meritorious it might even be obligatory.

Can/Should I donate my organs after I die? Are there any halakhic impediments? What do I need to do to be ready? This is an area of halakha which has had many evolutions over the years and it is one which is quite misunderstood. Most Jews think it is forbidden and don't even bother looking into the subject. A wikipedia article quotes Nancy Scheper-Hughes of Organ Watch who writes that "Israel has become a 'pariah' in the organ transplant world. The lack of donations due to Jewish custom heightened the disparity between the supply and demand of organs." All this when Israel is at the forefront in transplant technology. 

Before we can discuss organ donation after death, we must decide when a person dies. What is the definition of death? Is it when the heart stops beating or is it the cessation of respiration (Brain-Stem death)? "Brain-stem death is a term used to describe the whole brain dying – both the cortex and the brain-stem. The brain-stem is the central nervous system of the human body and it is the center of consciousness. If the brain-stem dies, respiration will stop. Once the heart stops receiving oxygen it too will die and stop beating and all other organs also die as a result of oxygen deprivation." Dr Paul Ratzker

Ratzker concludes "a brain-stem dead patient is not a person suffering from brain-stem death – he is dead! Once death has been established the question facing the family in this situation is, what to do? Should the family turn off the ventilator and bury the deceased? Or should the family keep the body on a ventilator in order to donate organs and save other people’s lives? Emotionally this is a difficult decision and every family has to do what they feel is right."

Scientifically there is no debate on this issue, the moment of death is brain-stem death. However, in Jewish law it is a little bit more complicated. Rabbi Shlomo M. Brody summarizes the halakhic positions very well in his book A Guide to the Complex: Contemporary Halakhic Debates. He explains that the position of Rav Moshe Feinstein "in 1976 that brain-stem death fulfils the halakhic criterion of death, even if the heart continues beating due to artificial respiration... In 1987, the Chief Rabbinate of Israel endorsed this position, pronouncing conventional, non-experimental organ transplants a great mitzva."

The Halachic Organ Donor Society (HODS) has the following to say. "Organs for donation are usually taken from a person whose heart is still beating and was declared dead because the patient’s brain had died.  Some Rabbis, however, view a beating heart as a sign of life (and prohibit removing organs) while other Rabbis do not deem a beating heart sufficient for life (requiring brain function and autonomous) and therefore allow donation from a brain dead patient.

"The Halachic Organ Donor Society recognizes this debate and encourages organ donation at either stage by offering a unique organ donor card that allows a person to choose donation at brain death or alternatively at cessation of heartbeat.

"From a medical perspective, however, it is difficult to recover organs after cardiac death.  In addition, the heart and lungs cannot be recovered once the heart dies. Therefore the decision about when to donate is significant." To read more about organ donations before and after death, please go to the HODS website

1 comment:

  1. I posted a comment but, as in 3 previous attempts, it did not go thru


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