Does Jewish Law Permit Organ Donations?

As Israeli parliamentarians debate whether organ donation should become the default for all citizens, an understanding of the real halakhic principles on the matter is vital.

Israeli legislators are looking for a way to increase the number of organs available for transplant. A bill that sought to change the model of organ donation from an “opt-in” system to an “opt-out” one was recently rejected by the Knesset’s Ministerial Committee for Legislation, which said it would wait for a government proposal on the matter.

As representatives of a state whose majority population is Jewish, Knesset members must consider the implications halakha (Jewish law) has on organ donation policies. For even secular Jewish Israelis may feel that when it comes to their death they want to be treated in a way that is deemed fit in the eyes of God.

Thus, an inevitable question arises: Is organ donation legal under Jewish law?

The way I see it, the vast majority of Jewish arguments against organ donation ultimately stem from concern over the dignity accorded to the human body - in particular in its deceased form (kevod hamet), which is when many organs are typically harvested. There is a passionate cultural debate about when the moment of death actually occurs (brain death vs. cardiac death), which leads some Jews – including rabbinic authorities – to fear that a living body could be desecrated if organs are harvested prematurely. Like cremation, which is forbidden, or an autopsy, which is highly discouraged, because they are deemed unnecessary desecrations of the body, harvesting a deceased person’s organs for a risky procedure could also be seen as an unnecessary desecration.

Another issue is the theological rationale that if a Jew donates an organ, his or her stake in tekhiyat hameytim, the resurrection of the dead that will take place during the messianic era, may be jeopardized, because one might need his organs in the future.

High risks and low levels of success associated with initial organ transplants also contributed to a historical hesitance among Jews to become donors.

Yet, Rabbi Avram Reisner points out in “The Observant Life” that the “experimental treatments, with substantial, life-threatening risks” that rabbinic authorities feared when transplants first started have now become procedures that save a significant number of lives (page 761). Innovative and less obtrusive breakthroughs in transplant medicine are being made every day, and I suspect that in due time, medical innovations will reach a point where even an artificial heart will remove our need to worry about desecrating the human body.

People concerned with kevod hamet and tekhiyat hameytim may also overlook something of far greater importance: the opportunity to affirm that the real halakha, the real guiding Jewish principles, of pikuah nefesh, that every life is precious, and areyvut, that all Jews have a responsibility to help one another.

This is the struggle that the Jewish state of Israel faces when deciding between making organ donations a default option or one where citizens must opt in. When it comes to donating organs, Jews, as we often are called to do, must weigh one set of values against the other: Which should take precedence, our theological concerns about the body or saving the life of another person?

The State of Israel has historically sided with saving Jewish lives and the sense that the Jewish people are all responsible for each other. This opportunity should be no exception. Given the trend for further advances in modern medicine, as well as my own experience, I have reached the conclusion that it is simply hypocritical for Jews to ask for organs when they are sick but to refuse to give them when someone else needs them.

When I worked as a chaplain intern in the cardiac unit of a New York City hospital, I would visit Peter, a Jewish man who had entered the hospital because his lifelong heart condition had deteriorated to the point where without a heart transplant he would not survive. Every day for nearly three agonizing months, I remember trying to raise his spirits while he would tell me stories about how his heart condition had made it nearly impossible for him to maintain a steady job or to live a normal family life. Eventually, Peter did receive his lifesaving transplant. But why did he spend years of his life in agony, and then three months in the hospital with a high probability that he might never leave? He had been waiting for his condition to deteriorate to the point where he could be bumped to the top of the transplant list, because, like in Israel, in the United States there is a significant shortage of available organs.

It is my sincere hope that, in due time, the Knesset will revisit this bill – which already has support from across the political spectrum – and will allow it to once again move forward. The bill will not in any way force Israelis with religious objections to donate their organs, but it will serve as a gentle reminder to all citizens that pikuah nefesh, saving a life, and areyvut, Jewish mutual responsibility, have always been and will continue to be the true religious values that govern the Jewish people and Israeli society.

Rabbi Dan Dorsch is the assistant rabbi at Temple Beth Shalom in Livingston, New Jersey. You can follow him on twitter @danieldorsch.

Kobi Kalmanovitz