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Organ donation is encouraged by most rabbinical authorities.
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Judaism’s perspectives on Organ Donation After Death
-- Gabrielle Loeb
Although many Jews believe that Jewish law forbids organ donation, most
rabbinical authorities not only permit it, but also encourage it. In 1990, the
Rabbinical Assembly of America approved a resolution to “encourage all Jews to
become enrolled as organ and tissue donors by signing and carrying cards or
driver’s licenses attesting to their commitment of such organs and tissues upon
their deaths to those in need.” Organ donation during life is generally
permitted as long as there is little risk for the donor and great benefit for
the recipient, but in the case of an already deceased donor, the risk is not an
issue. For already deceased donors, the main issues are Kavod Ha-met
(honor of the dead) Nivul Ha-met (disgrace if the dead), and the
definition of death.
Kavod Ha-met is the reason for the extensive Jewish laws regarding burial
customs. The body must be treated with respect since it is God’s property; we
are simply borrowing our bodies for the duration of our lives and we must return
them at death unblemished. This is the reason that permanent tattoos and
piercings are forbidden. Because of Kavod Ha-met, delaying the burial of
the deceased or gaining benefit from a dead body are considered Nivul Ha-met,
disgrace to the dead, and are therefore forbidden. This obviously poses a
problem since organ donation can delay the burial and allows us to benefit from
the dead body.
This problem with delayed burial and benefits from the dead body, however, is
superceded by the commandment Pikuach Nefesh, saving a life, which takes
precedence over every other commandment excluding murder, idolatry, incest, and
adultery. The Talmud Tractate
Yoma 85b says,
referring to the commandments, “You shall live by them, but you shall not die
because of them.” This means that we should not “stand idly by the blood of
[our] neighbor” (Lev.
19:16) because of the less important commandment of Kavod Ha-Met.
In fact, not only does this commandment cancel the Nivul Ha-met, it gives
Kavod Ha-met because it enhances the respect for the deceased since it
allows the donor to fulfill the mitzvah of Pikuach Nefesh. Donating
organs is therefore an honor to the deceased. In addition, the transplanted
tissue will ultimately be buried with the recipient, so the burial would not be
an issue even if it were overridden by Pikuach Nefesh. Finally,
Pikuach Nefesh is even more important to donors since they are thereby
saving the lives of both the recipient and any potential living donor whose life
might be at a slight risk due to the surgery involved in donating organs.
Because of the organ shortage, the Conservative movement’s Committee on Jewish
Law and Standards ruled in 1995 that organ donation is an obligation because not
doing so would be murder to the potential recipient and endangers the lives of
living donors.
Besides Pikuach Nefesh, Hesed is another reason supporting organ
donation. Hesed, acts of kindness, are not mandatory, but we are commanded to
“walk in God’s ways” and this would include helping those in need. Such progress
has been made in transplants in the past fifty years that they are now
acceptable therapeutic options instead of experimental procedures, and therefore
Hesed, in addition to Pikuach Nefesh, is more ensured. In 1954, the
first kidney was successfully transplanted followed by a liver in 1967, a heart
in 1968, a lung in 1983, and a pancreas in 1996. New genetic engineering
techniques will soon enhance the immune system’s ability to accept alien organs
and immunosuppressant drugs. In 1998, 21,000 transplants took place including
kidneys, livers, hearts, pancreases, and bone marrow. Success is now measured in
terms of years and quality of life following transplant instead of survival of
the surgery. When organ transplantation was still very experimental and
endangered life, Jewish law restricted it much more; however, with all this
recent progress in organ transplantation and with the organ shortage, donated
organs are sure to be an act of Hesed as well as Pikuach Nefesh.
In addition to following God through acts of
Hesed, we must practice Kiddush Ha-Shem, sanctifying God’s name, by
acting in a way to honor God and the Jewish people. With the current organ
shortage (In 1998, according to Lamm’s book
The Jewish Way in Death and Mourning, 4,855 people died waiting for
donors, most of whom were cadaveric donors. Every sixteen minutes on average,
one more person joins the 63,000 on the waiting list of the United Network for
Organ Sharing), Jewish organ donations would make the Jews look more honorable,
and it would therefore sanctify God’s name. On the other hand, if Jews were to
refuse to donate organs, this would look bad for God and the Jewish people, and
a forbidden Hillul Ha-Shem, desecrating God’s name. In fact, this is
exactly what is happening now, and that is one of the many reasons that
rabbinical authorities permit and even encourage organ donations: As Dorff
explains in his book
Matters of Life and Death, while 60% of the general population are willing
to donate organs, only 5% of Orthodox Jews are, and the statistics are similar
for other Jewish denominations. As a result of Israel accepting far more organs
than they provide, Israel has been banned from Europe’s transplant network
Eurotransplant. Israel’s exclusion from Eurotransplant not only is a huge Hillul
Ha-Shem, but it also increases the shortage in Israel of organs for people on
the long waiting list for transplants.
Even with the commandments of Pikuach Nefesh, Kiddush Ha-Shem, and
Hesed which take place in organ donation, it is not given a complete
authorization. There should be an advance directive saying that the deceased
wishes to donate his or her organs. If no advance directive is made, however, it
can be assumed that the deceased would be honored to be given the opportunity to
perform Pikuach Nefesh. In addition, the most restrictive Orthodox rabbis
require that there be a specific patient Lefaneinu, “before us,” who
would otherwise die or lose an entire physical faculty. This means that if the
potential recipient can see with one eye, they would not permit a corneal
transplant. These rabbis would also reject donations to organ banks because
there would be no particular known patient who would be served immediately by
the donation. Most Jewish authorities agree, however, that a donation is
justified to improve impaired vision, and that a donation to an organ bank is
justified as long as there is enough demand for that particular organ that it
can be safely assumed the donated organ will eventually be used.
The final restriction placed on organ donation concerns how death is defined. In
some cases the line between life and death is hazy, so it needs a precise
definition. Some rabbis go by the respiration test of placing a feather under
the nostrils and seeing if it moves; they consider death to be defined as
respiratory arrest. Others claim that respiratory arrest is only considered
death because it is a reliable sign of cardiac arrest, which is the true
definition of death. Since an organ donor must be dead according to Jewish law,
the moment when organs can be collected is debated. In addition, Jewish law
states that we must wait before we assume that a person is dead since they may
simply be unconscious or in some other state resembling death. However, waiting
would obstruct organ donation since the heart must be collected immediately, and
the heart must be beating to keep the other tissues alive. This problem was
solved by sphygmomanometers and electrocardiograms, which can measure breath and
heartbeat and remove the need for waiting. The issue of donating a heart is
further complicated, however, if a person whose heart is beating is considered
alive, yet the heart must be beating to collect organs. So how can it be that
the Chief Rabbinate of Israel approved heart transplants in 1998?
The answer is progress in medicine and more advanced ways of diagnosing death
being developed. Instead of using a feather or trying The answer is progress in
medicine and more advanced ways of diagnosing death being developed. Instead of
using a feather or trying to hear a heartbeat, a flat electroencephalogram is
used to declare someone officially dead. If someone has a flat
electroencephalogram, that person is and forever will by unable to breathe or
pump his or her heart himself or herself. Almost all Jewish authorities agree
that a flat encephalogram can be used to determine death. It indicates the
cessation of spontaneous brain activity and qualifies the patient as being
brainstem-dead instead of heart-dead or breathing-dead. Brainstem-dead should
not be confused with brain-dead, however, which is the cessation of higher
cerebral functions like intellect and memory that are lost in Alzheimer’s or a
vegetative state – in such cases the patient is considered alive and organ
donations are therefore not permitted. Going by the heart-death definition would
make less sense because a decapitated animal’s heart still beats for a short
while, and because the heart can beat even without a body as long as it is
nourished. Both The Conservative and Reform movements accepted
electroencephalograms (since they indicate the cessation of brain activity) as
the moment of death, and the Orthodox chief rabbinate followed suit twenty years
later, as did the Rabbinical Council of America in 1991. Since brainstem death
was approved and is the major rabbinic opinion (although some rabbis reject this
halachic decision), heart transplants and organ transplants can take
place.
However, there are other impediments to organ donations besides rabbinical
concerns: donors often have misconceptions about the process and cost of
donating organs, and sometimes other psychological factors come into play.
Donors sometimes wrongly believe that the donor’s body will be mutilated and the
funeral will be delayed a long time. On the contrary, the body is sewn up
quickly, and the funeral can occur without much delay. In addition, closed
caskets would prevent any surgery from being noticed. Secondly, some donors
assume that they must pay to donate organs. The truth is that the recipient (or
their insurance) pays for the organ transplant, not the donor. Other donors
believe that if their doctors know that they have agreed to donate organs, the
doctors would not try as vigilantly to keep them alive. This too is a myth since
the physician team for the organ transplant is entirely separate from the
physician team that would normally care for the patient, to serve this exact
purpose. Still other potential donors are hesitant due to an aversion to even
contemplate death, let alone things that would happen afterwards. People also
tend to imagine donating organs as though they would be conscious when the
donation would take place, and they imagine what the surgery would feel like for
them although they would have to be brainstem-dead and therefore could not feel
it.he body for three days after the death, during which the soul hovers over the
grave. Even for the first twelve months, while the body disintegrates, the soul
has a fleeting connection with the body, during which it comes and goes to and
from the body. Finally, there are spirits who live on after death in bodily
form. If the soul comes to the body, one might be uneasy with the idea of the
body “not being complete.”
Incompleteness of the body is also an issue to people when they contemplate
resurrection; they believe that in order to be resurrected in one piece, they
must be buriedIncompleteness of the body is also an issue to people when they
contemplate resurrection; they believe that in order to be resurrected in one
piece, they must be buried in one piece. Two main arguments contradict this
thought. First, organs which are not donated simply disintegrate in the ground
(unless the body is preserved, which is forbidden). Secondly, if God could make
the world from nothing, it should be relatively easy for God to make something
from something that once existed but just decomposed. When resurrection comes,
Jews will be resurrected regardless of parts missing or even whole bodies
missing. Maimonides further explains that people should not even consider a
bodily resurrection since resurrection is of the soul, not the body, since the
world to come will have no bodily functions of eating, drinking, anointing, or
sexual intercourse. Regardless of ones beliefs about resurrection, however, the
overriding rule is again
Pikuach Nefesh: saving a life immediately is far more important than
beliefs about what lies ahead.
But what if donating organs is not saving any life at all? What about donating
one’s body to science? As long as the body parts are preserved to bury, the
deceased’s (and his or her family’s) wishes are respected, and the family can
return to their lives even without the psychological closure of an immediate
burial, most rabbinical authorities permit donating one’s body to science for
the same reason as they permit organ donation. It is considered
Kibud Ha-Met, not as Nivul Ha-met, since dissection, necessary to
train physicians, facilitates the performing of Pikuach Nefesh, which is a great
honor. Also, it is Hillul Ha-Shem for Jews not to do it and
Kiddush Ha-Shem for Jews to do it, unless there is already ample supply
of bodies to dissect, in which case Jewish donations are unnecessary and
therefore unjustified. Some orthodox rabbis, however, again reject donating a
body to science as a justifying reason, since there is no specific patient who
is to gain from the donation.
Another question that is brought up concerning organ donation is whether the
donor can be paid. Even the United States is hesitant to condone such a
practice, although Pennsylvania does allow payment of renewable tissues such as
blood, hair, and semen. While the United States does not favor such practice
because vulnerable populations could be abused and exploited (while not being
able to afford organs which they may need), Jewish law does not favor such
practice because the body belongs to God, and we cannot sell what is not ours.
The Halachic Organ Donor Society
in New York City, whose mission is to spread information about Jewish legal
matters and rabbinic beliefs about organ donation, helps Jews donate organs in
accordance with their specific halachik beliefs. They try to raise awareness
about the importance of organ donation and to combat the myth that organ
donation is contrary to Jewish law.
There are numerous reasons for Jews to become organ donors; most reasons against
that choice are simply misconceptions. Jews should consult their own rabbi to
discuss the issue of organ donation. Most rabbis agree, however, that it is our
responsibility as Jews to honor God’s name and to save lives by giving the gift
of life even after are lives have terminated through the act of organ donation.
As
Mishnah Sanhedrin 4:6 says, “Whoever saves one life, it is as if he
saved the entire world.”
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