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Be a Mensch – Become an Organ Donor

June 2, 2010 – 9:32 pm8 Comments
If only I had a heart. Become an organ donor.

If only I had a heart. Picture from BarryNapierWriting.wordpress.com

By Rivqa Berger

I know an organ recipient who believes that organ donation is halachically prohibited. Generally I consider myself a fairly tolerant person, but if I saw him in the street I wouldn’t even say hello. That should make my position on the topic fairly clear, but let me spell it out anyway: I think that everyone should be signed up as a organ donor, and if they’re not, they shouldn’t be on a transplant list.

One donor can save up to 10 lives, as well as providing non-essential (but life-changing) tissue, such as corneas to cure blindness. The Jewish community (and other communities that are based on moral systems) should be leading the way, but Jews remain an ethnic group with one of the lowest rates of organ donation. Israel was expelled from the European Union Organ Donor Network because it took organs for transplant but didn’t donate.

From a halachic perspective, the first issue that many people think of when objecting to organ donation is “kavod hamet”, respecting a Jewish person’s corpse. This principle is derived from three biblical laws, which prohibit delay of burial and needless mutilation or derivation of benefit from a corpse. These laws are negated by the more important principle of “pikuach nefesh”, saving a life. “Kavod hamet” is such a weak excuse not to donate organs, it can only be ascribed to superstition, squeamishness or laziness.

Others oppose organ donation by Jews because the organs will most likely be transplanted into non-Jewish recipients. But any Jews on a transplant list will progress up the list if a non-Jew higher on the list receives an organ – or the next person on the list could be Jewish (admittedly unlikely in Australia, but still possible). Either way, Jewish people can benefit – and even if there were no Jews on the transplant list, presenting the racist attitude of Jews only helping themselves does nothing to lessen anti-Jewish sentiment.

However, it gets more complicated. Today, a person’s heart can stop beating but be jolted back into functionality; a damaged brain stem, conversely, can not be repaired, although breathing can be maintained artificially using a respirator. Most organs for life-saving transplantation are taken from donors who are “brain dead” (whose brain stems have stopped working), but whose bodies continue to function because they are on a respirator. This ensures that the organs are in usable condition, as organ quality degrades rapidly once oxygen is no longer provided.

As with so many other issues, the halacha (and equally, or more importantly, Jewish public sentiment) regarding organ donation has been playing catch-up with technology since the first successful organ transplant from a deceased donor, over 50 years ago. The original source of the debate is the Talmud, written long before respirators and defibrillators were invented. It centres around a discussion about whether death is defined as cessation of heart beat or breathing. If death is defined in this way, then given that breathing is controlled by the brain stem, organ donation is halachically acceptable as the donor is dead. If it’s not, the donor is still alive, and harvesting his or her organs is murder.

Organs can be obtained from donors whose hearts have stopped, but this is a developing technique. And it opens another can of worms, as in some cases it’s only a viable option if doctors give potential donors certain medications before they die. There are issues about consenting to such procedures, and possibly halachic issues as well.

Donation following brain stem death remains the more useful and prevalent technique. Those in search of a halachic opinion to support it are in good company: Rabbi Moshe Tendler, Rabbi Yosef Dov Soleveitchik, Rabbi Shlomo Zalman Auerbach, and the the Chief Rabbinate of Israel, among others. As far as I am aware, Reform and Conservative authorities encourage organ donation under either circumstance.

HODS (the Halachic Organ Donor Society) offers a donor card where you can choose which halachic opinion you follow; it’s succinctly worded in a way that any doctor could understand. They also provide more detailed halachic discussions; the information here is really just a summary.

It can be uncomfortable to make plans about your body after death, and of course it’s highly unlikely that you will become an organ donor. But that’s precisely why it’s so important to have more potential organ donors willing and registered. It can also be helpful to consider registering for the Bone Marrow Register and donating blood regularly; in the context of these living donations, the focus is taken off donation after death.

According to Australia’s Organ and Tissue Authority, fewer than one in five Australians have discussed their wishes regarding donation with their families. This is why donation rates are so low: people don’t know their loved one’s wishes and err on the side of refusal. The message is pretty clear: register as an organ donor and talk about it with your family. If the halacha is important to you, discuss that as well. It might save a life – or several – one day.

Rivqa Berger likes to have the best of both worlds, so she followed her Bachelor of Science with a Masters of Arts. She appreciates critical thinking and campaigns against irrationality. She blogs at Enoughsnark.blogspot.com.

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  • Michael says:

    Great article, my only problem is with the discussion of the idea that organs will go to non-Jews. You offer two arguments:
    (1) This will benefit Jews in the long run
    (2) Not doing it will contribute to anti-Semitism which will be bad for Jews in the long run.
    The most obvious argument (that it is extremely wrong in and of itself to discriminate against non-Jews in this manner, regardless of whether this will benefit Jews or not). Based on your article I think you agree with this, but then just wondering why you framed it like that? If you think that the obvious argument won’t fly with those who are opposed then that would be a sad state of affairs. I don’t know if it would but I’d like to maintain some shred of optimism :)

  • rivqaberger says:

    You’re right, and I agree 100%. I didn’t make a conscious decision not to spell that out, but I would put that obvious reason in with common sense. The other two are linked more clearly to halachic principles, which is what I was focusing on for this article (even though halacha is possibly not the main reason why Jewish people don’t donate… it’s a start). For example, there are arguments about whether pikuach nefesh only applies to Jews, or to non-Jews as well; I didn’t want to get into that.

  • Michael says:

    As I thought, but I guess the mere fact that it’s seen as separate is troubling — if I was religious I would be troubled by the fact that common sense (or even common decency) and halakha are divorced, at least in the minds of enough people in the community that our discussion is influenced in this way.
    As for pikuach nefesh, I think at least for the readers of this blog it would be a pretty safe consideration that non-Jews should be saved. There are plenty of extreme opinions (I think Rambam ruled that one MAY NOT save the life of the idolater, and many Jews consider pretty much all other religions as idolatry) but most Jews in Australia are not at that level of discourse. Probably.

  • Liz says:

    great article!
    just another point….isn’t it especially important for Ashkenazi Jews to be on the Bone Marrow and Organ Donor registries because our relatively small gene pool increases the chances we may actually match with someone and be able to help save a life? I have heard this claim several times and it certainly seems logical.
    one of the few benefits of being so inbred, maybe…. :P

  • Well-written and concise: I agree with your conclusions. Nonetheless, I don’t think that you do your argument any favours by name-dropping Orthodox rabbis. Organ donation is an halakhically complex issue, so you should either focus solely on the ethical aspect, or attend to the halakhic controversies. To that end, you have completely glossed over the very real and very important issue of live organ donation, which was either rejected by the halakhic authorities that you named, or (depending on the organ in question) given a very qualified support. And while the opposition to post-mortem donation might come down to “superstition” and “squeamishness”, it’s an opposition that nonetheless finds mandate in the literature. The Israeli rabbinate, for example, made it clear that it was permissable (not obligatory), and only under the condition that the recipient would eventually be buried. The only Orthodox rabbi I know of to actually militate in favour of transplants was Rabbi Aviner, an Israeli posek.
    (I don’t have responsa of Feinstein or Tendler at hand, so maybe you correct me on that final point. I know that Tendler went so far as to “reluctantly” permit remunerating live donors of certain organs, so perhaps it follows that he also emphasised the obligation to donate in death. Nonetheless, I’d like to see it in print.)

  • rivqaberger says:

    Michael: This is true, but if halacha were only common sense, it wouldn’t be seen as quite so necessary. There are certainly many elements of halacha that are racist, but for someone in the system that’s not a good enough reason to negate a law. Hence there’s a need to argue it from within, which is what I’ve tried to do.
    Liz: Certainly, that’s why Wolper has the drive going. The blood samples go to the Red Cross and join the regular registry (I’m not sure if they also keep the details on file). The main purpose of doing it this way is to get people in even if they’re not willing to give blood, which the Red Cross will try to get them to do.
    Simon: I’ve name-dropped not to strengthen the logical argument, but because it will hold weight with some people. It’s true that I haven’t dealt with some issues, like live donation, but I wasn’t intending to be exhaustive! To me donation after death is far more important as the gains are potentially greater… there won’t ever be live heart transplants! Likewise, it’s true that I haven’t discussed the halacha in detail. Most of my material comes from the HODS website; check out their articles page for responsa and other good material.

  • rachsd says:

    Interestingly, I heard that Israel has now introduced a system whereby people who have registered for organ donation are given priority for transplants. Not sure whether it’s meant that the numbers on the registry have increased, but it seems like a good way to add some extra motivation…

  • Robby Berman says:

    Congratulations on your post! I’m glad you found our website at the Halachic Organ Donor Society helpful. I advise everyone to go there and watch the videos and read the articles.
    Of course you may register for an organ donor card there as well.

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