The discussion of the appropriateness of organ donation from the perspective of halacha is a fascinating one from two perspectives. First, it helps us to understand how the development of Jewish Law works in the Conservative Movement and secondly, and more importantly, it helps us to confront a crucial subject in contemporary medicine.

Jewish tradition has always recognized the importance of pikuach nefesh: the obligation to save a human life if it is in our power to do so. This commandment is phrased both in the negative: "Do not stand idly by the blood of your neighbor." (Leviticus19:16) and in the positive: "Return your neighbor's lost possession (his or her life) to your neighbor. (Deuteronomy 22:2)

The tradition of pikuach nefesh takes precedence over every other commandment with very few exceptions. Thus, when we have the opportunity to save a life, we must act on that opportunity provided it does not place us in the certain situation of losing our own life in the process.

With the increased success rate of organ transplantation, Rabbis have begun to examine what might appear to be objections to organ donation in light of the great potential of pikuach nefesh.

The first and most obvious objection regards laws relating to the treatment of a body after death. Jewish law prohibits desecration of the body, gaining benefit from the body and delaying the burial of the body. However, the potential for saving a life overrides any of these concerns.

The second objection could come from the commandment to save a life itself. In Jewish law, the dead are not obligated to the mitzvot. Therefore, presumably, the dead could not be commanded to save a life. However, the opportunity to declare one's desire to be an organ donor, if the situation arose, and the ability of "patient advocates" for health care decisions to make crucial choices at time of illness and death seems to obviate this concern.

Finally, the most serious objection to organ donation in Jewish law regards establishing the time of death. Organs used for transplantation must be taken while respiration and circulation is ongoing. The only time when this can happen is when brain death has been established and the organs are being perfused by external means.

Jewish tradition did not know of the concept of brain death, establishing death as the cessation of respiration and circulation. Thus, the first Rabbis approached with the question of "post mortem" organ donation refused to allow it, calling the taking of organs from an individual in this situation to be murder.

This objection has been overruled by almost all Rabbinic authorities, certainly all within the Conservative movement. The establishment of firm criteria for "brain death" has been the assurance necessary that a person in this situation is not truly "alive".

In summary, there exists therefore the "permission" to donate organs for transplantation to save a specific life. The process of organ donation today enables the hospital to "search" for a potential recipient before removing organs. Thus, the opportunity to insure that a specific life would be affected is present.

The latest Rabbinical Assembly statement on Organ Donation, which was approved by a vote of 14-7 by the Committee on Jewish Law and Standards goes one step further. It terms organ donation not only to be a good idea or one which is encouraged but one to which a Jew is obligated by the law of pikuach nefesh. Thus, according to this statement, a person who is asked by the physicians for permission to remove organs for transplantation is required to comply and one who refuses is transgressing a negative commandment of the Torah.

This obligation and the prohibition to refuse applies only to cases in which a specific life can be saved by this procedure. The donation of organs for non direct life saving purposes, such as research, is not permitted unless the individual organ is needed for specific research relating to a rare condition (in that case, one could say that there was a better possibility for directly saving a life). The donation of life enhancing but not life-saving organs or tissue for purposes of transplantation is also permitted. (Jewish law occasionally equated blindness with death, thus cornea transplants are particularly appropriate.) Situations involving removal of organs from a living donor should be referred to a Rabbi on a case by case basis as the issue of risk enters into the discussion.

Based upon this recent statement by the Rabbinical Assembly, it is my belief that all individuals should register as potential organ donors and agree with the request of physicians, should God Forbid, one be asked to allow for the removal of organs for transplantation. Such decisions are in the tradition of the obligation for pikuach nefesh.

Please call with any further questions.

Robert Dobrusin, Rabbi
Copyright © 1996, Robert Dobrusin.
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This message was originally posted on June 24, 1996.

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