Organ Donation: Holiest of Mitzvot

When we pass from this world and our bodies enter the ground, do we merely wish to be remembered or do we wish to give the gift of life to others? For the medical, economic, and moral wellbeing of our society, the United States must change its policy on organ donation requirements.

Last week, we in my community were shocked and relieved when one congregant received a new kidney (a 100 percent perfect match, which is quite rare). After much pain and prolonged dialysis, she and her family are able to start a new life.

When my colleague and friend Robby Berman founded the Halachic Organ Donor Society, he sought to educate and inspire the Jewish community to save lives. Many had been confused by obscure teachings that Judaism was in some way opposed to organ donation, since, as some have told me, “I will emerge in heaven without that body part,” or that it is a violation of the dignity of the human corpse. Nothing could be further from the truth; organ donation is tantamount to pikuach nefesh (saving a life), one of the greatest of Jewish mitzvot.

The Nodah B’Yehuda, the great 18th century authority of Jewish law, teaches that saving a life is such a high priority that it overrides the prohibitions against cutting into or desecrating a cadaver. Jewish sources do not show that one must be buried with all of one’s organs to be resurrected and that there is only spiritual gain, not loss, in performing this mitzvah.

Consider the current state of Americans on the waiting list for organs and other transplant needs, which grows by 4,000 every day due to the sharp increase in type 2 diabetes (the leading cause of kidney failure) and other factors:

• In a recent 10-year period, the number of people waiting for kidney, heart, liver, lung, or pancreas transplants doubled, to a total of 98,000.
• Tens of thousands of others wait for bone and joint, skin, and heart valve transplants.
• Each organ donor has the capacity to get eight people off the organ transplant waiting list, and help as many as 50 people through donation of corneas, bone and joint tissue, heart valves, and skin.

Failure of the heart, liver, kidney, or another organ no longer has to mean the end of life. Most recipients live many years after their transplant. For example, in 2009, the percentage of people still living 5 years after their transplant ranged from a low of 54 percent for lung recipients to 75 percent for heart recipients. However, while about 79 organ transplants take place every day, another 18 people die on the waiting list before they receive a transplant.

Princeton University ethicist Peter Singer boldly argued that it is immoral to keep both of one’s kidneys, since we generally only need one and someone will die if we do not donate our kidney to them. We are not all on the moral level to donate our kidneys as living donors, but at least at the end of our lives we all must take this step. If everyone would commit to donating their organs at the time of their death, this would help to alleviate the worldwide organ shortage and its associated abuses. According to the World Health Organization, thousands of people a year in India, Pakistan, the Philippines, China, and other countries sell their organs to mostly wealthy recipients, in spite of international efforts to prohibit these activities. If more organs were available here, there would not be a demand to buy organs from more vulnerable individuals around the world.

On the positive side, 100 million Americans have signed up to be organ donors. However, America needs to offer more incentives to draw in those unwilling to donate. Spain and Austria, to take but two examples, have adopted an opt-out approach, called presumed consent, to posthumous organ donation. An opt-out, rather than an opt-in, approach is more likely to produce a society that takes care of its own.

There is an important rabbinic debate about whether death occurs at the cessation of the heartbeat or at the death of the brain stem, but virtually all major authorities take the lenient approach, agreeing that saving lives is the highest value.

Some ultra-Orthodox Israelis have said they will accept organ donations but not give them. This is clearly immoral. In response, the Israeli government has decided to try a new system that would give organ transplant priority to patients who have agreed to donate their own organs as well. Thus, Israel has become the first country in the world to incorporate “nonmedical” criteria into the organ donation priority system. Medical necessity would, of course, still be the first priority. This is a step in the right direction. We must be a nation of givers as that is the purpose of our people. The Israeli government should continue to lead the way toward incentivizing the moral commitment of organ donation.

In the Talmud, saving a life supersedes almost all other values, and thus organ donation is one of the great religious acts according to Jewish law. Mature religious thinking requires that we consider the big picture: our spiritual existence after our physical existence has expired. We should open up conversations with our loved ones about what we want to happen with our organs after we leave this world. The Halachic Organ Donor Society is leading the way in opening this conversation, but we also need more voices to advocate for positive change. We must be proactive and “choose life!”
 

Rabbi Shmuly Yanklowitz is the Founder and President of Uri L'Tzedek, the Senior Rabbi at Kehilath Israel, and is the author of "Jewish Ethics & Social Justice: A Guide for the 21st Century." Newsweek named Rav Shmuly one of the top 50 rabbis in America!"