Community Magazine December 2013

W hile organ transplantation has offered a new life to those whose native organs have failed, it has also raised a myriad of ethical questions. Although the issues raised in live and cadaveric donation are different, all organ transplantation questions have three ethical issues that must be clarified: with respect to the donor, the recipient, and society at large. The Donor Our discussion will focus solely on live donors, and we will thus not address the issues of desecration of the dead body and delaying the burial which arise concerning postmortem organ donations. The issues that arise when dealing with live donors are whether the donor is allowed to injure himself to donate the organ, and whether the harvesting is acceptably safe. In most cases, the prohibition of injuring oneself may be superceded by other considerations, such as medical necessity, or, as in this case, saving the life of another. The consensus of modern poskim 1 is that one may undergo a small risk to save someone else from certain danger or death. Nevertheless, one may never obligate or coerce someone to donate an organ, even to save another person’s life. Additionally, one may not significantly risk one’s own health to save the life of another, and one who does is called a “pious fool.” 2 Donating a Kidney With respect to kidney donation, the issue is whether the surgery poses a significant risk to the donor, and whether living with only one kidney is an unacceptable risk. Rabbi Moshe Feinstein zt”l 3 , among other rabbinic authorities 4 , permitted, but did not require, the donation of a kidney to a seriously ill patient, considering such a donation to be an act of piety. Rabbi Shlomo Zalman Auerbach zt”l , arguably the preeminent decisor of Jewish law in Israel during the latter part of the 20th century, ruled that “if the seriously ill patient is present (and known to him...) it is certainly permissible for a person to even undergo much suffering such as by donating his kidney to save the patient’s life.” 5 Rabbi Yosef Shalom Elyashiv zt”l , a leading decisor in Israel who passed away just last year, also ruled that live organ donation of kidneys is permissible and appropriate, while not obligatory. Rabbi Elyashiv became personally involved in the case of well-known Knesset member Rabbi Avraham Ravitz, who required a kidney transplant. Rabbi Ravitz’s 12 grown children argued over who would have the privilege of donating a kidney to their father. In the end, with the guidance of Rabbi Elyashiv, the choice was narrowed down to two sons, with the final decision being made by means of a lottery. 6 Dr. Avraham Steinberg, author of the Encyclopedia of Jewish Medical Ethics , delineates the four requirements necessary for ethical live organ donation. 7 He asserts that: the surgery to remove the organ must not be dangerous; the donor must be able to continue his life normally after the donation; the donor must not require prolonged and chronic medical care; the success rate in the recipient must be high. There were, however, some poskim who were hesitant to allow live organ donation, concerned that it poses too great a risk to the donor. Rabbi Yitzchak Weiss 8 was very concerned about both the danger associated with the donor’s surgery and the risk of living with only one kidney. As a result, he was inclined to forbid such a transplant, but suggested that kidney donation may be permissible if the donor will definitely save the life of the recipient by his donation. Even in such a case, he remained circumspect. DANIEL EISENBERG, M.D. THERE IS A SEVERE SHORTAGE OF ORGANS FOR TRANSPLANTATION THROUGHOUT THE WORLD, INCLUDING IN THE MOST SCIENTIFICALLY ADVANCED COUNTRIES. THE U.S. GOVERNMENT REPORTS THAT EACH DAY, ABOUT 79 PEOPLE RECEIVE AN ORGAN TRANSPLANT, BUT ANOTHER 18 PEOPLE DIE EACH DAYWAITING FOR TRANSPLANTS THAT CANNOT TAKE PLACE BECAUSE OF THE SHORTAGE OF DONATED ORGANS. DONATION DILEMMA THE LIVE ORGAN 62 COMMUNITY MAGAZINE