Community Magazine December 2013

Rabbi Eliezer Yehuda Waldenberg 9 was also hesitant to allow live donation, but writes that while it is not a mitzvah, if the expert doctors are sure that there will be no danger to the donor, he may donate a kidney to one who is seriously ill. Dr. Avraham Avraham clarified that Rabbi Waldenberg did not mean “there is no possibility of harm,” but rather that “there is a good possibility he will not suffer harm.” 10 Hacham Ovadia Yosef zt”l evaluated the objections of both Rabbi Weiss and Rabbi Waldenberg, but asserted that since the risks posed by kidney donation are so low, there is a great mitzvah to donate a kidney. 11 He even suggests the possibility that donating a kidney to save a life might be required by the Torah’s command not to “stand idly by as your neighbor’s blood is shed.” 12 Hacham Ovadia ends his responsa by saying, “Thus it appears that the standard rule is that it is permitted and also a mitzvah to donate one of his kidneys to save the life of a fellow Jew who suffers from renal failure.” 13 It is not unreasonable to assume that as the risk of complications has been significantly reduced over the years, even those poskim who expressed hesitation might permit kidney donations nowadays. DonatingBlood and BoneMarrow Donation of blood and bonemarrowaremuch easier to halachically justify. Blood and marrow are quickly renewable, and while the process of bone marrow donation entails a degree of pain (sometimes requiring general anesthesia), both forms of donation are very safe, presenting minimal risk to the donor. For these reasons, these types of live donation are permitted by all. Rabbi Shlomo Zalman Auerbach felt that it is a mitzvah to be a bone marrow donor to save a Jewish life. 14 Both Rabbi Auerbach and Rabbi Moshe Feinstein ruled that one is permitted to donate blood to a blood bank even without knowing that it will go to save a life. 15 Interestingly, Rabbi Auerbach ruled that a competent minor may agree to donate bone marrow, and the parents of an incompetent minor may consent for him. 16 If the potential donor does not wish to donate his blood or marrow, there is a difference of opinion as to whether he should be forced to do so. Some rabbinic authorities feel that one cannot be compelled to donate, eeven at the cost of the potential recipient’s life, while others feel that coercion is permitted to save a life. 17 By contrast, donations of other solid organs which present a significantly higher risk (such as liver lobes and lung lobes) are more difficult to justify. The Recipient The perspective of the recipient is straightforward. So long as the donor is permitted to donate the organ, there is a medical indication for the transplant, and no other viable, less dangerous medical treatment is available, the recipient is permitted to undergo the transplant. The recipient must be capable of following the post-transplant medical regimen. The recipient must understand the risks associated with the transplant, including the need for lifelong immunosuppressive therapy, andmust be capable of following the necessary post-transplant medical regimen, including being able to afford the anti-rejection drugs. Judaism has no intrinsic objection to accepting an organ donation per se, but only insists that no prohibitions be transgressed in the process of donation. Conclusion The consensus of Jewish legal experts is that live organ donation is a permissible and noble act, but is not an obligation. Those who are hesitant to allow live organ donation do not object to the concept per se, but rather feel that the risk to the donor is too great to justify the procedure. Since the risk of mortality or serious complication from live kidney donation is now so low, even those poskim who had discouraged live organ donation might consider it safe enough to be permitted. **Aswithany halachic discussion this article is for informational purposes only. For any practical applications one must consult his rabbi for further clarifications. Dr. Daniel Eisenberg is with the Department of Radiology at the Albert Einstein Medical Center in Philadelphia, PA and an Assistant Professor of Diagnostic Imaging at Thomas Jefferson University School of Medicine. Footnotes: 1. Iggerot Moshe, Yoreh Deah II 174:4. 2. Responsa Radvaz, 3:627 (1052). 3. Iggerot Moshe, Yoreh Deah II 174:4. 4. See Hershler, Rabbi Moshe, “Where Organ Donors are Considered Mentally Incompetent by the Halacha,” Halacha U’Refuah , 2:122-128, Regensberg Institute, 198; Zilberstein, Rabbi Yitzchak, “May Parents Give Permission to Donate the Kidney of a Child to a Sibling,” Halacha U’Refuah , vol. 4:156-57, Regensberg Institute, 1985; Halevi, Rabbi Chaim David. “Donating Organs from Living Donors and Cadavers in Jewish Law,” Assia 4:251- 259, Machon Schlesinger, 1983. 5. Nishmat Avraham,, ibid. 6. Personal communication with Dr. Avraham Steinberg. Rav Elyashiv used the “Vilna Gaon’s loterry,” a traditional means of deciding complex questions. 7. Steinberg, Dns of deciding complex questions. 7. Steinberg, Dr. Avraham, Encyclopedia of Jewish Medical Ethics , p. 1095; Feldheim: New York, 2003. 8. Minchat Yitzchak , 6:103. 9. Tzitz Eliezer , X:25:7 10. Avraham, Dr. Avraham, Nishmat Avraham , Yoreh Deah , p. 347 (English version). 11. The risk of mortality from live kidney donation is now estimated at .03 percent with a low rate of serious complications. See Surman, O.S., “Perspective: The Ethics of Partial-Liver Donation,” New England Journal of Medicine , 346:1038 (Number 14, April 4, 2002). 12. Vayikra19:16. 13. Yehaveh Da’at , III 84. 14. Avraham, Dr. Avraham, Nishmat Avraham, Yoreh Deah (Vol. 2), p. 346 (English version). 15. Iggerot Moshe, Hoshen Mishpat 1:103. 16. See Encyclopedia of Jewish Medical Ethics , p. 1096, for a full discussion of blood and bone marrow donation. 17. ibid. Rabbi Moshe Feinstein zt”l Rabbi Moshe Feinstein permitted, but did not require, the donation of a kidney to a seriously ill patient, considering such a donation an act of piety. Rabbi Yosef Shalom Elyashiv zt”l Rabbi Yosef Shalom Elyashiv ruled that live organ donation of kidneys is permissible and appropriate, while not obligatory. Rabbi Shlomo ZalmanAuerbach zt”l Rabbi Shlomo Zalman Auerbach 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.” Hacham Ovadia Yosef zt”l Hacham Ovadia Yosef asserted that since the risks posed by kidney donation are so low, there is a great mitzvah to donate a kidney. 64 COMMUNITY MAGAZINE