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The Halachos of Organ Donation

The halachic stance on organ donation distinguishes between the different types of donors. Living donations of blood, bone marrow, kidneys and liver tissue (as well as others) pose minimal risk to a healthy donor.

The Living Donor: Chessed or Duty?

Becoming a living donor is a mitzvah that can potentially save another’s life, but it is voluntary; most poskim do not obligate a person to put themselves in safek sakanah (possible danger) to save another (also taking into account a less than perfect success rate, see Halachah #612).

An exception is made concerning donating cells that regenerate themselves and are no “loss” to the donor, such as blood, obligating the donor-match when there is choleh mesukan lefaneinu ([the life of a] terminally ill patient on the line). According to some poskim, even such circumstances would not be obligatory if they involve significant risk to the donor, such as when general anesthesia is used in the case of bone marrow transplants.

The Million Dollar Question on Harvesting Organs

The other category is deceased (also called “cadaver”) donations. There are a number of issues to consider when harvesting organs from a deceased body: the issurim (prohibitions) of nivul hames (defiling the deceased), hana’ah (benefit) from a mes and also the mitzvah of kevurah (burial—which mandates that all body parts be buried). All these halachos are superseded by pikuach nefesh (saving a life). However, the most essential question remains: what is considered the definition of death in halachah?

Traditionally, death was perceived as the cessation of all vital systems of the body: neurological, respiratory and circulatory function, which would all fail at about the same time. This is termed biological death. Modern medicine and technology, however, monitors the breakdown of these distinct stages and gives us the tools to prolong some functions even while unable to maintain others. In contrast to biological death, the idea of neurological death, which includes terms such as “whole brain death” or “brainstem death,” is the “irreversible cessation of all brain function.” Brain death (also called clinical death) has been accepted by the medical establishment as the threshold between life and death, and has enabled harvesting healthy organs (which would begin to deteriorate once circulatory function ceases) from a brain-dead patient—hearts, lungs and all sorts of body tissue—before they fail on their own.

The Definition of Halachic Death

However, most contemporary poskim do not consider brain death definitive; some posit that the person is still fully alive until all other vital organs shut down. If the person is still halachically alive, removing vital organs would be an act that may well hasten their death. In addition, since the brain is often the first of vital functions to shut down, the patient might now be considered a goses (a terminally ill person in the throes of death) and moving or tampering with a body in that state might hasten death.

(The minority of halachic authorities who allow such donations believe brain death is equivalent to halachic death; but many poskim of this persuasion would still require far more extensive testing to verify “complete and irreversible loss of brain function” than the current medical protocol in many places. Furthermore, some poskim would require diagnostics that prove the death of each and every brain cell.

A minority view also argues that even if the brain-dead patient is halachically considered alive, the chayei shaah (temporary life) of the transplant donor may—or must—be set aside for the potential chayei olam (long-term life) of the transplant recipient—but this premise is not accepted by most poskim.)

When approached concerning heart transplants in 1968 and again in 1978, Rabbi Moshe Feinstein declared, “It is a double murder!”—judging the status of brain death in the donor to be non-authoritative and the abysmal success rate of such transplants to be a death sentence on the recipient, as well.*

A Concluding Argument: Donor or Recipient

In our era of advanced medicine and technology, when the rate of transplant successes has risen remarkably, there is still a halachic issue with signing away the vital organs of a person who may not be considered halachically deceased.

Modern-day poskim who are approached regarding being a recipient of a harvested vital organ are split in their responses, depending most significantly on geographic location: outside of Eretz Yisroel, where the vast majority of donors are non-Jews—many of whom recognize clinical death over biological death—receiving a vital organ from an anonymous brain-dead patient is acceptable, whereas in Eretz Yisroel, where most donors are Jews who are bound by halachah, taking an organ from a brain-dead patient may be an issue of hastening another Jew’s death. Even within this demographic, there are halachic authorities who allow receiving organs from a practical standpoint: long waiting lists exist for organs, so the organ would be donated regardless, and a particular patient is not directly gorem (causing) the harvesting.

*Based on Rabbi Moshe’s later responsa and the verbal testimony of family members, there are contemporary halachic authors who posit that Rabbi Moshe Feinstein’s decisions on this subject are more nuanced than recorded here.