What Does Judaism Have to Say About Organ Donation?

Depending upon your age, you might remember Jewish tradition on the topic of organ donation as very different from how it actually is today. Once opposed, Jewish law and practice on organ donation has changed dramatically, which is part of the beauty of Judaism as a living, evolving tradition. Now that organ transplantation is a highly successful way to save a life, organ donation has been deemed an obligatory act, a mitzvah chiyuvit, by every major branch of Judaism. 

Pikuakh nefesh--saving a life, is a primary Jewish value, and at any given minute, over 40,000 people are on the waiting list of the United Network for Organ Sharing. So what about donating an organ while alive, is that a mitzvah? So long as it will not literally risk your own sanity or life, surgical removal and donation of organs such as a lung or a kidney by a living donor is a mitzvah kiyumit, a praise-worthy but not obligatory mitzvah, since with all surgery there is some risk and for some, great fear.

Three verses from Torah frame the source for organ donation:

“You shall not stand by the blood of your neighbor” [Leviticus 19:16]
“You shall surely heal” [Exodus 21:19] and “
You shall restore” (a lost object, which includes someone’s health) [Exodus 23:4].

And amazingly, despite very different ways at coming to their decision – virtually the full spectrum of Judaism, with only a few rabbinic decisors dissenting, agree that post-mortem organ donation is an obligatory mitzvah.

How Did this Change Happen?

The transformation of perspective regarding organ donation and transplant ethics in Judaism has been driven by the increasing transplant success rate. The procedure for most organs has rapidly shifted from experimental and life-threatening (and in that case, not permissible), to often the only possible and medically proven way to save someone’s life. Since taking the medical steps necessary to save your life, if at all possible, is obligatory under Jewish law and custom, accepting an organ transplant, when it would be the most effective way of extending your life, has become obligatory. [On a parallel topic, the same is true for abortion--if the mother's life or sanity is threatened by a problem with the fetus, then her life and survival comes first.]

Once accepting a transplant became permissible within Judaism, could Jews also become organ donors? Jewish tradition treats a cadaver as sacred space--not to be viewed or invaded once the soul has moved on and can no longer animate that body in its own personal way. Autopsy is only allowed in Judaism under very special circumstances for this reason. So can a Jewish person’s body be used after death for such a medical reason? Yes, to save a life – as in proving the facts in a murder investigation or to determine a devastating genetic disease pattern, or restore mental health to an extremely distraught family member, then autopsy is allowed. So, now that one can fulfill the mitzvah of saving a life via organ donation, Jewish legal experts reasoned, the primacy of the integrity of a body is most definitely trumped by the mitzvah of saving a life.

What Criteria for Death before Harvesting Organs?

There were more issues to work out regarding Judaism and organ donation. The freshest organs often are the most viable, but important Jewish texts and prevailing traditions seemed to call for both heart and breathing to have stopped in order for a person to be officially dead. And a donor heart must be kept pumping after brain death in order for a heart-transplant to even be possible, and keeping the heart going until the organ donation team’s work is done keeps most other organs fresher as well. Now what to do?

Authorities in Jewish medical law delved into the sources and practices condoned by gedolim--“great teachers” of traditional life, such as was Rabbi Moshe Feinstein. And it was determined that the actual Jewish legal criterion for death would be shifted from cessation of heart beat, to the permanent loss of the independent ability to breathe – which could be noticed around the chest, mouth or nose. Not so long after this shift, another prevailed:

Our bio-ethics scholars next undertook to learn about technologies and aspects of death unknown to prior Jewish authorities, such as reliable tests for brain stem death. The research of these dedicated, observant Jewish professionals world-wide expanded to include the Chief Rabbinate of Israel which in 1986 ruled that the determination of death would be updated again, in accord with the findings of scientist researchers, to be determined by these factors:

1. clear knowledge of the cause of injury
2. absolute cessation of natural breathing (not breathing that requires a respirator)
3. clinical proof that the brain stem is indeed dead
4. objective proof such as the BAER test that the brain stem is dead, and proof that numbers two and three continue for at least 12 hours under full and normal treatment.

The Hadassah Hospital criteria have been in use for heart transplants at their Ein Kerem facility in Israel since August 1987 and are widely cited and applied in healthcare settings involving Jewish patients. As mentioned above, in traditional communities, check with your rabbi before assuming they concur with this approach.

An Inspiring Relevant Story

Recently a bar mitzvah student interpreted a verse in his Torah portion, nedivat lev-- “generosity of heart,” one of the conditions for the voluntary donations of the Israelites to the Mishkan (tabernacle), as meaning that every Jew would feel called to fulfill the mitzvah of organ donation. After giving his d’var Torah he asked everyone at his bar mitzvah who had either signed their organ donor card or now felt motivated to do so to rise for a blessing he would give them in honor of Torah and their commitment to applying this verse to fulfilling the mitzvah of saving a life. I asked how he came to his interpretation. His reply: “Because my little sister died for lack of an available heart. And surely, if every Jewish person fulfilled this mitzvah there would be enough hearts and organs for everyone who needs one!”

Be Sure Your Family Knows

If you have any questions about organ donation in your part of the Jewish spectrum, ask your rabbi to consult the appropriate Jewish religious authority for you. For sure, be sure to brief your family in advance about your decision to fulfill the mitzvah of organ donation, as well as signing the back of your driver’s license to indicate this is your intention. Include this information in any legal health proxy’s you sign and put a note there “this decision is part of my commitment as a Jew to fulfill the mitzvah of pikuakh nefesh. It is permitted.” Emotions are complicated and decisions get confusing when a loved one dies. Misplaced zeal and misinformation all-too-often lead families to block a soul’s chance to fulfill this post-mortem mitzvah.

Learn More

There are special organ donor cards, teaching videos and excellent source articles on this subject for every kind of Jew and Jewish family to found on the web, for example, by and for Othodox Jews at HODS.org [2].  

May you be blessed to consider this topic deeply, to take the time to honor and to hopefully be able overcome any inner fears or conceptual obstacles to making the mitzvah of organ donation. 

Whoever saves one life is considered as if one had saved the entire world. 
Mishnah Sanhedrin 4:6