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J
udaism places great value on human life. The Torah has many
guidelines for how a Jew should live his life, yet the Torah
believes that preservation of life is more important
than are most Torah commandments. This is evident from
the commandment that states: You shall keep My statutes and
My judgments: which if a man do, he shall live by them [1]. The
Talmud derives from this pasuk that one should live by these laws,
but not die from them, implying that one should not sacrifce his
life in order to keep the Torahs commandments [2]. The only three
laws for which one must sacrifce his life in order to avoid these
transgressions are idolatry, forbidden sexual relations, and murder
[3]. Thus, it is clear that Judaism places great emphasis on the value
of human life, and one should do the most he can to preserve his
life while still living a Torah lifestyle.
One is also required to do whatever he can in order to save a fellow
Jews life. The Torah says that you should not stand idly by the
blood of your neighbor demonstrating the Torah obligation to
save the life of any Jew who is in danger [4]. Similarly, the Talmud
states: He who saves a single life is as if he saved an entire world
[5]. Thus, it is clear that Judaism also places great emphasis on
doing whatever one can in order to save another Jew.
It is clear that the Torah charges a Jew to both do his best to
preserve ones own life and do whatever he can to save a fellow
Jews life. What would the Torah say, however, about risking ones
own life in order to save a fellow Jew? For example, would the
Torah allow someone to undergo surgery to remove a kidney and
give it to someone who is need of a kidney transplant? On the one
hand, by performing the surgery, the donor can save someone elses
life. Yet, surgery in and of itself poses risk to the donor.
Rabbi Reuven Finks article, Organ Transplants, noted that the
Talmud Yerushalmi states that one is obligated to save anothers
life from certain death, even if he may pose a danger to his own
life by doing so. He explained that commentaries elaborate that
this is because, without intervention, the victim will surely die,
and the one intervening only has the possibility of dying. Yet, the
Talmud Bavli, the more widely accepted Talmud in determining the
practice of Jewish law, states that one is not obligated to risk his
life to save another life [6]. This position is accepted lehalacha, as
noted in the commentary of the Radbaz, who writes that one is not
obligated to lose a limb to save someone elses life, but if he does
so, it is considered a pious act. He continues to say, though, that
if someone puts his life in jeopardy (i.e. a clearly greater risk than
losing a limb) to save another Jew, he is a chassid soteh, or a foolish
pious individual [6]. The Radbaz is clearly of the opinion that if one
can lose his life while attempting to save anothers life, this would be
a foolish act to perform, as Jewish law encourages one to value his
own life. Yet, the Radbaz also demonstrates that one is considered
pious for saving another Jews life, even at the risk of losing a limb,
Kidney Donation: Its Complicated
Sara Kaszovitz
refecting the Jewish value of doing whatever one can in order to
save another Jews life. Thus, when one is deciding whether or not
to try to save another individual, he should weigh the potential risks
to himself and the potential benefts of the recipient to determine
whether or not the act would be considered recommended by
Jewish law.
Donating a kidney poses two threats to the donor. First, removing
a kidney requires surgery, and there are substantial risks that come
with any surgery, certainly one of this magnitude [7]. Additionally,
although an individual can live with one kidney, physicians debate
the long-term effects removing one kidney can have, and some
suggest donating a kidney can result in a potential shortened life-
span for the donor [8].
For a kidney transplant to be successful, a few conditions must
be met. The most important condition is that the recipient has
a similar genetic makeup to that of the donor, particularly in
terms of the human leukocyte antigen (HLA) complex. The
HLA system is composed of multiple genes that make up a major
histocompatibility complex, a complex involved in monitoring ones
immune system. If the HLA system recognizes foreign antigens
(such as those of a virus) that do not match the cellular antigens
of the body, it will destroy the invading antigen. Antigens are
substances that stimulate production of antibodies. Thus, if one
receives an organ from a donor, they must have almost identical
HLA complexes to ensure that the recipients HLA system does not
fght off the donors cells of the donated organ. An HLA complex
is made up of multiple genes, and individuals vary in terms of the
makeup of this complex. Therefore, it is extremely rare to fnd two
individuals who have the same genes comprising the HLA system.
Consequently, if one is a match for an organ donation, it means
that the donor has a genetic makeup that is close enough to the
patient in need of the transplant. A match is a rare occurrence.
Therefore, if one has the ability to save another individuals life by
donating a kidney, it is a unique opportunity, and if that individual
passes up the opportunity to donate the organ, it is unlikely that
another individual will have a close enough genetic makeup to
donate the organ.
Even if someone receives a kidney from a donor with a similar
HLA complex, it is not defnitive that the transplant will be
successful. Sometimes, the body still recognizes the new organ
as foreign, and the immune system fghts off these new cells,
preventing a successful transplant. Therefore, even after donating a
kidney, one can never be sure at the outset if the transplant will be
successful or not.
The Minchat Yitzchak was asked a question as to whether a healthy
individual can donate a kidney to save someone who is ill. The
Minchat Yitzchak responded that one needs to weigh the danger
Derech Hateva
he poses to himself and how effective the transplant will be when
making this decision. If the donor will be able to continue a healthy
life, then Jewish law would encourage him to donate the organ, as
Jewish law places tremendous value on saving another individuals
life. Yet, if the individual could pose threats to his own life, and
the surgery may not be successful, Jewish law may prohibit the
donation, as one is prohibited from putting his own life in danger
[9].
From the above discussion, it is clear that kidney donation is very
complex. The results for both the donor and the recipient are not
usually known prior to the surgery. Furthermore, Jewish law is also
complicated in that it values saving someone elses life but prohibits
risking ones own life. Thus, if someone is a match for a kidney
donation he should ask a posek what to do, as kidney donation is
complicated both from a medical standpoint and from a Jewish law
standpoint.
Acknowledgments:
I would like to acknowledge Dr. Babich for his support and assistance in writing this article. I would also like to thank Rabbi Ari Zahtz and my father for
proofreading the manuscript.
References:
[1] Leviticus 18:5
[2] Yoma 85b
[3] Sanhedrin 74a
[4] Leviticus 19:16
[5] Aruch Hashulchan 426
[6] Fink, R. (1983) Halachik Aspects of Organ Transplantation. J. Halacha Contemp. Soc. 5:45-64.
[7] Breitowitz, Y. (2003) What Does Halacha Say About Organ Donation? Hlth. Med. 64: 11-12, 14-16.
[8] Halpern, M. (1991) Organ Transplants From Living Donors. Jewish Med. Ethics. 4:29-32.
[9] Shut Minchat Yitzchak 6:103:2