Chapter 21

Skin Grafts and

Skin Banks

T he need for skin banks in Israel, which came up in the eight-

ies, brought together both kinds of extensions discussed in the autopsy
and cornea donation essays.

• Skin – Grafts are often not lifesaving in the narrow sense of the
term. Nevertheless, they are extremely important for quality of
life, both for health reasons (avoiding infections) and for aes-
thetic and social reasons. Thus, any heter for skin grafts must ex-
tend the definition of lifesaving to include these concerns. (This
parallels the corneal transplant situation.)
• Banking – The disconnect between donor and (eventual) recipi-
ent brings donating to an organ bank into direct opposition with
the principle of Rabbi Landau and Rabbi Sofer that the ill per-
son must be “before us,” i.e., in need at the time of retrieval. (This
parallels the autopsy situation.)

Although this essay will focus on the banking of skin, it is worthwhile

first to look at how the question regarding a parallel process, banking
of corneas, was treated.

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 Section IV – Extending the Definition of Lifesaving

I. CORNEA BANKS
Already in the forties, Rabbi Chaim David Regensberg, whose
article  on corneal transplants was discussed in the previous essay,
touched on the issue of banking corneas. He quotes from a letter in
the Ha-Do’ar newspaper (28 Iyyar 5705) by Dr. Ben-Tziyyon Weiss,
who describes people who make living wills requesting their corneas
be banked:1

‫אבל בעת האחרונה נפתח‬ Recently, an institute for the ­preservation

‫בניו יארק מוסד לחסכון עינים‬
‫שתעודתו להמציא עינים‬
‫בריאות בשביל אלפי החיילים‬
‫שנסתמאו בשדה המלחמה על‬
...‫ידי נתוח מתאים של הקרנית‬
‫ויש נדיבים שרושמים בצוואתם‬
‫מתן רשיון לרופאים לנקר את‬
‫עיניהם אחרי מותם לטובת‬
‫ כדי לגונזן אחר‬,‫המדע הרפואי‬
‫כך בבאנק המיוחד במדת חום‬
‫ מוכנות ומזומנות‬,‫מתאימה‬
.‫לשמוש המנתחים בהן‬
surgeons when necessary.
of eyes has opened in New York whose
purpose is to produce healthy eyes for
the thousands of soldiers who became
blind on the battlefield [during World
War II], by appropriate surgery on the
cornea…and there are generous volun-
teers who write permission into their
wills for physicians to remove their eyes
after their death for the benefit of medi-
cine, to store them afterward in a special
storage bank built for this very purpose,
so that they will be ready for the use of

Given his attitude to science, Rabbi Regensberg does not see

any problem with a person’s donating his or her corneas to a storage
bank; “in such a way,” he writes, “there is no concern about desecra-
tion.” The reality Rabbi Regensberg was facing is important to remem-
ber. By the mid-forties, the storage technology was good enough that
there was little fear that delay due to the lack of an immediate transplant
recipient would lead to deterioration of the cornea. Further, injured
patients, especially soldiers, were coming in from all over the United

1. Ha-Pardes 19:4 (5705/1945): section 20 (pp. 24–28) [Hebrew]; the article was
reprinted in Rabbi Regensberg’s collection of responsa, Mishmeret Ĥaim (Chicago:
Moetzet Rabbanim, 5726 [1965/66]), 19.

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 Chapter 21 – Skin Grafts and Skin Banks

States and the world for this surgery. At no given time would there be
enough bodies of willing donors to supply the need. Hence, even if
one did not know exactly when or to whom the cornea would go, one
could rest assured that there was a person in need somewhere and the
cornea would be put to good use.
Nevertheless, some authorities who seem to permit cornea dona-
tion balked at the possibility of donating them to a storage facility. Rabbi
Shmuel Wosner, for example, writes (Shevet. ha-Levi 2:211):

‫בענין מי שצווה שיסירו את‬ Regarding someone who left instructions

‫עיניו אחר מותו לשלחם לבנק‬
‫העינים – ע[ל] פ[י] העדות‬
]‫ששמע כ“ת שע[ל] י[די‬
‫עינים האלה יכולים לפקח‬
]‫ וספיקו ע[ל] פ[י‬,‫עוורים‬
]‫דברת הנו[דע] ב[יהודה‬
]‫ת[נינא] יו[רה] ד[עה] סי[מן‬
,‫ר“ו להתיר אם יש חולה לפנינו‬
that his eyes be donated to an organ bank
after his death – the honorable questioner
has heard that with the donation of these
eyes, blind people can be cured, and he is
in doubt because of the principle of the
Noda bi-Yehuda (vol. 2 YD 206) allowing
[autopsy only] when there is an ill person
before us.

‫אמנם לענ[יות] ד[עתי] קשה‬ Indeed, in my humble opinion it would

‫ כי יסוד ההיתר בזה‬,‫להתיר‬ be difficult to permit this, for the basis of
,‫אינו מה שמחל זה בחייו‬ this permission is not that he forgave any
...‫דכבר האריכו בזה רבותינו‬ offense [of desecrating his body by donat-
...‫דאין בידו למחול על זה‬ ing his cornea] during his lifetime – for our
rabbis already wrote extensively regarding
this…that he does not have the power to
forgive this…

‫רק עיקר היסוד להתיר‬
]‫הוא מ[ה] שכ[תב] נו[דע‬
‫ב[יהודה] ת[נינא] שם דאם‬
‫חולה כיו[צא] ב[ו] מונח‬
‫ הו[ה] ל[יה] כשאר‬,‫לפניו‬
‫ שדוחה כל התורה‬,‫פקוח נפש‬
.‫מלבד ג‘ מצוות‬
Rather, the basis for permission is that
the Noda bi-Yehuda wrote that if there is
an ill person with the same illness before
us, it is a case of lifesaving and it overrides
the entire Torah other than the three
exceptions.

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‫אמנם רבותינו לא דברו רק‬ In truth, our rabbis spoke only about a case
‫ אבל להוציא‬,‫ביש כבר לפניו‬ where an ill person is present; removing
,‫ע[ל] מ[נת] לשלחם לפקדון‬ [corneas] in order to send them to a stor-
,‫סו[ף] ס[וף] עדיין ספק גמור‬ age facility – in the end, [the utility of such
‫דמי יימר דיהיו מתאימים‬ an act] is exceedingly doubtful, for who
‫ועוד הרבה ספיקות שבדרכי‬ says that they will be a match, and there
,‫הרפואה‬ are many other doubts accompanying any
medical procedure.

‫ואם נכניס בזה בדין ספק‬ And if we define this as a case of possible
‫ נבא‬,]‫ א[ם] כ[ן‬,‫פקוח נפש‬ lifesaving, then we will come to a situa-
‫ח“ו לכך שיוציאו העינים של‬ tion in which – Heaven forbid – they will
‫כל המתים ב“מ להפקיד אותם‬ remove the eyes of every corpse without
‫ ויהי[ה] בטענה‬,‫בבנק עינים‬ distinction – let it not happen to us – in
‫לפקוח עוורים – ויעשה מזה‬ order to store them in an eye bank. The
,‫היתר גם בלי שיצוה על כך‬ claim will be that this is intended to restore
‫כיון שאתה מכניסו בדין ספק‬ the vision of the blind, and then it will
.‫פקוח נפש‬ become a standard permission used even
on people who did not ask for this to be
done to them, since one now has catego-
rized it as possible lifesaving.

]‫ע[ל] כ[ן] לענ[יות] ד[עתי‬ For this reason, in my humble opinion,

‫ ואין לנו‬,‫דלא יעשה כזאת‬ this should not be done, for we have
.‫אלא מה שהתירו רבותינו‬ only what was permitted [explicitly] by
our rabbis.

In his three points, Rabbi Wosner expresses distrust of doctors

and medicine:

• He expresses doubts that banking really can save many lives.

• He fears that if this case is permitted, all people’s corneas will be
removed as a matter of routine.
• He feels that only matters permitted in the rulings of previous
generations can be permitted now. Organ banks do not meet
this standard.

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 Chapter 21 – Skin Grafts and Skin Banks

Rabbi Wosner takes a simple and literal understanding of Rabbi Landau’s

responsum as his premise and Rabbi Landau’s view as the final word on
the subject. He argues that the only permission on the books for desecrat-
ing a body exists when it is done for a specific ill person in need. Such
is not the case in an organ-banking situation, and thus it is forbidden.
Rabbi Wosner mentions the possibility of using the fact that the
donor explicitly forgives any desecration of his or her body in the will,
but discounts this as outside the realm of halakhic discourse without
mentioning that this was the opinion of no less an authority than Rabbi
Jacob Ettlinger in his Binyan Tziyyon (see the first essay on autopsy for
discussion). Since other rabbis argued against this view, Rabbi Wosner
discounts it, even just as a snif le-haqqel (a mitigating factor) to help
permit cornea banking. (Remember, Rabbi Wosner permits cornea
donation.)
In addition to the above, Rabbi Wosner brings up the slippery
slope argument: if one were to argue that donation to an organ bank
should be considered possible lifesaving, then what is to stop Jews from
turning to a policy of immediate and automatic donation of all corneas
just in case they will be usable in the future, even without the donor’s
permission? For this reason, he argues that donations to storage facili-
ties should not be defined as possible lifesaving and therefore should
not be permitted under this rubric.
Although the slippery slope problem in this case is a genuine con-
cern, Rabbi Wosner does not give equal weight to the other side of the
question: weighing the diminution of the prohibition of bizzuy ha-meit
(cutting the corpse and removing its corneas) against the increase in
lifesaving and life improvement (restoring someone’s sight). Had Rabbi
Wosner’s decision been the final word on the subject, there would be no
cornea banks – and by extension, no organ banks – leaving thousands
of people to die or live with handicaps or disfigurement due to the lack
of sufficient replacement organs.
One very instructive example of a poseq who grappled with both
sides of the equation is Rabbi Shlomo Goren. Interestingly, he began
with a position on organ banks rather similar to that of Rabbi Wosner.
In response to a letter from Knesset Member Menahem Sabidor dated 12
Shevat. 5739 (February 9, 1979) asking about the permissibility of kidney

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 Section IV – Extending the Definition of Lifesaving

and cornea transplants, Rabbi Goren wrote that doing so was permit-
ted. This was hardly surprising, as Rabbi Goren was already on record
regarding the importance of organ donation. However, he included the
following caveat:

‫אבל כל זה בתנאי מפורש שאין‬ All this is assuming the explicit condi-
‫מתכוונים לאחסן את הכליות או‬ tion that [the hospital] does not intend
‫את קרניות העיניים בבנק מיוחד‬ to store the kidneys or the corneas in a
,‫כדי להיות מוכנים בשעת הצורך‬ storage bank so that they will be ready
‫שאז אין זה בגדר של פקוח נפש‬ at a time of need, for then this would
‫לפי דעת הנודע ביהודה והחתם‬ not count as saving a life according to
‫ שמפיהם אנו חיים‬,‫סופר הנ“ל‬ the position of the Noda bi-Yehuda and
.‫ומימיהם אנו שותים‬ the Ĥatam Sofer, referenced above, from
whose mouths we live and whose water
we drink.

Although when Rabbi Goren wrote this letter, he seems to have

been a staunch opponent of organ storage, as will be seen in the discus-
sion of skin banks, Rabbi Goren made a 180-degree turn on this issue,
becoming one of the most vocal advocates for the creation of an Israeli
skin bank.

II. SKIN DONATION

The question of skin donation is similar to the question of cornea dona-
tion. Although cases in which skin is necessary in order for the patient
to avoid life-threatening infections do exist, in many cases the skin is
used to improve quality of life, whether to avoid minor infections or
pain or just for cosmetic purposes. In order to permit skin donation,
either a technicality needed to be found or the idea of lifesaving needed
to be stretched.2

2. As seen in the previous essay, both strategies were employed for cornea donation.
See the discussion of Rabbi Eliezer Melamed on skin grafts in general in his Peninei
Halakha, Liqutim 2, 14.4, “Hashtalat Eivarim (organ transplantation),” Haqamat Bank
Or (establishing a skin bank), http://ph.yhb.org.il/08-14-04/ [Hebrew].

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 Chapter 21 – Skin Grafts and Skin Banks

Rabbi Shaul Yisraeli

The preliminary push toward permitting skin donation was made by
Rabbi Shaul Yisraeli in an article he published in the first edition of
Tchumin,3 in which he addresses both the question of skin banks and
the more fundamental question of skin donation itself:

‫השאלה נשאלה מטעם‬
‫בתי החולים אם מותר‬
‫להכין לשעת חירום עור מן‬
‫הנפטרים על מנת שיהא מוכן‬
‫ כפי‬.‫לשימוש בשעת הצורך‬
‫ בשעת חירום‬,‫שהוכח מנסיון‬
,‫שרבים הנפגעים ל“ע בכויות‬
‫שלשם ריפוים נחוץ שימוש‬
‫ אין מספיק מאלה‬,‫בעור אדם‬
‫ אם‬,‫המצויים באותה שעה‬
.‫לא יוכן מלאי בעוד מועד‬
The question has been asked by the hos-
pitals whether it is permitted to collect
skin from the deceased for emergency use
so that there will be a ready supply when
the need arises. As experience has shown,
during times of crisis in which many are
injured with burns – may it not happen to
us – whose treatment requires grafting of
human skin, there is an insufficient quantity
at any given time if none has been stored
in advance.

‫ שאם כי‬,‫החומר שבשאלה‬ One difficult aspect of the question is that

‫המדובר על פי רב בצורך לשם‬
‫ אין לך‬,‫הצלת נפשות ממש‬
...‫דבר העומד בפני פקוח נפש‬
‫הרי קיים פסקו של הנודע‬
‫ והרי כאן המדובר‬...‫ביהודה‬
‫על צורך שאינו קיים בזמנים‬
‫רגילים רק בשעת החירום‬
‫ שאז אין מספיק ממה‬.‫כנ“ל‬
.‫שמזדמן באותה שעה‬
even though these cases generally are about
literally saving a person’s life and there is
nothing that stands in the way of saving
lives…there is the position of the Noda bi-
Yehuda…and here the discussion is about
a need that exists not at regular times, but
only during emergencies, when the sup-
ply of [skin] that happens to be available
is insufficient.

‫ יש והצורך לתקן‬,‫נוסף לכך‬ Additionally, there are times when a need

,‫פגמים בפנים של הפצוע‬ arises to correct distortions in the burn vic-
‫ ואין בזה‬,‫היינו לתקן מראיתו‬ tim’s face, meaning to improve his appear-
.‫משום פקוח נפש ממש‬ ance, and this is not literally lifesaving activity.

3. Shaul Yisraeli, “Healing Burns Through Transplantation of Skin from Cadavers,”

Tchumin 1 (5740/1979–80): 237–47 [Hebrew].

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 Section IV – Extending the Definition of Lifesaving

Rabbi Yisraeli’s key point is his admission that many cases of skin
donation are aimed not at saving life, but at cosmetic surgery to correct
deformities or burns. How can one permit desecrating a body or receiv-
ing benefit from a corpse – the two main prohibitions – if no lives are
saved? It is the paramount significance of lifesaving that overrides these
prohibitions for autopsy and organ donation.
Nevertheless, Rabbi Yisraeli wants to permit both grafting and
skin-banking. To overcome the problem of deriving benefit from the
dead, he makes use of a halakhic technicality. He argues that the prohi-
bition does not apply to skin, basing himself on a comment made by the
Tosafot in a number of places, itself an interpretation of Ula’s comment
in the Babylonian Talmud (Nidda 55a):

‫ דבר תורה – עור‬:‫אמר עולא‬ Ula said: According to Torah law, human
‫ ומאי טעמא אמרו‬.‫אדם טהור‬ skin is pure. So why did [the rabbis] call
‫טמא? גזרה שמא יעשה אדם‬ it impure? It was a decree, lest someone
.‫עורות אביו ואמו שטיחין לחמור‬ use the skin of his father or mother as
mats for his donkey.

Ula’s statement establishes that skin is something other than the

standard corpse substance, which is impure according to Torah law.
Skin, he claims, is impure only according to rabbinic law. Ula’s distinc-
tion between skin and the rest of the body inspires the Tosafot’s com-
ment (ad loc., s.v. “shema”):

‫ והלא מת אסור‬:‫ואם תאמר‬ But if you will argue that it is forbidden

‫ נראה דעור אינו בכלל‬...‫בהנאה‬ to derive benefit from a corpse…it would
.‫בשר ליאסר בהנאה‬ appear that skin is not included in the
category of flesh, such that it would be
considered forbidden to derive benefit.

Taking Ula’s statement at face value, the Tosafot argue that if

skin is not subject to the laws of purity according to Torah law, it must
not be subject to the other laws governing human bodies, such as the
prohibition to derive benefit from a corpse, either. Rabbi Yisraeli notes
that if one were to follow the Tosafot, the prohibition to derive benefit

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 Chapter 21 – Skin Grafts and Skin Banks

from the skin of a corpse would be assumed to be only rabbinic, mak-

ing it easy to override in cases of suffering or need.
Rabbi Yisraeli is aware, however, that the Tosafot’s position is
not the only one offered in halakha. The Tosafot themselves quote an
alternative explanation for the rabbinic decree, that of Rabbeinu Tam
(b. Sanhedrin 48a, s.v. “meshameshin”): 4

]‫ומפרש ר[בינו] ת[ם] דא[ף‬ Rabbeinu Tam explained that even

,‫ע[ל] ג[ב] דאסור מדאורייתא‬ though [deriving benefit from the skin
‫הוצרכו לגזור טומאה משום‬ of a corpse] is forbidden according to
‫דחמירא להו לאינשי טומאה‬ Torah law, [the rabbis] needed to make
.‫מאיסורא‬ a decree about impurity because the peo-
ple were more concerned about impurity
than they were about a prohibition.4

Rabbeinu Tam believes that since impurity was taken more seri-
ously than prohibitions, the rabbinic decree against impurity of skin
was put in place to reinforce the already existing prohibition of deriving
benefit from cadaveric skin.
Taking Rabbeinu Tam’s position into consideration, Rabbi Yis-
raeli offers a two-part argument for permitting a skin graft. First, he
brings up Rabbi Ettlinger’s principle of consent in advance of death in
the matter of autopsy. Second, he notes the rule that benefit derived
in an unusual way is not forbidden according to Torah law.5 Since the
usual way of deriving benefit from skin, as understood by the Talmud,
was making it into leather, using it for grafting would be unusual, and
therefore even Rabbeinu Tam would have to admit that doing so violates

4. This same position is referenced anonymously in the Tosafot to b. Nidda (55a) as

well.
5. Among other things, this halakha is based upon the talmudic statement (b. Pesaĥim
24b):
‫ כל‬:‫אמר רבי אבהו אמר רבי יוחנן‬ Rabbi Abbahu quoted Rabbi Yoĥanan: One
‫איסורין שבתורה – אין לוקין עליהן‬ receives lashes for any violation of a Torah
.‫אלא דרך הנאתן‬ prohibition only when it is done in the manner
benefit is generally derived.

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 Section IV – Extending the Definition of Lifesaving

only a rabbinic prohibition. Finally, Rabbi Yisraeli extends his permis-

sive ruling to include banking skin:

‫ דשלא‬...‫מסקנת הדברים‬ The conclusion of the matter is…that

,‫בהסכמת המת בעודו חיותו‬ without the consent of the donor while
‫יש בו איסור הנאה מן התורה‬ he is still alive, use of the skin would vio-
]‫בשימוש בעור לדעת ר[בנו‬ late the prohibition of deriving benefit
‫ ואיסור זה גם שלא כדרך‬,]‫ת[ם‬ [from the dead] according to Rabbeinu
‫ כגון שמוש בעור לצורך‬,‫הנאתו‬ Tam, and this Torah prohibition would
‫ ואין‬.‫ מן התורה‬,‫שתילתו בגוף‬ apply even when the benefit was not of
‫לדון בו להיתר אלא כשהחולה‬ the usual variety, such as if the skin were
‫לפנינו הוא זקוק לזה בגדר של‬ grafted onto a living body. Hence, one
.‫פקוח נפש‬ should not rule permissively unless the
sick person is before us and needs the
graft in order to save his life.

‫אולם כשהנפטר עצמו נתן רשות‬ However, if the deceased gave permis-
...]‫ בזה לדעת ר[בנו] ת[ם‬,‫לזה‬ sion, then according to Rabbeinu Tam,
‫איסור הנאה זו רק בכדרך‬ the Torah prohibition of deriving benefit
‫ אולם גם‬...‫הנאתם מן התורה‬ applies when the benefit is of the usual
‫ בחולה‬,‫לדעת האוסרת מדרבנן‬ variety…and even according to the posi-
‫שאין בו סכנה מותר איסור זה‬ tion that this is prohibited rabbinically,
...‫לדברי הכל‬ according to everybody, this prohibi-
tion is overridden for a sick person in
danger…

‫ומאחר שריפוי על ידי השתלת‬ Now since the procedure of grafting skin
‫העור בגוף החולה אין בזה‬ from a cadaver onto the body of an ill
]‫ ע[ל] כ[ן‬...‫כדרך הנאה מהעור‬ person is an example of deriving benefit
‫ לא‬,‫מותר ריפוי זה דעור המת‬ from skin in a non-standard way…it is
‫רק בחולה שיש בו סכנה אלא‬ permitted to use the skin from a cadaver
,‫ אף שאין בו סכנה‬,‫בכל חולה‬ to heal not only a sick person in dan-
‫ומותר יהיה גם להכין לצורך זה‬ ger, but any sick person, even one in no
.‫גם כשאין חולה לפנינו‬ danger. It is permitted even to prepare
beforehand for this eventuality, even
when there is no sick person before us.

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 Chapter 21 – Skin Grafts and Skin Banks

Rabbi Yisraeli now turns to the issue of desecrating a body. To do

this, he begins by equating the prohibition of desecrating a body with
abrogating the obligation to bury the deceased (Deut. 21:23). Rabbi
Yisraeli then turns to a passage in the Jerusalem Talmud (Nazir 7:1):

‫“כי קבור תקברנו“ – מיכן שאינו‬ “For you shall surely bury him” (Deut.
‫נעשה מת מצוה עד שיהא ראשו‬ 21:23) – from here we learn that a body
.‫ורובו‬ is not considered one that requires burial
unless it contains his head and torso.

Taking this derasha at face value, it means that skin per se, when
not attached to the head or torso, does not require burial. This argument
is explicitly made by Rabbi Yehuda Rosanes (1657–1727; Constantino-
ple) in his glosses on Maimonides’ Mishneh Torah (Mishneh la-Melekh,
Laws of Mourning 14).

“‫ומדיליף לה מ“קבור תקברנו‬ From the fact that [halakha] learns this
‫– ש[מע] מ[ינה] דליכא חיוב‬ from [the phrase] “you shall surely bury
.‫קבורה כי אם על ראשו ורובו‬ him” we gather that no obligation to bury
exists except for the head and torso.

Following Rabbi Rosanes’ lead, Rabbi Yisraeli argues that the

requirement of burial applies only to the head and torso, but not to
patches of skin. Nevertheless, he is aware that Rabbi Yom T.ov ­Lipmann
Heller (1579–1654), in his glosses on the Mishna (Tosefot Yom T. ov,
Shabbat 10:5), offers exactly the opposite interpretation. The comment
is an attempt to explain why carrying an olive’s worth of human skin
would violate Shabbat:

‫ מצניעין‬,‫ דאסור בהנאה‬,‫ומת‬ [Flesh from] a corpse, from which one

.‫אותו כדי לקוברו‬ is forbidden to derive benefit, is stored
in order for it to be buried.

Rabbi Heller’s statement implies that even a detached patch of

flesh should be buried. Nevertheless, in a classic hair-splitting maneuver,
Rabbi Yisraeli tries to recruit Rabbi Heller to his side:

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 Section IV – Extending the Definition of Lifesaving

‫אך נראה שגם התוספות יום‬ It would seem that even the Tosefot Yom
‫ אלא‬... .‫טוב לא פליג בזה‬ T.ov would not argue this point [i.e., that
‫שמכל מקום סבירא ליה‬ only the head and torso require burial].…
,‫שמצד שלא יהא מוטל בבזיון‬ Rather, what he thinks is that [the piece
‫ אך בזה‬,‫יש עליו חיוב לקברו‬ of flesh] should not be disrespectfully left
.‫סגי גם בהצנעתו‬ to lie, but should be buried. However, just
putting it away suffices.

Having “established” that the laws of burial apply only to the

head and torso, Rabbi Yisraeli takes the next step to permit skin grafts:

‫מכל הנ“ל נראה ברור שאין‬
‫בעור משום מצוות קבורה‬
‫ וגדר בזיון‬,‫ואיסור הלנה‬
‫ודאי לא שייך בכל כהאי‬
‫גוונה שמשתמש בו לצורך‬
‫ריפוי והצלת אדם ממות או‬
‫ כל‬,‫ ומאחר וכנ“ל‬.‫מיסורים‬
‫שהמת מחל בחייו ונתן רשות‬
,‫להשתמש בעורו לצורך ריפוי‬
.‫אין בשימוש משום איסור‬
From all the above it seems clear that there
is no mitzva to bury skin or prohibition to
leave it unburied overnight. And the concept
of degrading the dead body is certainly irrel-
evant as long as [the skin] is used for medical
healing or to save a person’s life or save him
from pain. So in keeping with the earlier argu-
ment, as long as the deceased gave permission
during his lifetime to use his skin for medi-
cal healing, there is no prohibition in its use.

Rabbi Yisraeli argues that since skin does not require burial, it is
not subject to the prohibition of leaving the dead unburied. Furthermore,
he adds that since the removal of the skin is done for medical purposes,
one cannot argue that the corpse is degraded in some way.
With that argument made, Rabbi Yisraeli returns to the issue of
skin banks and offers the following:

‫ נראה שמותר‬,‫וכיון דאתינן להכי‬
‫ גם‬,‫גם הכנת העור למטרה זו‬
‫טרם יש חולה לפנינו הזקוק‬
‫ כיון שכל עוד שאין החולה‬,‫לזה‬
‫ אין שום מעשה הנאה‬,‫זקוק לזה‬
‫ ואילו כשבא לידי שמוש‬,‫מהעור‬
.‫הרי הנאה זו מותרת‬
And once we have reached this point, it
would appear that it is permitted to prepare
for this eventuality even before there is a
sick person in need before us, since as long
as there is no sick person, there anyway is no
benefit from the skin, and once there is a use
for the skin, receiving benefit is permitted.

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 Chapter 21 – Skin Grafts and Skin Banks

With this creative understanding of benefit, Rabbi Yisraeli effectively

permits skin banking.

Rabbi Shalom Messas

Many of Rabbi Yisraeli’s arguments are forced: they rely on tortuous
analysis of very technical points and counterintuitive positions in hal-
akha. This was pointed out in an article a few years later by Rabbi Shalom
­Messas (1913, Morocco–2003, Israel; a younger cousin of Rabbi Yosef
Messas), then Sephardic chief rabbi of Jerusalem, in an article in Tchumin.6
Rabbi Messas does not stop at his critique of Rabbi Yisraeli’s
position, however, as this would require him to forbid the creation of
skin banks, something he does not want to do. Rabbi Messas discusses
this problem explicitly in section 14 of the article: 7

‫ולפי כל האמור נפל פיתא‬
‫ ואין מקום להתיר‬,‫בבירא‬
‫ולהסיר עור המת מעליו‬
,‫להצניעו גם לצורך רפואה‬
,‫זולת במקום פיקוח נפש‬
...‫שהחולה מוטל לפנינו‬
According to all that was said, “the medicine
has fallen into the well”7 and there is no way
to permit the removal of skin from a cadaver
and store it for medical purposes except in a
case in which it will be lifesaving and the ill
person is before us…

‫אך מכיון דבזמנינו זה הוא זמן‬
‫ ובפרט בארץ‬,‫המלחמות בעולם‬
‫ישראל המחבלים סבונו גם‬
‫ כמעט אין יום אשר אין‬,‫סבבונו‬
‫ וכל שכן בעת המלחמה‬,‫שם מת‬
‫ ולכן חפשתי ומצאתי לזה‬.‫ממש‬
.‫קצת טעמא להתיר‬
However, since our days are days of war
throughout the world, and this goes espe-
cially for the Land of Israel, where we are
totally surrounded by terrorists, there is virtu-
ally no day when no one dies, and this is even
truer in a time of actual war, I have searched
out and found some reason to be lenient.

6. Shalom Messas, “Skin Banks for Healing Burns,” Tchumin 7 (5746): 193–205 [Hebrew].
Rabbi Yisraeli responded to this critique in an article in the same volume: Shaul
Yisraeli, “Transplanting Skin from a Cadaver,” Tchumin 7 (5746): 206–13 [Hebrew].
Additionally, as the two rabbis had corresponded about this issue, selections from this
correspondence were also published in the same volume: Shaul Yisraeli and Shalom
Messas, “Cadaveric Skin: An Exchange of Letters,” Tchumin 7 (5746): 214–18 [Hebrew].
7. An expression from the Talmud (b. Shabbat 66b) used when the specific requirement
in a given case is so cumbersome as to make the medicine virtually useless.

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 Section IV – Extending the Definition of Lifesaving

Although unconvinced by the arguments proffered by

Rabbi  Yisraeli, Rabbi Messas feels that his job is to try to find
some way to be lenient because – as he says – in reality, the skin is
needed. People are injured all the time and it would be terrible if
a halakhic technicality were to stop injured people from obtaining
treatment.
As a counterpoint to Rabbi Landau, Rabbi Messas quotes the
position taken by Rabbi Avraham Yeshaya Karelitz (Ĥazon Ish), dis-
cussed in the first essay in this section, on autopsy. As described there,
Rabbi Karelitz argues that in our world the question is about not
whether a particular sick person is under the care of a particular doctor,
but whether a disease is a current threat to others around the world at
any given time. Rabbi Messas points out that this analysis formed the
practical basis for Rabbi Shlomo Goren’s pesaq allowing power stations
to be run on Shabbat in case of a surprise attack. Using this concept as
precedent, Rabbi Messas argues:

‫ומינה לנדון דידן כאשר עלינו‬ We can apply this precedent to our case,
‫לדאוג לכל החולים שבמדינה‬ for we must concern ourselves with all
‫ זה‬,‫והם שכיחים וזקוקים תמיד‬ the sick people in the state and there
‫ ומינה יש‬.‫נקרא שהחולה לפנינו‬ are always many of these and they are
‫ללמוד בקל וחומר לעת מלחמה‬ always in need. This should be consid-
‫ דודאי‬,‫שאנו נמצאים בה תמיד‬ ered equivalent to an ill person before
.‫יש להתיר‬ us. From here, one can argue, a fortiori
concerning the perpetual state of war
in which we find ourselves, that we cer-
tainly should permit [skin grafts].

Having gone this far, Rabbi Messas buttresses his permissive

position by referencing lenient responsa on related issues. Specifically,
he references Rabbi Ben-Tziyyon Meir Ĥai Uzziel’s position on autopsy
(discussed in the first essay on autopsy), the positions of Rabbi Unter-
man and Rabbi Regensberg regarding corneal transplants, and finally
his cousin Rabbi Yosef Messas’ responsum on corneal transplants and
autopsies.
Summing up his view, Rabbi Shalom Messas writes:

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 Chapter 21 – Skin Grafts and Skin Banks

‫הרי שרבו הפוסקים שהתירו‬ There are many posqim who, for the
‫מן הטעמים הנזכרים לעיל‬ reasons stated above, have permitted
‫לקחת עור מהמת לצורך חולים‬ retrieving skin from a cadaver on behalf
‫ ויש‬,‫המצויים שיבואו אחר כך‬ of the wounded who will appear in the
‫ וזה‬...‫לסמוך על זה למעשה‬ future, and this should be relied on prac-
‫צריך שיהיה בצנעה גדולה‬ tically…but this must be done with great
.‫באופן שלא יהיה ניוול המת‬ delicacy, in a way that there will be no
degradation of the dead.

Despite this permissive ruling, Rabbi Messas is well aware of the

slippery slope problem and deals with it explicitly:

‫אמנם יפה עשתה מועצת‬ In truth, the council of the Chief Rab-
‫הרבנות הראשית שהגבילה‬ binate did a good thing by limiting the
‫הדבר להצניע רק חמשים עורות‬ number to be stored to fifty skins and
‫ דאם לא כן חזרנו‬,‫ולא יותר‬ no more, for if they had not done so,
‫לחששות הנודע ביהודה שיבואו‬ we would return to the concern of the
.‫לנתח כל המתים‬ Noda bi-Yehuda that [all] cadavers would
be cut.

Rabbi Messas’ position is instructive. On one hand, he is

unconvinced by Rabbi Yisraeli’s arguments and writes an entire article
to disprove them. On the other hand, he wants people to be able to
receive skin grafts and even advocates for limited banking of skin in
Israel. From this perspective, Rabbi Messas’ treatment can be seen
as a model of an undecided poseq struggling with an issue. He sees
the halakhic problems but also the human need, and he responds
affirmatively.

III. ISRAELI SKIN BANKS AND THE FIRST LEBANON WAR

Despite Rabbi Shlomo Goren’s reluctance in his 1979 responsum to allow
banking of kidneys and corneas, during his tenure as chief rabbi, the issue
of banking skin in Israeli hospitals came to the fore. It turned out that
due to rabbinic pressure against retrieving skin for a skin bank, there was
an insufficient supply of skin when the casualties of the First Lebanon
War mounted. Rabbi Goren’s shift to strong advocacy for creating skin

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 Section IV – Extending the Definition of Lifesaving

banks emerges loud and clear in his responsum, which summarizes the
controversy from his vantage point.8
Rabbi Goren opens with the sad incident that precipitated the
public debate on the crisis of lack of sufficient donor skin:

‫כתוצאה מהפגיעה הקשה‬ As a result of the terrible attack against the

‫בחיילי צה“ל שהיו במשאית‬
‫הספארי בלבנון ואשר כתוצאה‬
‫ חיילים ונפגעו‬12 ‫ממנה נהרגו‬
‫ פורסם‬,‫רבים בכוויות קשות‬
‫להפתעת אזרחי ישראל כי‬
‫קיים בארץ מחסור חמור‬
‫ בעקבות‬,‫בעור אדם להשתלה‬
‫סגירת בנק העור בבית חולים‬
‫ לכן היה‬.‫“הדסה“ בירושלים‬
‫צורך ליבא עור אדם להשתלה‬
.‫מהולנד‬
Israeli soldiers in a Safari truck in Lebanon
that led to the death of twelve soldiers and
many others injured with severe burns,
the fact was publicized – to the bewilder-
ment of Israeli citizens – that the country
has a serious shortage of human skin for
grafting, due to the closure of the skin
bank in Hadassah Hospital in Jerusalem.
Therefore, there was a need to import
human skin for grafting from Holland.

‫כמו כן התפרסם באמצעי‬ Additionally, the reason for the closing of

‫התקשורת שסיבת סגירת‬
‫בנק העור היתה התנגדות‬
,‫של הרבנות לקיום בנק העור‬
‫ כי לפי ההלכה‬,‫שפסקה כביכול‬
‫אין להוריד עור מהמת ולשמרו‬
‫כדי להשתילו בעתיד באדם‬
‫ או שמא נאסר‬,‫שיפגע בכוויות‬
‫להסיר עור אדם יהודי אפילו‬
‫לצורך השתלה של העור‬
,‫בנפגעי כוויות עמוקות בהוה‬
‫על אף שיש בזה משום פקוח‬
.‫נפש ממש‬
the skin bank, as publicized on the radio,
was the objection of the rabbinate to estab-
lishing a skin bank, since it rendered a
pesaq, as it were, that according to halakha,
skin may not be removed from a cadaver in
order to store it for future grafting onto a
person with severe burns. And perhaps it is
forbidden to remove skin from the corpse
of a Jew even for the purpose of transplan-
tation onto victims of severe burns waiting
[for a graft], even though this could liter-
ally be a lifesaving gift.

8. Shlomo Goren, “Grafting Skin onto Burn Victims and Establishing a Skin Bank in
Hospitals,” Ha-Tzofeh, March 22, 1985; reprinted in Shlomo Goren, Torat ha-Refu’a
( Jerusalem: Ha-Idra Rabba Press, 5761), 150–61 [Hebrew].

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 Chapter 21 – Skin Grafts and Skin Banks

‫מכיון שאין יודעים מי פסק‬ Since we do not know who offered this
‫לאסור על קיום בנק עור ומי ציוה‬ pesaq forbidding the maintaining of a skin
‫לסגור את בנק העור בבית חולים‬ bank and who ordered the closing of the
‫“הדסה“ ירושלים או בכל בית‬ bank in Hadassah Hospital in Jerusalem or
‫ דבר שהצריך‬,‫חולים אחר בארץ‬ in all other hospitals in the state – a deci-
‫ עלינו‬,]‫יבוא עור מחו[ץ] ל[ארץ‬ sion that ended up requiring the importa-
‫ללבן סוגיא זו על כל היבטיה‬ tion of skin from outside Israel – we will
.‫ההלכתיים ורפואיים כאחד‬ take the opportunity to clarify the issues,
both halakhic and medical, in this matter.

Rabbi Goren’s dismay at the closing of the skin banks and the
need to import skin stands out clearly in his introduction. He is livid
at the unknown posqim and their irresponsible decision. The first point
Rabbi Goren tackles in his discussion is what he sees as the problem
of importing skin or organs from other countries to service Israeli burn
victims:

‫השימוש בעור מיובא של גויים‬
‫כדי לרפא את פצועינו אינו‬
,‫יכול להיות פתרון לבעיא‬
‫משום שזה מהווה חילול השם‬
‫ בחשבם‬,‫לעיני כל העולם‬
‫כי תורת ישראל וההלכה‬
‫היהודית אין בכוחן כביכול‬
‫לפתור את הבעיות החיוניות‬
.‫ביותר של חיינו בארץ‬
The use of imported skin from gentiles in
order to treat our own wounded cannot
be considered a solution to the problem,
for doing so brings about a desecration of
God’s name before the entire world. They
will think that the Torah of Israel and Jew-
ish law do not have the power, as it were, to
solve the problems most critical for the life
of the country.

‫והרי ביסוד האמונה שלנו הוא‬
‫הכתוב “ושמרתם את חקתי‬
‫ואת משפטי אשר יעשה‬
“‘‫ אני ה‬,‫אתם האדם וחי בהם‬
‫ ובדאי שזה‬... .)‫ ה‬,‫(ויקרא יח‬
‫בזיון התורה אם נזדקק לעור‬
‫של מתים נכרים להצלת חיי‬
.‫הפצועים שלנו‬
Yet it is an article of faith among us, as
stated in a verse (Lev. 18:5): “you should
keep My statutes and My laws that a per-
son should practice and live by; I am the
Lord”.… Certainly it causes contempt for
the Torah if we need to resort to the skin
of [imported] gentile cadavers in order to
save the lives of our wounded.

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 Section IV – Extending the Definition of Lifesaving

Rabbi Goren believes that importing skin to solve an Israeli cri-

sis is tantamount to admitting the inadequacy of the Torah to solve the
problems of the Jewish state. Behaving this way will mark Jews, Israel,
and Torah as backward and in need of Western support to function.
This is a striking position to take, especially in light of the suggestion
taken on autopsy by the first Ashkenazic chief rabbi of Palestine, Rabbi
Avraham Yitzĥak Kook, who argued that the world would understand
if Israel needed to import gentile bodies. Rabbi Goren clearly believed
the opposite. The inability of a Jewish society to solve its own problems
would be a public admission of the inadequacy of Judaism as a religion
and Israel as a society.
Rabbi Goren next details how the skin banks originally were cre-
ated under his guidance (a fact that goes some way to explain his ire at
a group of unnamed rabbis undoing what he created):

‫בהתגבר הטרור בארץ לפני‬ When terrorist attacks became rampant

‫ פנה אלי מנהל המחלקה‬,‫שנים‬
‫לכירורגיה פלסטית בבית‬
,‫חולים “הדסה“ בירושלים‬
‫ובקשתו בידו להתיר להקים‬
‫ כדי להיות‬,“‫בנק עור ב“הדסה‬
‫מוכנים לכל פגיעה המונית‬
‫ לאחר דיון‬.‫שלא תבוא‬
‫משותף הוא קיבל ממני היתר‬
‫לרכז ב“הדסה“ מלאי של עור‬
‫ והמלאי היה‬,‫מהרוגים וממתים‬
‫ כאשר מנהל‬,‫קיים עד לפני שנה‬
‫בית החולים “הדסה“ קיבל עליו‬
‫משום מה את מרות הפסיקה‬
,‫של העדה החרדית בירושלים‬
.‫וביטל את בנק העור‬
some years ago, the director of the depart-
ment of plastic surgery at Hadassah Hospi-
tal in Jerusalem turned to me with a request
to permit the establishment of a skin bank
at Hadassah in order to be prepared for
any possible large-scale terrorist attack that
might occur. After we looked into the issue
together, he received permission from me
to organize in Hadassah a reserve of skin
from cadavers, and this reserve was in exis-
tence up until a year ago, when the direc-
tor of Hadassah Hospital decided for some
reason to accept the authority of the Eida
ha-Ĥaredit in Jerusalem and discontinued
the skin bank.

Rabbi Goren describes having worked with the director of Hadas-

sah Medical Center’s department of plastic surgery to start a skin bank and
that after Rabbi Goren’s tenure as chief rabbi came to a close, Hadassah

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 Chapter 21 – Skin Grafts and Skin Banks

turned to other sources for a halakhic decision and following the new rec-
ommendation, closed the storage bank. Whether Rabbi Goren’s descrip-
tion is fully accurate we do not really know. Nevertheless, it is interesting
that he flings the accusation at the Eida ha-Ĥaredit and not at his successor,
Rabbi Avraham Shapira.
If the latter was not involved in the change of policy, then the
hospital shifted its policies to accommodate the Ĥaredi Orthodox in
the years between Rabbi Goren’s initial consultation and the closing
of the bank. Since Hadassah is not a formally Orthodox organization,
one can guess that the shift probably reflected the growing percentage
of Ĥaredim in Hadassah’s patient constituency – hence the need to be
approved by the Eida ha-Ĥaredit in order to obtain patients.
Having described this situation, Rabbi Goren continues with
a discussion of the tragic realities facing Israel during the outbreak of
the First Lebanon War ( June 1982) and what he did to help solve the
problem:9

‫כשביקרתי את הפצועים בבית‬ When I visited the injured [soldiers] in

‫ עם פרוץ‬,‫חולים “רמב“ם“ בחיפה‬
‫ ביניהם‬,‫מלחמת שלום הגליל‬
‫נפגעים רבים וקשים מכוויות‬
‫ שאלו אותי‬,‫מקרב חיילי השריון‬
,‫מנהל בית החולים והמנתחים‬
‫אם מותר להשתמש בעור של‬
‫הרוגי המלחמה והרוגי תאונות‬
‫ לצורך השתלה בפצועי‬,‫דרכים‬
‫ שלגבם השתלה כזו היא‬,‫הכוויות‬
.‫פקוח נפש להציל את חייהם‬
Rambam Hospital in Haifa when the
Lebanon War first broke out, among them
were many from the Armored Corps who
had been severely injured with burns. The
director of the hospital and the surgeons
asked whether it was permitted to use skin
from people killed either in the war or in
car accidents for grafting onto the burn
victims. Some of them needed a skin graft
in order to save their lives.

9. The section is titled:

‫עם פרוץ מלחמת של“ג התרנו לבית‬ With the commencement of the Lebanon War,
.‫החולים רמב“ם לרכז מלאי עור אדם‬ we permitted Rambam Hospital in Haifa to
create a reserve of human skin.

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 Section IV – Extending the Definition of Lifesaving

‫נוכחתי לראות שככל שנתרבו‬
‫הפצועים של חיילי השריון ושל‬
‫ הוחמרה‬,‫אחרים עקב ההפגזות‬
‫יותר ויותר הבעיא הרפואית‬
‫ אז נתתי להם היתר מידי‬.‫הזו‬
‫להשתמש בעור ההרוגים‬
.‫להצלת חייהם של הפצועים‬
I saw for myself that as more injured sol-
diers from the armored brigades or others
arrived injured by explosives, the medical
problem [of untreated burns] became
more severe. So I gave them immediate
permission to use the skin of cadavers
to save the lives of the injured [soldiers].

Rabbi Goren does not speak of any deaths, though later on in the
responsum he states that the grafts literally saved people’s lives. Thus one
wonders: as there was a shortage of skin to use for grafts on burns, did
people die for lack of treatment (until skin was imported from abroad)?
It seems likely. Again we see that insistence on not changing past rulings
has consequences in real life – possibly including deaths. This violates
the principle of va-ĥai ba-hem, “and live by [the commandments].” In
Maimonides’ words, such rulings turn the Torah’s laws into “neqama” –
the retaliation of a vengeful, angry God.10
Seeing the horrible plight of the burn victims during the Leba-
non War, Rabbi Goren gave his blessing to the creation of a skin bank
in Rambam Hospital. He understood, however, that this was not exactly
the same thing as permitting the opening of a skin bank during peace-
time, as during wartime, the hospitals are constantly filled with victims.
Rabbi Goren himself points out this conceptual and halakhic jump in
the next paragraph:

‫התשובה היתה במקרה זה קלה‬
‫ מכיון שמחד גיסא ברור‬,‫יותר‬
‫שיש בשימוש בעור ההרוגים‬
‫לצורך השתלה פקוח נפש מידי‬
‫ שהיו ביניהם קשים‬,‫של הפצועים‬
‫ כפי שנוכחתי לראות במו‬,‫ביותר‬
‫ ואשר כתוצאה מהשתלות‬,‫עיני‬
‫אלו נותרו בחיים רבים מן‬
In this case, the answer was easier, since
for one thing, it was clear that the use
of cadaveric skin for grafting was for
the immediate lifesaving benefit of the
injured, some of whom were in a most
serious condition, as I saw with my
own eyes. Many of the injured patients
remained alive as a result of these grafts.

10. Maimonides, MT Laws of Shabbat 2:3.

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 Chapter 21 – Skin Grafts and Skin Banks

‫ ואני מכיר אחדים מהם‬,‫הפצועים‬ I know some of them who recovered

‫שהם נתרפאו לגמרי מפצעיהם‬
‫ מאידך גיסא‬.‫על ידי ההשתלות‬
‫הפצועים שהיו זקוקים להשתלה‬
‫ ואז‬,‫היו לפניני בבתי החולים‬
‫ברור כי פקוח נפש דוחה כל‬
...‫איסורי תורה‬
completely from their injuries due to the
transplants. Additionally, the patients
who required skin grafts were before us
in the hospital, in which case it is clear
that lifesaving overrides any prohibition
in the Torah…

‫והנה הבעיה שעמדה בפנינו‬ The problem before us that needs to be

‫ אינה אם‬,‫ושיש לדון בה‬
‫מותר להשתמש בעור המת‬
‫כדי להשתילו בפצועי קרבות‬
‫שלפנינו כאשר יש בזה פקוח‬
‫ אלא אם מותר להקים‬,‫נפש כנ“ל‬
‫בנק של עור אדם כדי שיהיה‬
‫מלאי עור לכל מקרה של פציעה‬
‫המונית חו“ח בעתיד לנפגעי‬
‫ ולא רק בעת‬,‫כוויות קשות‬
.‫מלחמה‬
of war.
discussed is not whether it is permitted
to use cadaveric skin in order to graft it
onto injured soldiers before us when
such a thing could save the person’s life,
but whether it is permitted to create a
bank of human skin in order to main-
tain a reserve of skin for cases of mass
injury, God forbid, that could occur in
the future, which might include severe-
burn victims, and not only during a time

‫זו היתה שאלתם של הרופאים‬
“‫מבית החולים “הדסה‬
‫ זמן רב לפני מלחמת‬,‫בירושלים‬
‫ המלאי הזה של‬.‫שלום הגליל‬
]‫עור אדם מהרוגי תאונות וכי[ו‬
‫צ[א] ב[הם] שעורם כשיר יותר‬
‫ יהיה מוכן ומיועד‬,‫להשתלה‬
.‫לכל שעת חרום‬
This was the question asked of me by the
doctors from Hadassah Hospital in Jeru-
salem many years before the outbreak of
the Lebanon War. This reserve of human
skin from car accident victims and the
like whose skin is well-suited for graft-
ing would be ready and available in case
of emergency.

Having explained the history of the situation in Israel and the

palpable need for a reserve of human skin even during peacetime, Rabbi
Goren dedicates most of the article to the halakhic defense of skin grafts
and organ storage. Much of his defense is built upon the position dis-
cussed above taken by Rabbi Karelitz (and utilized by Rabbi Shalom

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 Section IV – Extending the Definition of Lifesaving
Messas in his own defense of skin grafts and skin banks), albeit with a
Zionist twist:11
‫יש בידינו שיטה נוספת כדי‬
‫להתגבר על הבעיא שקבעו‬
‫גדולי ישראל הנודע ביהודה‬
‫ שפקוח‬,‫והחת[ם] ס[ופר] הנ“ל‬
‫נפש הוא רק כאשר החולה‬
‫נמצא לפנינו וזקוק לתרופה‬
.‫עתה כדי להצילו מסכנה‬
‫כי בררנו שאין דבריהם אמורים‬
‫אלא כאשר מדובר ברופא יחיד‬
‫שבא לעבור עבירה כדי ללמוד‬
‫ולדעת איך לרפא חולים אחרים‬
‫ במקרא זה אנו‬.‫שאינם לפנינו‬
‫אומרים שאין זה ענינו של‬
‫הרופא המיוחד הזה מה שיקרה‬
‫ ואין זה מאחריותו לדאוג‬,‫בעתיד‬
.‫לחולים שאינם לפנינו‬
‫אבל כאשר מדובר במדינה‬
‫ריבונית שהיא אחראית‬
‫ היא אינה‬,‫לבריאות הציבור כולו‬
‫יכולה להתחשב רק עם החולים‬
‫הנמצאים למשל בבתי חולים‬
‫ אלא היא אחראית‬,‫מסוימים‬
‫לתכנון בריאות העם באופן‬
‫ והיא חייבת לעשות כל‬,‫כללי‬
11. The section is titled:
‫במדינה ריבונית האחראית לבריאות‬
‫ נחשבת כל מחלה או סכנה כאילו‬,‫העם‬
.‫היא כבר לפנינו‬
Halakhic Realities - Organ Donation.indd 476
We have an additional way of overcom-
ing the problem put forward by the great
ones of Israel, the Noda bi-Yehuda and the
Ĥatam Sofer, discussed above, that an act is
defined as lifesaving only if the sick ­person
is before us and in need of immediate
medical attention to save him from danger.
We have made it clear that their words
apply only to an individual doctor who
wishes to violate a prohibition in order to
learn how to treat other sick patients who
are not before him. In such a case, we say
that what might happen in the future is
not relevant to this specific doctor, and
it is not his responsibility to worry about
patients who might appear in the future.
However, when we are speaking about
a sovereign country responsible for the
health of its entire population, it cannot
think about only the sick people found
now, for instance, in particular hospitals.
Rather, it is responsible for planning
for the health of the nation in general,
and it must do all in its power to create
In an independent country responsible for
the health of its people, any illness or danger
must be considered as if it is already before us.
476
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 Chapter 21 – Skin Grafts and Skin Banks

‫שביכולתה כדי להכין מלאי‬ a reserve of medications of the highest

‫תרופות ברמה הגבוהה ביותר‬
‫כדי לרפא גם חולים או פצועים‬
,‫ ואם לא תנהג כן‬.‫בעתיד‬
,‫ולא תכין מלאי של תרופות‬
‫הרופאים יהיו כאילו שופכי‬
...‫דמים‬
possible order so that it can treat sick or
injured patients in the future. If it did not
behave this way and it did not prepare
a reserve of medications, these doctors
would be akin to murderers…

‫מזה יוצא שהמדינה שהיא‬ From this it follows that a country

‫אחראית לבריאות העם חייבת‬ responsible for the health of its citizens
‫לדאוג גם בשעת חירום לכל‬ is obligated to concern itself with pre-
‫הציוד הרפואי הדרוש ברמה‬ paring for emergency situations with
‫ ואם לא עשו כן ולא‬,‫הגבוהה‬ adequate stock of medical supplies of
‫דאגו לרמה הרפואית הגבוהה‬ the highest quality. If the authorities do
...‫ כאילו שפכו דמים‬,‫של רופאיה‬ not do this, if they do not concern them-
selves with supplying medical assistance
of the highest quality, it is as if they have
murdered people…

‫באחריות שכזאת אין להבחין‬ With this kind of responsibility, we

‫בין אם החולה לפנינו לבין אם‬ should distinguish not whether the sick
.‫ אלא שעתיד לבוא‬,‫אינו לפנינו‬ person is before us or is not before us,
but whether the patient will show up in
the future.

‫יוצא גם לפי שיטתו של הגאון‬ From this it follows that according to

‫ שמכיון‬,‫החזון איש זצ“ל הנ“ל‬ the position of the great Ĥazon Ish,
,‫שבמדינה של מיליוני תושבים‬ since the state has millions of inhab-
‫כל סוגי המחלות גם המסובכות‬ itants, and every sort of illness, how-
‫ ועלינו לטפל‬,‫הם שכיחות‬ ever extraordinary, is common, and we
‫ נחשב תמיד‬,‫למניעתן ולריפויין‬ need to deal with these [illnesses], both
.‫כאילו החולה לפנינו‬ preventing them and treating them,
it is always considered as if the sick
person is before us.

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 Section IV – Extending the Definition of Lifesaving

‫ מלבד שכיחות המחלות‬,‫כמו כן‬ Similarly, in addition to the ­pervasiveness

‫ גם משום‬,‫בקרב ציבור גדול‬ of all illnesses in a large population,
‫שבמדינה ריבונית האחראית על‬ no independent state responsible for
‫ אי אפשר‬,‫בריאות הציבור כולו‬ the health of the entire population can
‫להבטיח את הרמה הרפואית‬ ­possibly guarantee the proper level
‫הנאותה אלא א[ם] כ[ן] יתכננו‬ of ­medical intervention unless all is
‫ בבחינת‬,‫ויכינו את הכל מראש‬ planned and prepared in advance, as
.‫סוף מעשה במחשבה תחילה‬ the phrase goes: “The final action
is rooted in initial thought [i.e.,
­planning].”

Here Rabbi Goren makes the leap to the difference

between  a  doctor’s individual responsibility and the responsi-
bility of a sovereign state – the same leap made by Rabbi Yeĥiel
Ya’aqov Weinberg in his letter on autopsy. As a sovereign state,
Israel must  make  decisions that will affect millions of people. On
a scale  of  this magnitude,  the question of whether a given disease
is “before us” becomes  moot. Virtually any disease is manifest to
some degree in a population of this size. Furthermore, a state must
be prepared in advance for any exigency, so even if there is only the
possibility of a future outbreak of a disease, the state must be pre-
pared, and as Rabbi Goren puts it, equipped with the highest level of
medical treatment. Otherwise, the government fails its citizens and
jeopardizes their lives.
Tying this point in with his previous points, for Israel to fail its
citizens due to a “Torah law” would be the ultimate insult to the Jewish
God and God’s Torah, as its ineffectiveness as a source of wisdom for
governance would be exposed to all. For the Torah to be a Torah of life,
it is necessary that it not condemn citizens of a Jewish country to death
due to nothing more than its own inability to grow or to overcome a legal
precedent – even in a new situation. Here Rabbi Goren touched upon
one of the besetting problems of the dominance of Ĥaredi posqim. Their
rulings are designed to meet the needs of their sector and often ignore
or are antithetical to the needs of a functioning state and the rest of the
population.

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 Chapter 21 – Skin Grafts and Skin Banks

Rabbi Goren finally argues that his position is not actually in con-
flict with Rabbi Landau and Rabbi Sofer, but they too would agree to it:12

‫סביר להניח שגם הנודע ביהודה‬
‫והחת[ם] ס[ופר] יורו שבעת‬
‫ או כשקיים‬,‫כוננות למלחמה‬
‫חשש לפגיעה המונית שבעטיה‬
‫יצטרכו קרוב לודאי להשתיל עור‬
‫ אפשר להפעיל לגבם את‬,‫אדם‬
‫ההלכה של פקוח נפש ולהתיר‬
‫ אלא‬,‫לא רק את ההשתלה עצמה‬
‫גם להכין מלאי גדול של עור אדם‬
‫ כדי שיהיה‬,‫מהרוגים וממתים‬
‫מוכן להצלת נפשות ונחשב‬
.‫הדבר כאילו הנפגעים כבר לפנינו‬
as if the wounded are already before us.
It is reasonable to assume that even the
Noda bi-Yehuda and the Ĥatam Sofer
would rule that in a time of preparation
for war or if there is a concern about a
possible massive terrorist attack in the
wake of which there almost definitely will
be a need for human skin, it is possible to
make use of the law of lifesaving to permit
not only the transplant itself, but also the
preparation of a large reserve of human
skin from cadavers so that it will be ready
for saving lives. This situation is considered

‫אין להשתמש בעור זה שנלקח‬
‫מהרוגים וממתים לצורך ניתוחים‬
‫ אלא‬,‫קוסמטיים של אנשים אחרים‬
‫רק לצורך ריפוי כוויות שיש בהם‬
‫ ואפילו‬.‫חשש של סכנת נפשות‬
‫ וגם כשהחשש לסכנה‬,‫בספק סכנה‬
‫רחוק – מותר לבצע השתלה של‬
‫עור ולהכין למטרה זו מלאי של‬
.‫עורות ממתים ומהרוגים‬
This skin taken from cadavers should be
used not for cosmetic surgery for others
[i.e., non-burn victims], but only for the
healing of burn victims whose lives it is
thought may be in danger. Even if the
danger is only a possibility, even if it is
improbable, it is permitted to perform
the skin graft and to prepare a reserve of
cadaveric skin for this purpose.

Tying up the loose ends, Rabbi Goren argues that even the posqim
who require the ill person to be “before us” and the cutting of the body

12. The section is titled:

‫לדעת כל הפוסקים מותר להכין מלאי‬ According to all posqim, it is permitted
‫של עורות ממתים לריפוי נפגעי כוויות‬ to prepare a reserve of cadaveric skin for
.‫בשעת חירום‬ the treatment of burn victims in times of
emergency.

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 Section IV – Extending the Definition of Lifesaving

to be directly lifesaving would accept both his main points, namely, that a
skin graft for a burn victim should be considered a potentially lifesaving
treatment and that the state is responsible for being reasonably prepared
for emergency situations by maintaining a reserve of cadaveric skin.
Note that Rabbi Goren forbids using this stored skin for cosmetic
surgery. Although this may reflect a general position of Rabbi Goren on the
question of the permissibility of using cadaveric skin for cosmetic surgery,
it is likely a reflection of the nature of his argument in this case. Since he
believes that a skin graft for burn victims should be considered lifesaving,
this allows him the argument that hospitals may take the skin even with-
out prior consent of the deceased; next of kin consent would be enough.
Without this lifesaving factor, it would be impossible to make such an argu-
ment. In effect, if cadaveric skin were to be used in elective, cosmetic sur-
gery, then prior consent of the deceased would have to be obtained as per
R. Ettlinger’s position (discussed in the first essay on autopsy). But he knows
that this will lead to a shortfall and he does not wish to go down that path.
Note that unlike the more technical approach suggested by Rabbi
Yisraeli, Rabbi Goren opts to focus on extending the definition of lifesav-
ing. He does this both by pushing the potential danger to burn victims
who do not receive skin grafts and by extending the responsibility for
lifesaving to the state itself, as opposed to the individual doctor. Never-
theless, Rabbi Goren is not one to pass up an opportunity to back up his
argument with technical points as well, and he accepts the basic premise
of Rabbi Yisraeli’s analysis. He expresses this best in a short summary of
his thoughts on skin banks in the final section of a different introductory
piece laying out his thoughts on organ donation in general:13

‫ביחס להבחנות בין סוגי‬ With reference to the distinctions between

‫ יש לציין כי‬,‫ההשתלה השונים‬
‫מבחינת ההלכה קיים הבדל‬
,‫עקרוני גדול בין השתלת לב‬
‫ לבין השתלת עור‬,‫כליות וכבד‬
.‫וקרנית עין‬
different forms of transplantation, it should
be noted that halakhically speaking, there
is an essential difference between trans-
planting a heart, kidneys, or a liver and
transplanting skin or a cornea.

13. Shlomo Goren, “Introduction to Organ Transplantation Through the Prism of Halakha,”
in Torat ha-Refu’a (Jerusalem: Ha-Idra Rabba Press, 5761), 79–83 [“Skin Bank,” 82–83].

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 Chapter 21 – Skin Grafts and Skin Banks
‫במאמר מיוחד שפרסמתי בנושא‬
,‫השתלות עור בנפגעי כוויות‬
‫נתברר שכל שלשת איסורי‬
‫תורה הכרוכים בהשתלות של‬
‫ אינם‬,‫ כפי שמנינו לעיל‬,‫אברים‬
.‫קיימים בהשתלות עור וקרנית‬
‫אין בהפשטן מן האדם איסור‬
‫ אין עליהם איסור‬.‫ניוול המת‬
.‫הנאה ולא מצות קבורה‬
mandment to bury them.
‫ עוד לפני‬,‫לכן התרתי בזמנו‬
‫ לבית חולים‬,‫מלחמת של“ג‬
‫ להקים‬,‫“הדסה“ בירושלים‬
‫ כדי להיות‬,‫מאגר של עור אדם‬
‫ערוכים ומוכנים לקראת כל‬
‫ אם חס‬,‫מצב מלחמתי שיתפתח‬
‫וחלילה יתרבו נפגעים מקרב‬
]‫החיילים שבטנקים וכיוצ[א‬
.]‫ב[הם‬
‫אולם להפתעתי נשבה רוח‬
.“‫אחרת בבית חולים “הדסה‬
‫ההנהלה פזלה לעבר מנהיגי‬
,‫העדה החרדית בירושלים‬
‫ולפי ההוראות שלהם ביטלו‬
.“‫את בנק העור ב“הדסה‬
‫התוצאה המידית היתה‬
,‫שכאשר פרצה מלחמת של“ג‬
‫ כדי‬,‫לא היה להם עור אדם‬
‫לעמוד בדרישות הגוברות‬
,‫והולכות של הפצועים‬
‫ בדלית ברירה‬.‫שהועברו לשם‬
‫נאלצו לבושתנו לייבא עור‬
.‫אדם של נכרים מהולנד‬
Halakhic Realities - Organ Donation.indd 481
In an article I published specifically on the
topic of skin grafts for burn victims, it was
clarified that the three Torah prohibitions
relevant to organ donations…do not apply
to the transplantation of skin or corneas.
Removing them from a corpse does not
violate the prohibition to desecrate the
dead. There is neither any law prohibiting
receiving benefit from them nor any com-
For this reason, I gave permission even
before the outbreak of the Lebanon War
to Hadassah Hospital in Jerusalem to
establish a skin bank in order to be ready
for any situation of war that might arise,
in case, God forbid, there were many
wounded in tank battles or the like.
Nevertheless, to my surprise, the winds at
Hadassah Hospital were blowing a differ-
ent way. The administration slunk toward
the leaders of the Eida ha-Ĥaredit in Jeru-
salem and following their guidelines,
discontinued the skin bank in Hadassah.
The immediate consequence of their
doing so was that once the Lebanon
War had broken out, they did not have
any human skin in order to deal with the
ever-increasing demands of the injured
who had been sent there. As there was no
choice, we were forced – to our shame – to
import gentile human skin from Holland.
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Although Rabbi Goren was an outspoken advocate of all forms of

organ donation, including of hearts and kidneys, this did not stop him
from making the technical argument here. The import of the distinction
he makes is that even those who are bothered by the application of the
brain death definition to halakha and even those who are bothered by
the argument for autopsy in halakha should be able to accept skin grafts
and corneal grafts as permissible for technical reasons (such as Rabbi
Yisraeli’s argument that the prohibition of receiving benefit from a corpse
does not apply to skin or Rabbi Frank’s argument that it does not apply
to a cornea since it is smaller than an olive).
It is striking that Rabbi Goren yet again takes the opportunity
to vent about the closing of the skin bank in Hadassah Medical Center.
Here, instead of calling it a desecration of God’s name, he calls it a source
of shame, but the meaning remains the same. Rabbi Goren understands
that for halakha to have relevance in modern Israel, it must take active
responsibility for real-life problems in society, as opposed to advocat-
ing for theoretical, non-workable or minimally workable solutions to
problems. For Rabbi Goren, the failure of an Israeli hospital to prepare
properly for the needs of its patients, current or future, is a blot on the
reputation of Israel, Torah, Jews, and God. This blot haunts Rabbi Goren
as it should haunt any Torah authority in Israel charged with deciding
responsibly on issues of life and death and representing these decisions
to the larger world.

CONCLUSION
We conclude with the sage advice of Rabbi Immanuel Jakobovits from
his essay on autopsy:

‫הרופאים צריכים להבין שעמדת‬ The doctors need to understand that

‫ההלכה אינה רק ענין של פולחן‬
‫דתי גרידא אלא דבר הנוגע‬
‫לאצילות האדם שנברא בצלם‬
‫א־להים ולזכויות היחיד שאי‬
‫אפשר לסלקן באורח אוטומטי‬
‫ הם‬,‫אפילו לטובת הציבור‬
‫צריכים לדעת שגופו של אדם‬
the position taken by halakha is not just
a matter of religious worship, but some-
thing that touches upon the dignity
of humanity, which was created in the
image of God, as well as the rights of the
individual, which cannot be reflexively
pushed aside even for the benefit of the

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 Chapter 21 – Skin Grafts and Skin Banks

‫לא שייך לו ולא לקרוביו ובודאי‬ larger community. They need to under-
‫לא לרופאים אלא קנין של‬ stand that a person’s body is not owned
...‫הקב“ה הוא‬ by the said person or the person’s rela-
tives, and certainly not by the doctors,
but is a possession of the Holy One,
Blessed Be He…

‫ צריכים‬,‫ מאידך גיסא‬,‫הרבנים‬ The rabbis, on the other hand, need to

‫להעריך דרישות המחקר‬
‫הרפואי לביתור מתים לשם‬
‫הצלת נפשות במימדים של‬
‫מיליונים; להכיר את השינויים‬
‫בחכמת הרפואה שאירעו מזמן‬
‫ לשים לב‬,]‫הנו[דע] ב[יהודה‬
‫אל הסיבוכים בטענה שהרבנים‬
‫מתנגדים להגנת החיים‬
.‫והבריאות‬
14
respect the medical research require-
ment of cadaver dissection to save lives
on the scale of millions, to recognize the
changes in medical knowledge that have
taken place since the time of the Noda
bi-Yehuda, and to pay attention to the
complications caused by the claim that
the rabbis oppose saving people’s lives
and restoring their health.14

In these essays, we see how posqim who value science, medicine,

life, and modernity have been able to utilize their knowledge of Torah
and their God-given creativity to find ways to advance lifesaving while
maintaining fealty to tradition. Conversely, poor pesaq in these areas stems
from the trend of valuing traditionalism over lifesaving, as well as from
an unhealthy cynicism about medicine and doctors, as opposed to a cau-
tious optimism about the possibilities inherent in medical advancement.
Torat ĥaim – a Torah of life – can be found with those rabbis who
see their role as being partners – albeit cautious partners – to physicians
and medical specialists in assisting people to improve and extend their lives.
It cannot be found with those who see their main legacy as defending out-
moded and no longer relevant pesaqim in a desperate attempt to uphold the
fiction of a world that never changes and a static Torah that does not evolve.
The best posqim on medical ethics take the time to learn both
halakha and medical reality and can view matters from all sides. They

14. See also Rabbi Jason Weiner’s similar advice in this volume to doctors and chaplains
about proper communication and respect for each other.

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 Section IV – Extending the Definition of Lifesaving

understand the doctor’s desire to cure and the patient’s desire to be cured,
but they also understand the traditionalist’s desire to maintain the value
of respect for the dead, lest the corpse lose its halakhic significance and
the deceased lose his or her personhood and dignity.
Human dignity and human life are two values that should be
recognized by all. The doctor’s job is mainly to cure, but he or she must
also be considerate of patients’ religious sensibilities. The rabbi’s job is
not to protect traditional precedents and outlooks at the expense of the
sick and dying, but to help Jews navigate the tortuous path of halakha
so that the Torah can remain a source of life and hope in this world.

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