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Rabbi Goldie Milgram
Rabbi Goldie Milgram

Living Judaism

The Living Judaism feature in each issue focuses on Jewish spirituality, meaning and activism with invited columns written by rabbis belonging to the various movements of Judaism. Jewish clergy interested in writing for Living Judaism are invited to make contact with Rabbi Goldie Milgram at judaism @

What does Judaism have to say about organ donation?
Rabbi Dr. Goldie Milgram,

Living a mitzvah-centered life is the spiritual essence of being a Jew. Organ transplantation and donation were once strongly limited by Jewish law because they were experimental and endangered life, today these are essential, successful medical life-saving methods. Accordingly, organ donation has become a mitzvah chiyuvit, an obligatory mitzvah, fulfilling Judaism's great mitzvah of pikuakh nefesh, that of saving a life. So long as it will not significantly risk your own 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 danger and distress to the donor.

Three verses from Torah frame the sources 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]. 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 also become obligatory.

Depending upon your age, this may all sound rather different to how you might remember Jewish tradition on the topic of organ donation. Once opposed, Jewish law and practice on organ transplantation and donation has changed dramatically, which is the beauty of Judaism as a living, evolving tradition. And amazingly, despite very different ways of coming to their decision ? virtually the full spectrum of Judaism, with only some ultra-orthodox rabbis dissenting due to issues they have on how death must be determined, agree that post-mortem organ donation is an obligatory mitzvah. . 

Our 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. So can a Jewish person's body really be used after death for medical reasons? 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.

The model being used to discuss this question is called either psycho-halachah, or kavod lev halachah, "honoring the evolving heart of Jewish law" while taking to heart and focused attention any emotional and spiritual issues. Other issues that needed to be worked out regarding Judaism and organ donation show us more about how the halachic process works. 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. Now what to do?

Authorities in Jewish medical law delved into the sources and reviewed practices condoned by gedolim, the "greatest" halachic decisors (of Jewish law) in recent times. They found that the actual Jewish legal criterion for death was not cessation of heart beat, but rather the permanent loss of the independent ability to breathe, which our ancestors determined by observing the movement of the chest area near the heart and by the airflow from the nose, as described in the Talmud. These scholars also 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, Jewish professionals world-wide expanded to include the Chief Rabbinate of Israel which in 1986 ruled that death would be determined by l) 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 points two and three continue for at least 12 hours under full and normal treatment. These criteria have been in use for heart transplants at Hadassah Hospital at Ein Kerem since August 1987. Feeling clear and comfortable with this evolution in practice, rabbis and scholars have since begun to get the word out and all the denominations now have initiatives in place to encourage the mega-mitzvah of organ donation.

There can be significant emotional and spiritual blocks to fulfilling a mitzvah such as organ donation. It is important to ask God, a rabbi, friend, or counselor to listen and help you to work through such obstacles as fear, and attachment to your own physicality. Also, be sure everyone in your family knows about and clears any resistance they might have to your plan for your soul to fulfill this uniquely post-mortem mitzvah. There is a lot of memory out there about the former Jewish position on organ donation and sometimes family members will mistakenly and successfully block their deceased loved one's intentions out of emotional discomfort or misplaced devotion.

I recall a bar mitzvah student interpreting 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 this teaching, 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 with this approach. He replied: "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 so many more to be able to survive." 

The Halachic Organ Donor Society website offers special organ donor cards, relevant short teaching videos and excellent primary and secondary source material on this subject. The Rabbinical Council of America (orthodox affiliation) offers a Health Care Proxy Form as an option through that site. The Rabbinical Assembly (Conservative/Masorti affiliation) may be reached.on their website for information and forms. 

May you be blessed to take the time to honor and overcome any inner fears or conceptual obstacles to making the mitzvah of organ donation. Remember, whoever saves one life is considered as if [s]he had saved the entire world. [Mishnah Sanhedrin 4:6].