The genesis of this essay began with an inquiry by the Jewish Action editors as to whether there is enough novel or substantive material about the halachic issues of living kidney donation to merit an article.
“It seems clear that kidney donation is permitted, though not obligatory. Is there anything else to discuss?” it was queried. While this assessment is technically absolutely correct, it is perhaps instructive to place this halachic ruling in historical and halachic context to gain an appreciation as to how we have come to take for granted the halachic permissibility of surgically removing a vital organ from one human being and transplanting it into another.
The Talmud states that the kidneys give advice (Berachot 60a). While the exact meaning of this Talmudic pronouncement remains elusive, the anatomical and physiological functions of the kidney are well established in modern medicine. The treatment of kidney failure has evolved, with the first artificial kidney (dialysis) machine invented in the 1940s and the first kidney transplant occurring in 1950.
Posekim began discussions about living kidney transplants shortly thereafter. The major halachic issue addressed was the nature of risk involved for the donor. While the verse in the Torah “Do not stand idly by as the blood of your brother is shed” obligates us to save the life of one in danger, how much risk can one assume in order to save another? In the case of kidney donation, there is both the immediate risk of the surgical procedure, as well as the long-term risk of living with only one remaining kidney.
The analyses of the posekim revolved around risk assessment. In the very early days of kidney transplantation, a number of rabbinic authorities, including Rabbi Eliezer Waldenberg and Rabbi Yitzchak Weiss, forbade one to serve as a living kidney donor due to the intolerable level of risk involved for the donor. As with all medical halachic matters, however, updating the information is essential. Living organ donation is now commonplace; the donor risk has been well studied and quantified, and the success rate has significantly improved and is well within the halachically accepted risk category. In fact, no posek today forbids live kidney donation, and many, though stopping short of declaring it obligatory, encourage donation and consider it to be an extraordinary mitzvah.
Today, we rarely come across a Jewish periodical without an ad seeking a kidney donor, and there are organizations devoted to encouraging living kidney donation. The current halachic state of kidney donation is most beautifully reflected in a sefer aptly titled Klayot Yoatzot (The Kidneys Give Advice), which describes the following case: A man was told by his physician that he was in need of a kidney transplant. Upon returning home, one of his many sons was there to receive the news. The son immediately rushed to the hospital to begin the process of donor testing. Upon his return from the hospital, he was met by his brothers, all of whom likewise wished to be tested and all laid claim to the privilege of being their father’s kidney donor. How would they determine which son would serve as a donor for their father? They were unable to resolve the dispute and thus approached a prominent posek. The entire sefer is an analysis of the halachic issues relevant to the resolution of this question.
Aside from kidneys, other organs can also be donated from living donors, such as bone marrow, a lobe of the lung, and a lobe of the liver. From a halachic point of view, there are many questions related to living organ donation that require detailed analysis, including:
1. Is it permissible to receive compensation for kidney or bone marrow donation? If so, in what form, and how much?
2. Can one travel to other countries to receive organs when the circumstances surrounding the organ donor and harvest are somewhat dubious?
3. Can one harvest a kidney from a katan (minor) who is unable to consent to the procedure?
4. Can one demand the return of one’s kidney after the transplant has occurred?
5. Are bone marrow, liver or lung donations halachically comparable to kidney donation?
6. If one is found to be a bone marrow match to an anonymous recipient, is one halachically obligated to serve as a donor?
These questions and many others are addressed in halachic literature.
As human kidney transplantation has evolved since its inception some sixty years ago, we have also witnessed advances in medicine and science that may soon render human organ transplantation obsolete. Both xenotransplantation (the transplantation of animal organs into humans) and stem cell research have made limited strides, in different ways, in addressing the need for organs. Neither requires the involvement of, and attendant risk to, a human donor. The chapter in the Jewish medical ethics textbook on living kidney donation may soon be excised and relocated to the volume on the history of Jewish medical ethics.
Living organ donation is a truly unparalleled act of chesed. I am confident that such individuals who would consider donating their organs will, im yirtzeh Hashem, find other ways to channel their desire to help Klal Yisrael. But for now, as living kidney donation in the Jewish community is on the rise, if the kidneys’ advisory powers are transferred to the organ recipient, then we will doubtless continue to see an increase in extraordinary acts of true chesed and hatzalat nefashot in the world.
Dr. Edward Reichman is an associate professor of emergency medicine and associate professor in the Division of Education and Bioethics at the Albert Einstein College of Medicine of Yeshiva University. He received his rabbinic ordination from the Rabbi Isaac Elchanan Theological Seminary and writes and lectures internationally in the field of Jewish medical ethics.