Modern medical technology has made it possible to transplant hearts, kidneys, pancreases, corneas, lungs, and livers from one human being to another. Organs can be transplanted from a dead person to a live person if certain post-mortem conditions are maintained, and organs like kidneys (of which most people have two) can even be transplanted from a live volunteer donor. Initially, there were many ethical and halakhic questions regarding organ transplants. Now, however, there is an unusual amount of official—even cross-denominational—agreement about the solutions to these questions.
With all transplants there is a danger of rejection and complication. Any time a person receives an organ there is the possibility of experiencing more harm than good. In addition, a live donor risks complications from donor surgery. Deuteronomy 4:9 commands, “Take heed to thyself and keep thy soul diligently,” and this verse was interpreted by the Talmud and by Maimonides to mean that a person is obligated to avoid dangerous situations. Can a person ever purposely endanger herself? This is one of the primary ethical questions in regards to organ donation, both for the donor and the recipient. Many of the other questions about organ donation revolve around the treatment of a dead donor. Jewish law prohibits deriving benefit from a cadaver, mutilating a dead body, and delaying burial. All of these laws must be transgressed in order to transplant organs.
However, according to most authorities, all of these concerns are overridden by a single halakhic (legal) concept: pikuach nefesh—the Jewish obligation to save lives. Thus a person is allowed to put herself in a reasonable amount of danger if it is likely to save a life. In addition, we may waive the normal prohibitions regarding cadavers when a person’s life is at stake.
Ultimately, the critical issue with organ donation is defining the moment of death. According to the Talmud, a person is considered dead when a feather held below his nose doesn’t move and when an ear pressed against his chest does not detect a heartbeat. However, defining death these days is not so easy. One’s heartbeat can be maintained by machine even after one loses brain stem function and the ability to breath on one’s own. Do we define death as the cessation of brain activity or heart activity? As long as a person’s heart still beats, organs can routinely be harvested, even if brain activity has ceased. However, once a heart stops beating, organs are deprived of oxygen, and it becomes more difficult to successfully remove and transplant them. If Judaism defines death as cessation of brain activity, than organ transplants are a viable option for Jews. If we define death as cessation of heart activity, then removing an organ prior to this point would be murder. Pikuach nefesh does not override murder; one cannot kill someone to save another’s life.
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