Halakhic Questions about Organ Transplants

What are the Jewish legal issues with organ transplantation?

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Reprinted with permission from Biomedical Ethics and Jewish Law, published by KTAV.

The halakhic (Jewish legal) issues concerning the transplantation of a human organ can be conveniently subdivided into those which pertain to the recipient, those that involve the physician or medical team, and those that primarily affect the donor.

 

In regard to the recipient, what is the status of the transplanted organ? Does it become a permanent part of the recipient, or must it be returned to the donor upon the eventual death of the recipient? The donor may long since have been buried, and his identity and/or burial site may not be known.

Furthermore, where a diseased organ such as a heart, liver, or lung is removed before implantation of a new organ, what does one do with the “old” or diseased organ? Can one just discard it? Must it be buried? Can one incinerate it or place it in formalin for preservation? Must it be treated with respect as part of a human being who was created in the image of God? This problem is not unique to organ transplantation but applies to any organ or part removed from a living human being. Thus, the rabbis discuss whether or not a gallbladder, stomach, uterus, appendix, foot, leg, or other diseased organ or limb removed at surgery or traumatically avulsed requires burial. An entire chapter in Rabbi Joseph Karo’s code of Jewish law [the Shulkhan Aruch] is devoted to this question.

Another halakhic question is whether or not the recipient is allowed to subject himself to the danger of the operative procedure. In Judaism, it is not proper to intentionally wound oneself for no valid medical reason. Does this rule apply to surgery in general and to an organ transplant in particular? Furthermore, does the recipient transgress the biblical commandments “Take heed to thyself” and “Keep thy soul diligently and take ye therefore good heed unto yourselves,” which both the Talmud and Maimonides interpret to mean the removal (i.e., avoidance) of all danger to one’s physical well‑being?

Another Jewish legal issue concerns a recipient who is a priest (kohen). The latter is commanded not to become ritually defiled by corpse contact. Does this question of ritual defilement apply to an organ from a dead donor which is now to be implanted into a priest?

Finally, what are the halakhic priorities, if any, for choosing a recipient in view of the shortage of organ donors? In Jewish law, a woman takes precedence over a man when both desperately need food because it is less dignified and more shameful for a woman to go begging than a man. A woman is ransomed before a man if both are captives, but a man takes precedence over a woman if both are drowning because he is subject to more commandments. Additional priorities are enumerated in the Talmud. Do any of these priorities apply to organ transplant recipients? Should medical criteria be used exclusively in the selection of recipients?

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Dr. Fred Rosner

Dr. Fred Rosner is Director of the Department of Medicine of the Mount Sinai Services at the Queens Hospital Center and Professor of Medicine at New York's Mount Sinai School of Medicine. He is a diplomat of the American Board of Internal Medicine and a Fellow of the American College of Physicians.