Jonah Rubin
MD, soon Pulmonary/Critical Care fellow, views my own.

Organ donation is not ‘taboo’ in Judaism

Organ donation saves lives and we must make every appropriate effort to increase the pool of donors. This includes education and clarification of medical or religious misinformation, the admirable stated goal of the Halachic Organ Donor Society (HODS). In yesterday’s Times of Israel, however, an article decrying “misinformation” about organ donation in the Jewish community was itself ironically and shamelessly riddled with misinformation, even slander, about Jews and organ donation in Jewish law and practice.

“Jewish communities worldwide rank among the lowest by percentage of donors – both living and posthumous.” Not only is this false and unsourced, but the opposite is true, regarding altruistic living organ donation. Jews, specifically the “ultra-Orthodox”, actually donate substantially and significantly out of proportion to their population, in rates greater than any other known group. In 2014 in the United States, “ultra-Orthodox” Jews, 0.2% of the population, donated a whopping 17% of all kidneys given to complete strangers. Far from prohibiting this noble and supremely selfless kindness, all rabbis encourage it, because, in Judaism, saving a life is among the greatest deeds one can perform. Anyone with even a cursory understanding of Jewish law appreciates how rarely the rabbinate can unanimously agree in a “controversial” area. That’s because there is nothing intrinsically controversial at all about living organ donation. It is certainly not taboo.

Like most of yesterday’s TOI article, the claim that Jews rank lowest among deceased organ donors is based purely on anecdotal evidence, some statistical acrobatics with the limited actual data available, and misrepresentation of what being a registered organ donor does, and does not, mean. The United Network for Organ Sharing (UNOS), maintains a national database on organ donation, but does not record donors’ religion. So how might one conclude that Jews donate the least?

Compared to a national average of 55%, only 30% of New Yorkers are registered organ donors. Robby Berman, founder of HODS, claims that “part of the reason for New York’s low rates is that most Jews and Chinese who live in America are concentrated in the Empire State, and those two groups tend not to donate.” The claim is statistically insignificant to the point of irrelevance. Only 0.3% of people (3 in 1,000) die in a way that allows for organ transplantation. Jews constitute less than 9% of the New York State population. Wrongly assuming that none of them are registered donors, and all of them refuse to donate for religious reasons (when the vast majority are not even remotely religious), reversing this would increase organ donation by 0.027%. Obviously, there are far fewer religious Jews, and many of them already are registered donors. Based on Mr. Berman’s anecdotal experience of some non-observant Jews with tattoos eating cheeseburgers who told him they wouldn’t donate an organ because of Jewish law, we are told that organ donation “has become a taboo of immense proportions” even among secular Jews. There is no evidence provided that such individuals constitute a meaningful percentage of this group.

Furthermore, in addition to broadly mentioning that “some ethnic and religious groups have historically discouraged organ donation,” the NYU article (cited by the TOI article itself) noted several other compelling explanations for the organ donor registration deficit in New York. “Until last year, only residents age 18 or older could register as donors, and before last year, New York was one of only four states that did not permit online registration. Moreover, many New York City residents have never applied for a driver’s license, a common venue for donor registration.”

So, if living organ donation is encouraged, why is there controversy in donating after death? Rosh Kehilah Dina Najman is correct that defacing the dead, delaying burial, or concern for incomplete resurrection of the dead are not halachic reasons to refuse organ donation. She is incorrect in saying this is why many do. Yet, there is a halachic issue, not mentioned anywhere in the TOI article, that makes many religious Jews uneasy about formally registering as organ donors. It is therefore surprising that Rabbi Steve Moskowitz is quoted as saying “As for donation after death, I can loosely say that everyone should do it; why would you not?” For a rabbi “familiar with the issue”, he is astonishingly uninformed.

The issue arises specifically with deceased organ donation, because according to Halacha, United States law, and all accepted ethical and moral standards, one may not remove a vital organ from a living person to save another person’s life. RK Najman says this herself: “One may transgress any prohibition of the Torah to save a life, so long as it doesn’t endanger one’s own life.” She erroneously left out other exceptions, and is also incomplete with this qualifier. In fact, one may, in many circumstances including via living organ donation, endanger their own life to save another, but one cannot kill oneself to save another. To donate most organs after death, the donor’s heart must still be beating, so the organ can remain perfused until the moment it is explanted. This is possible only when someone dies from brain death, not cardiac death, a medical phenomenon made possible by the development of mechanical ventilation which can keep blood oxygenated, and therefore the heart beating, even after all brain function has permanently ceased. While United States law, Western society, and many Jewish religious halachic authorities accept brain death as true death, and therefore allow donation of a brain dead patient’s organs, many other mainstream Jewish religious halachic authorities do not accept brain death as death. Rather, they consider such a patient alive, and therefore forbid removing such a person’s organs. Those whose rabbis maintain the latter position will understandably not register to become an organ donor after death, given the possibility of brain death. Judaism places such supreme value on life that the life of a critically ill person is not considered any less significant than that of a younger, healthier person who is unfortunately in need of an organ. As long as someone is considered alive, removing a vital organ would be killing them. Somehow, this most important – and only – true explanation for why some religious Jews do not register to donate organs after death is glaringly absent from the article.

It is also important to understand what being a registered organ donor does, and does not, mean. The entire concept of donor registration applies only to potential donation after someone dies, not living donations. If a selfless hero wishes to donate a non-vital organ while alive, there is no need to register. Registration for deceased donation is a way of letting society know a person’s wishes in the event of their death. Family and surrogate decision-makers, who know the patient well and can represent the deceased’s interests, can override the registration, or non-registration, of their loved one. In this way, many registered donors who are capable of donation ultimately do not. Conversely, some who have never registered ultimately do. Thus, as is common among tightly-knit ethnic and religious groups, people often prefer to rely on their family to make decisions on their passing based on the specific circumstances of their death and in accordance with their religious leaders’ advice, to donate or not to donate, without any confusion or issues from having registered or not registered.

It is surprising and disappointing that an article promoting a new, laudable educational effort to correct misinformation was so seriously inaccurate about the issues under discussion. It is highly probable that some religious Jews are unaware that their rabbi might permit deceased organ donation in certain circumstances, and we should certainly support life-saving educational interventions. Let’s counter any such misinformation with accurate information and positive efforts, without coloring the approach with one-sided libelous shaming and misrepresentation.

About the Author
Jonah Rubin received his BA from Yeshiva University and MD from Columbia University, is completing Internal Medicine residency at Columbia University Medical Center/NewYork-Presbyterian Hospital, and will be a Pulmonary & Critical Care fellow at Harvard University/Massachusetts General Hospital. He has a strong interest in the intersection of medical ethics, end of life care, and secular and Jewish law. Views are his own.
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