Organ donation – myths and reality

My Adi donor card (picture taken by A Samuels)

Having grown up and lived in a Jewish community in Manchester for most of my adult life, I was always under the impression that I couldn’t be an organ donor after my death.

I knew that live donation of a kidney, for example, was permitted. That would be a mitzvah. Post-mortem donation, as far as I was aware, however, was a strict no no. I am a Jew and as such, it simply wasn’t permitted. Or so I thought.

When I came to live in Israel five years ago, I began to wonder how a country made up of 75% Jews dealt with this issue. Where would these lifesaving organs come from? How could life saving transplants take place if most of the population were forbidden from donating?

With this in mind, I asked around and to my surprise, found that almost all of my friends here carried organ donor cards.

I had been living under a misapprehension virtually my whole life.

Instead of it being forbidden by Jewish law, organ donation is in fact seen as the ultimate Mitzvah by many Jews, including a significant number of rabbis. The chance to save a life trumps all other issues and therefore organ donation is not only permitted, but encouraged.

The way it works here in Israel is as follows.

Those who wish to donate their organs after death can do so by signing up for an Adi donor card. This card is named after Ehud (Adi) Ben Dror, who died aged 26, having been forced to wait two long years for a kidney. By the time the kidney had been found and the transplant took place, it was too late. He was too weak and his body couldn’t cope with the complications. Sadly, he passed away shortly after the operation.

During his illness, Adi expressed a wish that people should sign a register stating their willingness to donate their organs after death. Accordingly, the Adi Association was set up in October 1978.

This was a turning point for organ donation awareness in Israel as the public began to sign up for the donor card.

As the issue of organ donation became more prominent, so too did the contentious issue of the halacha surrounding it. This was and remains a source of much controversy and debate amongst rabbis across the globe.

The rabbinic ruling that organ donation is permissible so long as it is carried out in accordance with halachic laws has gone some way to settle the matter. However, some disagreement remains amongst certain rabbis, particularly over the issue of what constitutes death. For these purposes, it is widely accepted that as long as brain death has been established in accordance with a strict set of criteria, then that person is declared dead for the purposes of halacha and his or her wish to donate their organs can be carried out.

Thus we have now reached a point in Israel whereby organ donation is widely permitted, even encouraged by many rabbis. When carried out in accordance with halacha, the deceased donor is performing the ultimate mitzvah known as pikuach nefesh (saving human life).  

Another reason why I thought Jews weren’t permitted to donate organs after death was my mistaken belief that the body had to be buried fully intact and the harvesting of organs would prevent this. I now appreciate that this simply isn’t true. If organs are donated in order to save a life, then it is allowed.

The subject of organ donation is, of course, extremely sensitive. In Israel, in order for a donor’s wishes to be fulfilled, his or her family also has to consent to the donation after the death of their loved one. Stressful decisions have to be made under intense pressure as time is invariably of the essence. The donor can ask for a rabbi to be involved in the decision making at the relevant time.

Former Liverpool and Israel footballer Avi Cohen sustained a serious brain injury in a motorcycle accident in Tel Aviv in December 2010. He was taken to hospital where he underwent emergency surgery and was placed on a ventilator. Whilst on the ventilator, one of the nurses informed his wife, Dorit and their children that Avi carried an Adi donor card. Prior to this they had no idea he wished to donate his organs.

As the head of the Israel Professional Footballers Association, Avi wanted to set an example to others by carrying the card.

In accordance with the rules, Avi’s family had to give permission for his wish to be granted. As they were about to sign the permission form, they were persuaded by a rabbi not to do so on the basis that Avi would soon regain consciousness. Sadly, he never did, leaving his heartbroken widow facing criticism for the decision she made.

As a result of Avi’s death, the issue of organ donation once again came to the fore, resulting in an increase in the number of people signing up for the Adi donor card. This is something which Avi had wanted all along and in some small way brings comfort to his widow.

Like Avi, many Israelis feel passionately about organ donation and do whatever they can to promote it. Netanel is another such person. Netanel sadly lost his brother, Yaniv in 2006. Yaniv had suffered a severe deterioration in his lung function and was on the list for a lung transplant.  

Whilst waiting for the transplant, Yaniv and his family were approached by a Japanese surgeon who specialised in live lung lobe transplants, with a view to carrying out the first such transplant in Israel. Yaniv agreed, with his sister and brother both acting as the donors. 

The operation, which took place in Beilinson hospital, Petah Tikva, was the first of its kind in Israel. It was long and arduous for all 3 participants and sadly, Yaniv passed away 10 days later, aged 36. He left behind his loving wife, Estelle and 2 young boys, Nor and Ziv.

 Netanel, who was serving in the IDF at the time, was forced to give up his position as a combat soldier after the operation. He spent the following year and a half single handedly trying to raise awareness of organ donation amongst army personnel. He travelled all over the country, in a bid to try and reach as many soldiers as possible. Eventually, the IDF recognised the need for Netanel’s work and they carved out a new, unique role for him, specifically for this purpose. He was stationed in the medical corps and from there, he travelled round the bases in a bid to encourage soldiers to sign up for the Adi donor card.

  Another way in which Jews outside Israel can register their wish to donate organs, safe in the knowledge that halacha will be respected, is through The Halachic Organ Donation Society (HODS). HODS is an international organisation set up around 20 years ago in New York by Robby Berman, who now lives in Israel. A significant number of rabbis across the globe have obtained their organ donor cards through HODS. Their mission is simple, “to save lives by increasing organ donations from Jews to the general public (Jews and non-Jews alike)”.

 In England, a new law recently came into force, known as Max and Keira’s Law. Now, all adults are considered as having agreed to donate their own organs unless they state otherwise, or opt out. The families of those who haven’t expressed their wishes are given support in order to help them to make a decision based on what their loved one would have wanted. If the decision is not to donate, this will be honoured. The law states that people’s faith, beliefs and culture will continue to be respected.

 In Britain, everyone is encouraged to make their wishes known by signing the NHSBT (National Health Service Blood Transplant) register. As part of this process, a new question has been added, “is your faith important to you?” This provides those who are concerned about organ donation from a halachic perspective, with reassurance that nothing will be done without the consent of their rabbi if they so wish.  

 The myths surrounding organ donation, which have led many Jews, myself included, to believe they were not permitted to become organ donors, are thankfully being debunked.  As a result, more Jews are choosing to sign up.

A spokesman for Chief Rabbi Ephraim Mirvis said:

“As of 20th May 2020, English Law on organ donation changed from what is often referred to as an ‘Opt-in’ system to an ‘Opt-out’ system or ‘Deemed Consent’. In other words, whereas previously the law only permitted organ donation in cases where it could be established that this was the express wish of the donor or where the family consented, now it will be permitted unless it can be established that it would be contrary to the express wish of the donor.

NHS organ donor card (Via Jewish News)

 “This change has important implications for those in the Jewish community who would wish any decision about donating organs to be made in accordance with appropriate Halachic advice.

 “It is important to be absolutely clear that no person’s organs can be taken against their wishes at any time and consultation with a person’s family remains an absolutely essential part of the organ donation process. This means that if, for example, a person had shared their wishes with their next-of-kin but not formally registered them on the Organ Donor Register (ODR), those wishes would still be respected.

 “This is one of the reasons why it is a good idea to discuss the issue of organ donation with family and friends so that they are aware of your preferences.

 “Over the last few years, the Office of the Chief Rabbi has worked closely with NHS Blood and Transplant (NHSBT) to deliver an essential accommodation within the opt-out system which will allow a person to declare on the Organ Donor Register that their wishes for donation are entirely subject to guidance from their chosen religious authority. The effect of this accommodation will be to allow observant Jews to engage positively with the new system, safe in the knowledge that their faith will be respected.  

 “The Chief Rabbi encourages everyone to visit the NHS organ donation website and register their wishes, safe in the knowledge that if they are able to donate, such donation will only go ahead in a Halachically compliant way.”

About the Author
I’m a British lawyer from Manchester. I made aliyah in 2016 and now live in Netanya with my husband, 3 children and 3 dogs. As I wasn’t able to pursue my legal career here in Israel, I started a small business editing English language papers for academics. I also write short stories or ‘blogs’ about the trials and tribulations of my new life.
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