General Jewish Principles
“Judaism is a religion of life, not death”.
[The then head of the London Beth Din, Dayan Ehrentreu, made this the starting point of the Jewish community presentation to the “Human Bodies Human Choices” discussions with the Chief Medical Officer, and it has served as an important preamble to the Jewish contribution to the debate about organ donation]
The Jewish community is not unique in its concerns about organ donation. This is common to all, and Jews are no different. At a time of stress and grief, often linked to sudden unexpected illness and death, talking about donation, and reaching a decision, can be difficult for a family.
The Jewish community, which has had the longest experience of the “non – Christian” faiths in discussion on medical issues with the UK Government, has a particular obligation to help other faiths get recognition for our mutual worries and concerns about biomedical issues such as organ donation. .
There is no evidence to show that when confronted with the question at the time of possible transplant UK / European Jews are less likely to agree to organ donation requests than members of other faith (or ethnic) community.
The attitude of Jewish religious authorities to donation in general is positive. For example:
- Blood donation is permitted.
- Jews participate actively in bone marrow transplant registries. [In the UK in particular the Sue Harris Bone Marrow Registry worked closely with the Anthony Nolan Centre to recruit Jewish donors].
- Jews have donated kidneys in “live related donor” programmes.
- Jews donate corneas after death.
Organ donation has to be seen in the context of the strong Jewish tradition of caring for the sick: “Pikuach nefesh” – “saving of life” – takes priority.
At the same time Jewish law poses questions about all new developments in medical treatment for serious illness:
- Does the treatment indeed save life?
- How do the beneficial effects balance with the risks?
Rabbinic authorities have discussed these issues in relationship to organ donation; a current consensus suggests that:
- For the sick recipient, transplantation is life-saving.
- The benefit of many types of transplant outweighs risk.
- Thus organ donation (in fact, organ gift) falls clearly within an altruistic caring tradition.
- Organ donation for “pikuach nefesh” is not forbidden in principle in Jewish law.
- Some Rabbinic experts have expressed the view that there are circumstances where donation may be a “positive obligation”, or “mitzva chiyuvit”.
For observant Jews there are several resultant practical questions that may be raised concerning the actual act of organ donation. Judaism holds that:
- The body of the dead person must be treated with the utmost respect, as in life
- Any needless mutilation must be avoided
- No benefit may be derived from a dead body.
- The process of interference with the body may cause undue distress to relatives
- Taking an organ may delay burial.
Thus before advising donation, a Rabbi involved would help the Jewish family to address several questions:
- Does the proposed organ donation fulfil the criteria of helping a “choleh lefanecha” – you must not stand idly by when there is a sick patient before you? (To-day modern communications, with rapid transfer of organs, means that “choleh lefanecha” does not mean a patient in the same hospital, town or country).
- The concern that death of the donor, as defined in Jewish law, needs to have occurred before donation. Like all other religions, Judaism has grappled with this problem in recent years. No organ may be removed from a donor until death, as defined in Jewish law, has occurred. This may create specific problems where time is of the essence.
- The respect due to the body after death, and the balance between this respect and the concern for “pikuach nefesh”.
The Jewish community role in organ donation includes:
That there are two ways that one may be involved in organ donation:
- as a donor
- as the close family member whose opinion is sought.
That the donor does not participate in the decision at the time: in Jewish religious terms, the “mitzva” – obligation – lies with the family, who are the agents of its fulfilment.
- Pre – discussion within families, and resultant better understanding of the Jewish approach to organ donation, is very important.
- An individual case approach, with discussion within the family, and with time for consultation, is central.
- There are serious concerns about proposals to move to an “opt-out” system of organ donation, which would conflict with these principles.
[The Office of the Chief Rabbi and the Beth Din have participated in initiatives by UK Transplant to educate the public about organ donation, and believe that what is needed is an ongoing educational process, which needs to be supported by Government – and not only for short term projects, as the expertise gained is soon lost, and as natural personnel changes means that this must be a continuing process].
The requests of the individual Jewish family involved in organ donation are to be allowed:
- Adequate consultation with Rabbinic authorities expert in this field during the decision making process.
- To observe the principles of honouring the dead – “kavod hamet”
- To ensure burial in a Jewish cemetery should follow as soon as possible after donation, without unnecessary further procedures.
- To take organs donated and not used (or rejected), for suitable burial.
- From a Jewish perspective each person is different, each donation is different – Judaism emphasises the individual nature of donation.
- Judaism stresses the importance of seeking competent halachic (religious law) guidance and advice to help in the decision and implementation process.
[ on the UK there has been a tragic case study where organs were donated by the family of Yonni Jesner, an observant young British Jew, after he had been mortally wounded in a suicide bomb attack in Tel Aviv. Subsequently his mother has made a television documentary about the donation process, which may be helpful both in explaining about donation in general and about how an observant Jewish family responds to this dilemma]