The State of Israel’s organ donation rate is one of the lowest of any Western country. According to statistics from 2010, the per capita donation rate in Israel was one-third that of the United States, and many European countries far surpass the U.S. rate.
The Israeli rate is so low that Eurotransplant, the European organ exchange program, has told the country that it can participate in their program only if it raises its donation rate. In the meantime, Israel has long waiting lists of people hoping to receive transplanted organs. No one knows for sure, but some suspect that the donation rate of organs among Jews in North America also falls short of the local average.
Why? The standard explanation is the conception, or misconception, that Judaism forbids donating organs.
Many Jews, observant or not, see the burial of the complete human body as a requirement that can never be compromised. When it comes to organized religion, the liberal branches of Judaism strongly support donating organs. Some Orthodox groups, however, have struggled with the issue.
Now the International Rabbinic Fellowship (IRF), a modern (or “open”) Orthodox rabbinic organization, has published its second volume on this subject, titled Halakhic Realities: Collected Essays on Organ Donation. The first, Halakhic Realities: Collected Essays on Brain Death, was reviewed in these pages two years ago. The latest volume was dedicated by Eli and Renée Rubinstein of Toronto.
In the modern literature of Halachah (Jewish law), the most serious concern about transplants is that donors may not be dead when their organs are removed. Thus, removing their organs is actually killing them. Most transplants are effective only if the organ is taken from a body in which the heart and lungs are still functioning. The so-called “harvesting” and transplanting of organs can thus be justified only if we accept that a brain dead, yet breathing body with a beating heart is really dead. Thus, the two volumes published by the IRF overlap: one cannot discuss organ transplants without discussing brain death.
As in the first volume, the vast majority of essays in this book support and encourage transplants, but the editor, Rabbi Zev Farber, has also given a voice to those who have doubts. For example, Professor Nehemia Polen writes: “The seductions of tangible and immediate benefits may blind us to possible hidden costs and long-term consequences of a utilitarian perspective on the body at death, a view that transforms the corpse from dead person into an assemblage of organs to be ‘harvested’.”
These volumes are partly responding to decisions on transplants by the older, modern (or “centrist”) Orthodox rabbinical organization, the Rabbinical Council of America (RCA). In the 1990s, the RCA issued a statement accepting brain death as death, but then in 2010, the organization published a lengthy discussion paper reevaluating the evidence and suggesting strongly that, according to Halachah, brain death is not a sufficient criterion for the harvesting of organs. The clear implication was that an observant Jew should not donate most organs.
At the same time that the RCA moved to a more stringent position, the Chief Rabbinate of Israel decided to accept brain death as death. That was surprising, since the Chief Rabbinate is generally seen as being more old fashioned than the RCA. Perhaps the Chief Rabbinate understood the desperate need for organs in Israel and knew that they almost always had to come from Jewish donors. The U.S.-based RCA, on the other hand, knew that in America, the vast majority of organs used for transplants would come from gentiles.
The RCA’s position on transplants has been heavily criticized, as it implies that an observant Jew can be a recipient of organs, but not a donor. A number of essays in the new volume, especially the one by Rabbi Eugene Korn, challenge the morality of being willing to accept an organ harvested from a brain dead patient, while refusing to permit the harvesting of organs from brain dead observant Jews. Other essays, such as Rabbi Shmuly Yanklowitz’s Incentivizing Organ Donations, discuss what society can do to increase the level of willingness to donate organs. (For Rabbi Yanklowitz, this isn’t just talk; he himself donated one of his kidneys to a stranger in need.)
The most moving parts of the book are the testimonials by parents who agreed to the transplanting of their child’s organs: Stephen Flatow, whose daughter, Alisa, died in a terrorist incident in Israel, and Blu Greenberg, whose son, JJ, an accomplished cyclist and athlete, was killed when a car ran a red light and hit his bicycle.
Greenberg describes in poignant detail how she and her husband, Rabbi Yitz (Irving) Greenberg, learned about their son’s accident and how they and other family members decided that donating his organs was the appropriate thing to do. She also describes the touching meeting that she and Rabbi Greenberg had with the family of the patient who had received JJ’s liver, an Arab father of seven from the Shuafat refugee camp. (As Greenberg writes, “Israeli medicine is race-, colour- and religion-blind.”)
“I tell you all this, dear reader, because I want to convey how little time there is to make the decision for organ donation, even less time if you are not present at the scene of accidental death, the context of most transplants,” writes Greenberg. While most of us will never be in such a situation, it behooves us to think about what our position should be. A book like this can help us make a more informed, if still agonizing, decision.