Depending upon your age, you might remember Jewish tradition on the topic of organ donation as very different from how it actually is today. Once opposed, Jewish law and practice on organ donation has changed dramatically, which is the beauty of Judaism as a living, evolving tradition. Now that organ transplantation is a highly successful way to save a life, organ donation has been deemed an obligatory act, a mitzvah chiyuvit, by every major branch of Judaism.

Now, it is important to note that some Orthodox leaders differ on how to determine the time of death, and prefer a point later than brain death, which results in some organs being rendered unusable but even in that case, the kidneys, barring kidney disease, remain transplantable after death. Accordingly, not to bequeath your organs has become a transgression of the mitzvah of pikuakh nefesh, “saving a life.”

Pikuakh nefesh, saving a life, is a primary Jewish value, and at any given minute, over 40,000 people are on the waiting list of the United Network for Organ Sharing. So what about donating an organ while alive, is that a mitzvah? So long as it will not risk your own life, surgical removal and donation of organs such as a lung or a kidney by a living donor is a mitzvah kiyumit, a praise-worthy but not obligatory mitzvah, since with all surgery there is some risk and for some, great fear.

Three verses from Torah frame the source for organ donation: “You shall not stand by the blood of your neighbor” [Leviticus 19:16], “You shall surely heal” [Exodus 21:19] and “You shall restore” (a lost object, which includes someone’s health) [Exodus 23:4].

And amazingly, despite very different ways at coming to their decision – virtually the full spectrum of Judaism, with only a few rabbinic decisors dissenting, agree that post-mortem organ donation is an obligatory mitzvah.

The engine of changing organ donation and transplant ethics in Judaism has been driven by the increasing transplant success rate. The procedure for most organs has rapidly shifted from experimental and life-threatening (and in that case, not permissible), to often the only possible and medically proven way to save someone’s life. Since taking the medical steps necessary to save your life if at all possible is obligatory under Jewish law and custom, accepting an organ transplant, when it would be the most effective way of extending your life, has become obligatory.

With accepting a transplant having been established as permissible, next Judaism had to confront the problem of organ donation. Our tradition treats a cadaver as sacred space not to be viewed or invaded once the soul has moved on and can no longer animate that body in its own personal way. Autopsy is only allowed in Judaism under very special circumstances for this reason. So can a Jewish person’s body be used after death for medical reasons? Yes, to save a life – as in proving the facts in a murder investigation or to determine a devastating genetic disease pattern, or restore mental health to an extremely distraught family member, then autopsy is allowed. So, now that one can fulfill the mitzvah of saving a life via organ donation, Jewish legal experts reasoned, the primacy of the integrity of a body is most definitely trumped by the mitzvah of saving a life.

There were more issues to work out regarding Judaism and organ donation. The freshest organs often are the most viable, but important Jewish texts and prevailing traditions seemed to call for both heart and breathing to have stopped in order for a person to be officially dead. And a donor heart must be kept pumping after brain death in order for a heart-transplant to even be possible, and keeping the heart going until the organ donation team’s work is done keeps most other organs fresher as well. Now what to do?

Authorities in Jewish medical law delved into the sources and practices condoned by gedolim, “great teachers” of traditional life such as Rabbi Moshe Feinstein and determined the actual Jewish legal criterion for death was not cessation of heart beat, but rather the permanent loss of the independent ability to breathe – which could be noticed around the chest, mouth or nose. These scholars also undertook to learn about technologies and aspects of death unknown to prior Jewish authorities, such as reliable tests for brain stem death. The research of these dedicated, observant Jewish professionals world-wide expanded to include the Chief Rabbinate of Israel which in 1986 ruled that death would be determined by these factors:

  • clear knowledge of the cause of injury
  • absolute cessation of natural breathing (not breathing that requires a respirator)
  • clinical proof that the brain stem is indeed dead
  • objective proof such as the BAER test that the brain stem is dead, and proof that numbers two and three continue for at least 12 hours under full and normal treatment.