APPENDIX A
General Jewish principles relating to organ
donation and transplantation:
(adapted from a presentation to UK Transplant—Multi-Faith
Perspectives on Organ Donation)
"Judaism is a religion of life, not death".
[This may be self-evident, but the then head
of the London Beth Din, Dayan Ehrenrteu, insisted that it was
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.
Hence:
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.
In addition:
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:
To remember:
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.
In addition:
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.
In summary:
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 recent 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]
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