SIXTH COMMANDMENT: You shall not murder and organ donation

We are finishing today exploring the Sixth Commandment, through examples which illustrate the extent and relevance of this commandant in our days, beyond the actual act of murder.

We will analyze today, very briefly a very complex subject: organ donation.  There are two types of organ donation: When the organs are taken from 1. living donors  and when they are taken from 2. cadaveric donors.

In the past, many rabbis, among them Rabbi Yitzchak Weiss and Rabbi Eliezer Yehuda Waldenberg z'”l, had certain reservations about the permission to donate a kidney, for example, because they thought that although a person can have a normal life with one kidney, the risks involved for the living donor, during and after surgery, were too high and would endanger his life.

In our days, however, donors are carefully screened physically and psychologically, and the surgical and post-surgical risks of complications for the donor have diminished dramatically, thanks to the advances of modern medicine. In one of his rabbinical response Rabbi Obadia Yosef z”l evaluates the objections of Rabbi Weiss and Rabbi Waldenberg, and asserts that since today the risks involved in kidney donation are so low, it is considered a great Mitsva to donate a kidney, fulfilling the commandment of saving a life, (piquah nefesh). Donating a kidney to save a life, he suggests, might be also required by the Tora’s commandment “lo ta’amod al dam re’ekha”, “You shall not stand still while your fellowman bleeds to death (i.e. is dying)” .

The most common form of organ donation and the one that is debated among modern Rabbis, is the cadaveric organ donation, i.e. donating the organs after one’s death. This is the organ donation which is alluded to in the driver licenses where one authorizes or not to remove his or her organs for donation.

With cadaveric donation there is a crucial point, entirely connected with the Sixth Commandment which needs to be defined. That is: the definition of “death”. Let me explain. Some organs, like the heart for example, cannot be transplanted after it stops functioning. The heart must be removed from the body of the donor while it is still beating. Up to the 1970s, this operation was impossible because irreversible cardiopulmonary failure was the only standard for determining death. But, later on, scientists developed ventilators and respirators which would maintain the breathing, avoiding the heart from stopping. In a situation known as ‘irreversible stem brain death’, the brain might completely stop its vital activities, while the patient would still be breathing and his heart still beating. Then, is this patient considered dead because his brain is dead, or is he considered to be still alive, because his heart is still functioning?

There are two opinions on this issue:

1. HEART. The stricter opinion holds that while the heart is beating and the person is breathing, the patient is still alive, even if the breathing is caused by a ventilator and even if his brain is dead. And therefore, taking his heart would be considered murder. The Biblical source for this opinion is that when man was created God insufflated in Adam’s earthly body a “breathing of life” (nishmat hayim), this indicates that life is determined by breathing.

2. BRAIN. The more lenient opinion also holds that breathing is the capital signal of life. But they explain that in order to be considered as a sign of life, breathing has to be autonomous. The Chief rabbinate of Israel issued a ruling a few years ago, indicating that in their opinion irreversible brain-death should be considered death, even if the patient is still attached to a ventilator, and his heart is still active.  They explained that although there seem to us that the patient is still breathing, once brain-stem death is determined, the control-center of autonomous breathing is irreversibly deactivated, and it has lost forever its control over the heart. Life is “breathing”, means, autonomous breathing, i.e. the capacity to breathe. A patient with a dead brain who still breathes is not really ‘breathing’. It is as if a decapitated body would be, somehow, connected to a ventilator: the heart would still beat because the hearth is an autonomous muscle and it could be kept functioning “mechanically” even when it is not controlled anymore by the brain-stem.  But, since there is no possibility for an autonomous breathing anymore, the patient is considered dead and under certain conditions, his organs might be removed for transplant.

In Israel (see https://www.adi.gov.il/en/) and in the US (https://www.hods.org/ ) there are two important institutions ADI and HODS which support halakhic organ donation and give the donor the choice to choose between the two above-mentioned opinions. Their websites have very important and serious sources of information on this issue.