Organ Transplants

(Lung and liver) There are patients for whom the only way to save them is an organ transplant. For example, a cystic fibrosis patient whose lungs have stopped functioning: the only way to save his life is for another person to donate one lobe of his lung, which will be transplanted into the patient’s chest and serve him as a lung. Usually two donors are taken, so that each will donate one lobe; thus the donor himself is not significantly harmed, while the patient can live with the two new lobes functioning for him as two lungs. Especially in the case of small children, one lobe from an adult can serve them almost as a normal lung, and thereby they can live as normal, healthy people. Likewise, there are diseases that damage the liver, and the only way to save the patient is for another person to donate part of his liver for him. That part will fulfill the function of the damaged liver, and the patient’s life will be saved.

The question that arises is whether, by virtue of the mitzva of “Do not stand idly by the blood of your fellow” (Vayikra 19:16), a person is commanded to donate one of his organs; or perhaps the opposite – it is forbidden to donate, since this is a difficult operation, and some of the donors may die as a result of post-operative complications?

Answer: According to most poskim, one who donates part of his lung or liver in order to save a friend or family member fulfills a great mitzva; however, according to halakha, there is no obligation upon him to do so.

This is because the mitzva of “Do not stand idly by the blood of your fellow,” according to most poskim, does not obligate a person to enter real mortal danger. And here, in donating a lobe or part of the liver, a person enters danger. In the lung operation there is a 0.5% risk that the donor will die in the operation, and in addition there are post-operative complications, some of which may be severe and dangerous. It is even possible that in the future additional complications in the lung or liver will arise. However, overall, the mortality risk for the donor does not exceed a few percent.

Seemingly, one could argue that since the percentage of risk is very low, and people are willing to take on such levels of risk even to earn money, then by virtue of the mitzva of “Do not stand idly by” every person should be obligated to donate some of his organs in order to save his fellow. But there is a difference. Although there is a general mitzva upon every person to be willing to take a small risk in order to save his fellow from mortal danger, nevertheless, this applies specifically to taking a short-term risk in which, by the overwhelming odds, everything will end well and peacefully. But organ donation involves the complete relinquishing of one of the organs, and this the Torah did not require. In addition, it is possible that even such a risk is already considered too great a risk – one that an ordinary person would not be willing to take for the sake of his livelihood – and therefore, even by virtue of the mitzva of “Do not stand idly by,” there is no obligation to take it.

The great posek R. David ben Zimra, who lived more than four hundred years ago, was likewise asked what a person should do if the cruel ruler said to him: either you agree to have your hand cut off, or we will kill your friend. Must he sacrifice his hand in order to save his friend or not? He answered that since amputating a hand also involves danger (of blood loss or infection), a person is not obligated to enter real mortal danger in order to save his fellow. In addition, the Radbaz wrote a very fundamental line of reasoning: it is impossible that the Torah would command us to do something contrary to human nature, for “its ways are ways of pleasantness,” and it is clear that an ordinary person would not agree to give up one of his limbs in order to save another person’s life. Therefore, in practice, by virtue of the mitzva of “Do not stand idly by” there is no obligation to sacrifice a limb for the sake of saving another; however, one who agrees to this fulfills a mitzva, and this is middat ḥasidut (an act of piety), and fortunate is his lot.

Likewise regarding the donation of a lobe or part of the liver: it is clear that an ordinary person would not agree to donate them in order to save a stranger whom he does not know. Only when it concerns a family member or an especially good friend do some people agree to donate an organ to save him.

To summarize, then: a person is not obligated to donate an organ to save another, even if he is a family member. But if he donates, he fulfills a mitzva, and this is an act of piety.^¹