Yom Shlishi, 25 AdarI 5781
Tuesday, 9 March 2021
Without organ donors, the story can’t end well for thousands

The Jewish News
1 August 2013

By Rabbi Danny Rich

Who cannot have been moved by the Jewish Newsreport last month headlined: ‘My kidney donor husband saved me’?

It told of the story of Yuval, who donated one of his kidneys to save the life of his desperately ill wife, Leony. The story will not end so well for the 10,000 people in the UK who languish on the donor register. They may well die before a match is found.

As the NHS blood and transfusion service confirms, while 4,000 lives were saved in the last year for which annual figures were available, some 1,000 others – nearly three per day – die waiting.

I therefore welcome the National Assembly of Wales’ decision to introduce legislation enabling Wales to adopt a “soft opt-out” of organ donation. This assumes that, unless an individual has made known their wish not to donate organs, consent will be deemed to have been given.

Family refusal is a major factor impacting on the number of organs available –rejection is often associated with not knowing their relatives’ wishes. The Welsh legislation is opposed by local Christian churches and by representatives of the Muslim and Jewish communities.

The concept of organ donation is barely controversial in the Jewish literature. The major halachic principle in play is pikuach nefesh: the saving of a human life, which arises from the Leviticus verse (19:16) in which one is required “not to stand upon” or “profit from the blood of another”.

Its precise meaning uncertain, it has come to be understood to be about the value of an individual human life and the efforts a Jew is required to take to save one. So binding is this obligation that there is very little that could provide a valid objection. According to some rabbinic authorities a technical issue remains as to when death occurs.

Liberal Judaism has traditionally placed the autonomy of the individual at the heart of its attempt to synthesise Judaism and modernity. It rejects the traditional view of Torah as the “word of God”, affirming it is each generation’s obligation, through prayer and reflection, study and discussion, to seek to understand what God requires to the best of its ability.

Each individual is required to use their “educated conscience” to contribute to the collective decision-making. Nevertheless, individual autonomy is not a licence to opt out of societal obligations. As Leviticus 19: 2 and 6 declares: not only must individuals be “holy”, but Jew (or the society in which they participate) as a whole is exhorted to be “a kingdom of priests and a holy nation”.

Liberal Jewish ethics understands this to mean that as the individual must fulfil social duties so must society realise its obligations. Presumed consent is perhaps a new idea for religious traditions, although the Talmud in Pe- sachim 4b gives an example where a friend dies, leaving a storehouse full of crops. Although one day old, it’s presumed the crop owner intended to (and did) carry out the mitzvah of paying his appropriate dues.

If we extend this principle to presumed consent, and recognise that the donation of organs can fulfil the highest of mitzvot, pekuach nefesh, would it not be reasonable to assume that in the absence of any evidence to the contrary, each one of us would wish to fulfil the mitzvah of saving a life by giving of our own bodies?

In contrast, the Israeli law of anatomy and pathology uses pikuach nefesh to give doctors the authority to harvest organs to save a life, regardless of the consent, expressed or implied, of the donor or the family. A doctor is allowed to use any part of a body to save life, subject to three qualified doctors declaring the operation is being performed for the purpose of saving a life.

In practice, consent is currently required, although plans are now in place to ensure every Israeli with a driver’s licence would automatically be added to the country’s organ donor list unless they explicitly refuse – presumed consent! In the context of pikuach nefesh, and the Jewish requirement to contribute to the wellbeing of society, I hope it won’t be long before the rest of the UK follows the Welsh Assembly’s lead.

May we all live a long and healthy life. And in death may we enable others to do so, too.