THE NEED
Despite advances in medicine and technology and increased awareness of organ donation and transplantation, the gap between supply and demand continues to widen.
While national rates of donation and transplant have increased in recent years, more progress is needed to ensure that all candidates have a chance to receive a transplant.
As of November 2018, there were just under 114,000 men, women, and children on the national transplant waiting list, all awaiting life-saving organ transplants. Each of these people is in desperate need of a kidney, liver, heart, or another organ. 33,400 transplants were performed before November of 2018, and 20 people die each day waiting for a transplant. Every 10 minutes, another person is added to the waiting list, and only 3 in 1,000 people die in a way that allows for organ donation. Each year, the number of people on the waiting list continues to be much larger than both the number of donors (16,000 as of November 2018) and the number of transplants, which increase slowly. Organ donors are continuously in short supply, and there are far more people in need of a transplant than there are people willing to donate an organ. Most of the organs that are available come from deceased donors, and a smaller number of organs come from well-conditioned, able-bodied individuals.
Organ and tissue donation are more important than many of us realize—for society and for the individuals it directly affects. For some people with end-stage organ failure, it is truly a matter of life and death. Add to these the thousands more whose lives will be improved through tissue and cornea donation and transplants that can help them move better, see better, and live better.
Donation affects more than the donors and recipients. It also affects the families, friends, colleagues, and acquaintances who love and support those in need of transplantation, and who benefit from their renewed life and improved health after transplant.
Organ donation provides a life-giving, life-enhancing opportunity to those who are at the end of the line for hope, and the need for organ donors is growing. One way to expand the number of organs available for transplantation is to expand the number of donors, through carefully and safely considering individuals who in the past were not included. As our knowledge and scientific capabilities regarding safety and availability grow and evolve, donors who in the past would not have been considered as donors are now able to provide the gift of life to others. It is the human aspect of donation and transplantation—helping people. It is the right thing to do.
Despite advances in medicine and technology and increased awareness of organ donation and transplantation, the gap between supply and demand continues to widen.
While national rates of donation and transplant have increased in recent years, more progress is needed to ensure that all candidates have a chance to receive a transplant.
As of November 2018, there were just under 114,000 men, women, and children on the national transplant waiting list, all awaiting life-saving organ transplants. Each of these people is in desperate need of a kidney, liver, heart, or another organ. 33,400 transplants were performed before November of 2018, and 20 people die each day waiting for a transplant. Every 10 minutes, another person is added to the waiting list, and only 3 in 1,000 people die in a way that allows for organ donation. Each year, the number of people on the waiting list continues to be much larger than both the number of donors (16,000 as of November 2018) and the number of transplants, which increase slowly. Organ donors are continuously in short supply, and there are far more people in need of a transplant than there are people willing to donate an organ. Most of the organs that are available come from deceased donors, and a smaller number of organs come from well-conditioned, able-bodied individuals.
Organ and tissue donation are more important than many of us realize—for society and for the individuals it directly affects. For some people with end-stage organ failure, it is truly a matter of life and death. Add to these the thousands more whose lives will be improved through tissue and cornea donation and transplants that can help them move better, see better, and live better.
Donation affects more than the donors and recipients. It also affects the families, friends, colleagues, and acquaintances who love and support those in need of transplantation, and who benefit from their renewed life and improved health after transplant.
Organ donation provides a life-giving, life-enhancing opportunity to those who are at the end of the line for hope, and the need for organ donors is growing. One way to expand the number of organs available for transplantation is to expand the number of donors, through carefully and safely considering individuals who in the past were not included. As our knowledge and scientific capabilities regarding safety and availability grow and evolve, donors who in the past would not have been considered as donors are now able to provide the gift of life to others. It is the human aspect of donation and transplantation—helping people. It is the right thing to do.
THE RISKS INVOLVED
As with any other surgery, there are both short and long-term risks involved in living donation. Surgical complications can include pain, infection, blood loss, blood clots, allergic reactions to anesthesia, pneumonia, injury to surrounding tissue or other organs, and even death. Nonetheless, as transplant surgeries are becoming more common and surgical techniques are advancing, risks involved with living donation continue to decrease.
There has been no national systematic long-term data collection on the risks associated with living organ donation. However, there are studies that are currently gathering such information. Based upon limited information that is currently available, overall risks are considered to be low. Risks can differ among donors and the type of organ. For kidney donors, there is only a 1% lifetime increase in the donor’s own risk of kidney failure. To put this into perspective, the general population has a 3% risk for kidney failure. Overall, there is only a three in 10,000 risk of dying during surgery and, in general, donation neither reduces life expectancy nor prevents donors from living normal, healthy lives. Some possible long-term risks of donating a kidney may include high blood pressure (hypertension); a large amount of protein in the urine; hernia; organ impairment or failure that leads to the need for dialysis or transplantation.
Liver transplantation carries a greater risk for both the donor and the recipient than kidney transplantation. Some possible long-term risks associated with donating a lobe of the liver may include wound infections; hernia; abdominal bleeding; bile leakage; narrowing of the bile duct; intestinal problems including blockages and tears; organ impairment or failure that leads to the need for transplantation.
One might also have negative psychological symptoms just after donation or later. The donor and recipient might face surgical complications. The transplanted organ might not work right away, and there is also a chance it will not work at all. Donors might feel upset, anxious, infuriated, or resentful proceeding surgery. Living donors must be made aware of the physical and psychological risks involved before they consent to donate an organ.
The Organ Procurement and Transplantation Network (OPTN) has limited long-term data available on how living donors do over time. Based on OPTN data from 1998 through 2007, of the 3,086 individuals who were living liver donors, at least four have been listed for a liver transplant due to complications related to the donation surgery. Of the 59,075 individuals who were living kidney donors from 1998 to 2007, at least 11 have been listed for a kidney transplant. However, the medical problems that caused these kidney donors to be listed for transplant may or may not be connected to the donation.
*This total only captures data on transplant candidates who are known to the OPTN/UNOS to be previous donors.
As with any other surgery, there are both short and long-term risks involved in living donation. Surgical complications can include pain, infection, blood loss, blood clots, allergic reactions to anesthesia, pneumonia, injury to surrounding tissue or other organs, and even death. Nonetheless, as transplant surgeries are becoming more common and surgical techniques are advancing, risks involved with living donation continue to decrease.
There has been no national systematic long-term data collection on the risks associated with living organ donation. However, there are studies that are currently gathering such information. Based upon limited information that is currently available, overall risks are considered to be low. Risks can differ among donors and the type of organ. For kidney donors, there is only a 1% lifetime increase in the donor’s own risk of kidney failure. To put this into perspective, the general population has a 3% risk for kidney failure. Overall, there is only a three in 10,000 risk of dying during surgery and, in general, donation neither reduces life expectancy nor prevents donors from living normal, healthy lives. Some possible long-term risks of donating a kidney may include high blood pressure (hypertension); a large amount of protein in the urine; hernia; organ impairment or failure that leads to the need for dialysis or transplantation.
Liver transplantation carries a greater risk for both the donor and the recipient than kidney transplantation. Some possible long-term risks associated with donating a lobe of the liver may include wound infections; hernia; abdominal bleeding; bile leakage; narrowing of the bile duct; intestinal problems including blockages and tears; organ impairment or failure that leads to the need for transplantation.
One might also have negative psychological symptoms just after donation or later. The donor and recipient might face surgical complications. The transplanted organ might not work right away, and there is also a chance it will not work at all. Donors might feel upset, anxious, infuriated, or resentful proceeding surgery. Living donors must be made aware of the physical and psychological risks involved before they consent to donate an organ.
The Organ Procurement and Transplantation Network (OPTN) has limited long-term data available on how living donors do over time. Based on OPTN data from 1998 through 2007, of the 3,086 individuals who were living liver donors, at least four have been listed for a liver transplant due to complications related to the donation surgery. Of the 59,075 individuals who were living kidney donors from 1998 to 2007, at least 11 have been listed for a kidney transplant. However, the medical problems that caused these kidney donors to be listed for transplant may or may not be connected to the donation.
*This total only captures data on transplant candidates who are known to the OPTN/UNOS to be previous donors.
גופא מניין לרואה את חברו שהוא טובע בנהר או חיה גוררתו או לסטין באין עליו שהוא חייב להצילו ת"ל לא תעמוד על דם רעך והא מהכא נפקא מהתם נפקא אבדת גופו מניין ת"ל והשבותו לו
Concerning the matter itself, it is taught in a baraita: From where is it derived that one who sees another drowning in a river, or being dragged away by a wild animal, or being attacked by bandits, is obligated to save him? The verse states: “You shall not stand idly by the blood of another” (Leviticus 19:16). The Gemara asks about this derivation: But is this really derived from here? It is derived from there, i.e., from a different verse, as it is taught: The Torah teaches that one must return lost property to its rightful owner. But from where is it derived that one must help his neighbor who may suffer the loss of his body or his health? The verse states: “And you shall restore it [vahashevato] to him [lo]” (Deuteronomy 22:2), which can also be read as: And you shall restore him [vehashevato] to him, i.e., saving his body. Consequently, there should be no need for the additional verse: “You shall not stand idly by the blood of another.”
שרש מצוה זו ידוע, כי כמו שיציל האחד את חברו כן חברו יציל אותו ויתישב העולם בכך, והאל חפץ בישובו כי לשבת יצרה... ונוהגת בכל מקום ובכל זמן בזכרים ונקבות. והעובר עליה ונמנע מלהציל ויש יכלת בידו עבר על לאו.
The root of this commandment is well-known - just as one will save his fellow, so too, will his fellow save him. And thus the world will be inhabited like this, and God desires its habitation, as "He created it to be inhabited." . . . And it is practiced in every place and at all times by males and females. And one who transgresses it and refrains from saving another and has the ability to do so has violated this negative commandment.
What if there is risk involved?
רבי אימי איתצד בסיפסיפה אמר ר' יונתן יכרך המת בסדינו אמר ר' שמעון בן לקיש עד דאנא קטיל אנא מתקטיל אנא איזיל ומשיזיב ליה בחיילא.
Rav Imi was captured in a dangerous area. R. Yochanan stated "Wrap the dead in his shrouds." R. Shimon ben Lakish responded, "I will either kill or be killed, I will go with might and save him."
תשובה ומ"מ אם הספק נוטה אל הודאי אינו חייב למסור עצמו להציל את חבירו ואפי' בספק מוכרע אינו חייב למסור נפשו דמאי חזית דדמא דידך סומק טפי דילמא דמא דידיה סומק טפי אבל אם הספק אינו מוכרע אלא נוטה אל ההצלה והוא לא יסתכן ולא הציל עבר על לא תעמוד על דם רעך. הנראה לע"ד כתבתי:
However, if the potential danger leans toward certainty, he is not obligated to put himself in such a position for another's benefit. And even if the potential is fifty-fifty, he is not obligated, for "Why would it be certain that your blood is redder, perhaps his blood is redder?" But, if the danger is not even fifty-fifty, but leans toward saving another without his being endangered, one violates "do not stand idly by the blood of your fellow" if one does not save him. So it seems in my opinion.
A Guide to the Complex: Contemporary Halakhic Debates
Shlomo M. Brody
Chapter 9: Blood and Bone Marrow Donation
Is one obligated to save a life?
Bone marrow and blood transfusions are miracles of modern medicine and gifts from God, but they also raise grave questions regarding the obligation to endanger oneself in order to save others. The sages compared saving a life to saving the entire world (Sanhedrin 37a). Yet how must we go to perform this great act?
The Talmud cites two biblical passages obligating us to save lives (Sanhedrin 73a). The first (and less obvious) verse comes from the general commandment to restore another's property, including his body (Deut. 22:2). The second verse, "You shall not stand idly by the blood of your fellow" (Lev. 19:16), mandates going beyond general assistance and committing financial resources to saving the lives of others.
Rabbinic authorities have debated whether these commandments demand even risking one's own life. When the sage R. Ami was abducted and faced execution, his colleagues disagreed as to whether a daring rescue effort was appropriate (Y. Terumot 8:4). While R. Yonatan answered negatively, Resh Lakish insisted on attempting a rescue mission (which ultimately succeeded). Based on this story, some have determined that if someone will definitely die, one must make every effort to save him, since the threat to the rescuer remains uncertain (Kesef Mishneh, Hilkhot Rotze'ah 1:14).
The vast majority of scholars, however, have rejected this position. In one celebrated responsum, Rabbi David ibn Zimra (sixteenth century, Egypt) ruled that a person need not volunteer to have a limb amputated by a despotic ruler in order to prevent him from killing another Jew (Shu"t HaRadbaz 3:627). Alluding to the talmudic dictum that one's life takes precedence over another's, Radbaz further claimed that dictating such self-endangerment would be immoral and go against the notion that the Torah represents "ways of pleasantness and peace" (Prov. 3:17). With the exception of committing the three cardinal sins, the Torah commands us to preserve our lives, even by violating commandments such as "You shall not stand idly by the blood of your fellow." As such, one need not endanger himself to save someone from imminent death (Shulhan Arukh HaRav OH 329:8).
In an extreme formulation, Rabbi Meir Simha of Dvinsk (Latvia, d. 1926) applied this principle even when many Jews or the entire nation faced an imminent fatal threat (Or Same'ah Laws of Murderers 7:8). This position was challenged by others, such as Rabbi Meir Plotzky (Klei Hemda, Parashat Pinhas 1), and in a lengthy treatise, Rabbi Abraham Isaac Kook (d. 1935) contended that under those circumstances, self-sacrifice is mandatory (Mishpat Kohen 143).
In general, many scholars recognize a range of life-threatening actions, and somewhere along that continuum, certain conduct becomes meritorious or mandatory, given the circumstances (AH HM 426:4). Rabbi ibn Zimra himself ruled in a different responsum that one should act if the potential threat to the rescuer is unlikely to occur (Shu"t HaRadbaz 5:218). In cases of somewhat greater but nonetheless distant threats, many authorities deem it permissible and even meritorious to risk one's life in order to save another's, as long as the rescuer's actions are not suicidal (IM YD 2:714). Decisors also debate whether a person must endure pain to save others (Nishmat Avraham YD 157:4).
For most people operating in hygienic conditions, donating blood entails minimal pain. The risk is also negotiable, since the lost blood easily regenerates. As such, scholars including Rabbis Shmuel HaLevi Wosner (Shevet HaLevi 5:219) and J. David Bleich (Tradition 27:3) contend that one must donate blood if a patient requires an immediate transfusion. Donating to blood banks, especially amid shortages, also represents a definitive mitzvah (Nishmat Avraham YD 349:3).
While bone marrow naturally regenerates, donors previously had to be placed under general anesthesia and hospitalized for a couple of days. Therefore Rabbi Moshe Sternbuch did not require one to donate, though he deemed it extremely meritorious (Teshuvot VeHanhagot 5:387). Rabbi Shlomo Zalman Auerbach believed a potential donor should be cajoled into donating, especially if he did not fear the surgery (Nishmat Avraham EH 80:1). Yet Rabbi Bleich and Rabbi Mordechai Willig obligate one to donate, since the dangers represent common and minimal risks regularly taken for less pressing needs. This is especially true today, when most bone marrow donations take place on and out-patient basis, without general anesthesia.
Gaining consent from minors to donate bone marrow for family members remains ethically complex. Rabbi Auerbach believes that an older, mentally competent child can consent, but remains conflicted regarding younger or mentally incompetent children. Rabbi Bleich, however, requires parental consent.
Since bone marrow matches are based on genetic similarities, the Jewish community must participate in bone marrow drives (such as those organized by the Gift of Life Bone Marrow Foundation) to ensure that enough potential donors are registered. God blessed us with these medical tools - it is our responsibility and obligation to use them to save lives.
Chapter 10: Kidney Donation
May one donate a kidney?
In the preceding essay, regarding blood and bone marrow donations, we concluded that most decisors believe halakha excuses (and sometimes prohibits) people from endangering themselves to save another's life. However, measures like donating blood or bone marrow entail minimal risk; therefore, it remains meritorious and possibly obligatory to perform such lifesaving actions.
Donating a kidney, on the other hand, clearly constitutes a greater endangerment. Unlike blood or bone marrow, the missing kidney does not regenerate. While a person can function normally with one kidney (as we hope the recipient will), the donor places himself at risk if his remaining kidney is damaged in an accident or through dehydration. (Regarding the latter danger, most kidney donors and recipients should therefore not fully fast on Yom Kippur.) Moreover, the procedure is much more invasive and entails at least a few weeks of outpatient recovery.
Rabbi Isser Unterman contended that the invasiveness of the surgery alone was sufficient to forbid live kidney donations, since he believed that self-injury (hababala) represented a form of self-endangerment prohibited by halakha, even to save a life (Shevet MiYehuda 1, p. 53). Others similarly prohibited renal transplantation in the early 1960s, deeming it too dangerous for the donor (Minhat Yitzhak 6:103).
However, most decisors, including Rabbi Moshe Feinstein, concluded that live kidney donations were permissible and meritorious, though the possible risks prevented halakha from compelling them (IM YD 2:174, para. 4). Today, transplants are no riskier than routine surgeries involving general anesthesia. Therefore, since halakha generally permits people to take common risks (shomer peta'im) (Shabbat 129b), donating a kidney would not constitute inappropriate self-endangerment.
While the pain remains significant, Rabbi Shlomo Zalman Auerbach ruled that temporary severe discomfort does not negate the requirement to save lives (Nishmat Avraham YD 157:2). Moreover, since the life expectancy and general health of successful transplant recipients greatly exceeds those of patients on dialysis, most believe that donating a kidney fulfills the mitzvah of saving a life (pikuah nefesh), which overrides any prohibitions of self-injury. Nonetheless, because of the risks entailed by the procedure, the vast majority of decisors deemed it meritorious but not compulsory, though Rabbi Ovadia Yosef intimates that donating might be obligatory (Yehaveh Daat 3:84). Similarly, many scholars prohibit children or the mentally incompetent from donating, since they cannot be reasonably consent to these risks.
In countries when organ sales are illegal, all agree that Jews many not engage in such activity. The wisdom of such a ban, however, remains subject to a heated debate in Jewish and general ethics.
Shlomo M. Brody
Chapter 9: Blood and Bone Marrow Donation
Is one obligated to save a life?
Bone marrow and blood transfusions are miracles of modern medicine and gifts from God, but they also raise grave questions regarding the obligation to endanger oneself in order to save others. The sages compared saving a life to saving the entire world (Sanhedrin 37a). Yet how must we go to perform this great act?
The Talmud cites two biblical passages obligating us to save lives (Sanhedrin 73a). The first (and less obvious) verse comes from the general commandment to restore another's property, including his body (Deut. 22:2). The second verse, "You shall not stand idly by the blood of your fellow" (Lev. 19:16), mandates going beyond general assistance and committing financial resources to saving the lives of others.
Rabbinic authorities have debated whether these commandments demand even risking one's own life. When the sage R. Ami was abducted and faced execution, his colleagues disagreed as to whether a daring rescue effort was appropriate (Y. Terumot 8:4). While R. Yonatan answered negatively, Resh Lakish insisted on attempting a rescue mission (which ultimately succeeded). Based on this story, some have determined that if someone will definitely die, one must make every effort to save him, since the threat to the rescuer remains uncertain (Kesef Mishneh, Hilkhot Rotze'ah 1:14).
The vast majority of scholars, however, have rejected this position. In one celebrated responsum, Rabbi David ibn Zimra (sixteenth century, Egypt) ruled that a person need not volunteer to have a limb amputated by a despotic ruler in order to prevent him from killing another Jew (Shu"t HaRadbaz 3:627). Alluding to the talmudic dictum that one's life takes precedence over another's, Radbaz further claimed that dictating such self-endangerment would be immoral and go against the notion that the Torah represents "ways of pleasantness and peace" (Prov. 3:17). With the exception of committing the three cardinal sins, the Torah commands us to preserve our lives, even by violating commandments such as "You shall not stand idly by the blood of your fellow." As such, one need not endanger himself to save someone from imminent death (Shulhan Arukh HaRav OH 329:8).
In an extreme formulation, Rabbi Meir Simha of Dvinsk (Latvia, d. 1926) applied this principle even when many Jews or the entire nation faced an imminent fatal threat (Or Same'ah Laws of Murderers 7:8). This position was challenged by others, such as Rabbi Meir Plotzky (Klei Hemda, Parashat Pinhas 1), and in a lengthy treatise, Rabbi Abraham Isaac Kook (d. 1935) contended that under those circumstances, self-sacrifice is mandatory (Mishpat Kohen 143).
In general, many scholars recognize a range of life-threatening actions, and somewhere along that continuum, certain conduct becomes meritorious or mandatory, given the circumstances (AH HM 426:4). Rabbi ibn Zimra himself ruled in a different responsum that one should act if the potential threat to the rescuer is unlikely to occur (Shu"t HaRadbaz 5:218). In cases of somewhat greater but nonetheless distant threats, many authorities deem it permissible and even meritorious to risk one's life in order to save another's, as long as the rescuer's actions are not suicidal (IM YD 2:714). Decisors also debate whether a person must endure pain to save others (Nishmat Avraham YD 157:4).
For most people operating in hygienic conditions, donating blood entails minimal pain. The risk is also negotiable, since the lost blood easily regenerates. As such, scholars including Rabbis Shmuel HaLevi Wosner (Shevet HaLevi 5:219) and J. David Bleich (Tradition 27:3) contend that one must donate blood if a patient requires an immediate transfusion. Donating to blood banks, especially amid shortages, also represents a definitive mitzvah (Nishmat Avraham YD 349:3).
While bone marrow naturally regenerates, donors previously had to be placed under general anesthesia and hospitalized for a couple of days. Therefore Rabbi Moshe Sternbuch did not require one to donate, though he deemed it extremely meritorious (Teshuvot VeHanhagot 5:387). Rabbi Shlomo Zalman Auerbach believed a potential donor should be cajoled into donating, especially if he did not fear the surgery (Nishmat Avraham EH 80:1). Yet Rabbi Bleich and Rabbi Mordechai Willig obligate one to donate, since the dangers represent common and minimal risks regularly taken for less pressing needs. This is especially true today, when most bone marrow donations take place on and out-patient basis, without general anesthesia.
Gaining consent from minors to donate bone marrow for family members remains ethically complex. Rabbi Auerbach believes that an older, mentally competent child can consent, but remains conflicted regarding younger or mentally incompetent children. Rabbi Bleich, however, requires parental consent.
Since bone marrow matches are based on genetic similarities, the Jewish community must participate in bone marrow drives (such as those organized by the Gift of Life Bone Marrow Foundation) to ensure that enough potential donors are registered. God blessed us with these medical tools - it is our responsibility and obligation to use them to save lives.
Chapter 10: Kidney Donation
May one donate a kidney?
In the preceding essay, regarding blood and bone marrow donations, we concluded that most decisors believe halakha excuses (and sometimes prohibits) people from endangering themselves to save another's life. However, measures like donating blood or bone marrow entail minimal risk; therefore, it remains meritorious and possibly obligatory to perform such lifesaving actions.
Donating a kidney, on the other hand, clearly constitutes a greater endangerment. Unlike blood or bone marrow, the missing kidney does not regenerate. While a person can function normally with one kidney (as we hope the recipient will), the donor places himself at risk if his remaining kidney is damaged in an accident or through dehydration. (Regarding the latter danger, most kidney donors and recipients should therefore not fully fast on Yom Kippur.) Moreover, the procedure is much more invasive and entails at least a few weeks of outpatient recovery.
Rabbi Isser Unterman contended that the invasiveness of the surgery alone was sufficient to forbid live kidney donations, since he believed that self-injury (hababala) represented a form of self-endangerment prohibited by halakha, even to save a life (Shevet MiYehuda 1, p. 53). Others similarly prohibited renal transplantation in the early 1960s, deeming it too dangerous for the donor (Minhat Yitzhak 6:103).
However, most decisors, including Rabbi Moshe Feinstein, concluded that live kidney donations were permissible and meritorious, though the possible risks prevented halakha from compelling them (IM YD 2:174, para. 4). Today, transplants are no riskier than routine surgeries involving general anesthesia. Therefore, since halakha generally permits people to take common risks (shomer peta'im) (Shabbat 129b), donating a kidney would not constitute inappropriate self-endangerment.
While the pain remains significant, Rabbi Shlomo Zalman Auerbach ruled that temporary severe discomfort does not negate the requirement to save lives (Nishmat Avraham YD 157:2). Moreover, since the life expectancy and general health of successful transplant recipients greatly exceeds those of patients on dialysis, most believe that donating a kidney fulfills the mitzvah of saving a life (pikuah nefesh), which overrides any prohibitions of self-injury. Nonetheless, because of the risks entailed by the procedure, the vast majority of decisors deemed it meritorious but not compulsory, though Rabbi Ovadia Yosef intimates that donating might be obligatory (Yehaveh Daat 3:84). Similarly, many scholars prohibit children or the mentally incompetent from donating, since they cannot be reasonably consent to these risks.
In countries when organ sales are illegal, all agree that Jews many not engage in such activity. The wisdom of such a ban, however, remains subject to a heated debate in Jewish and general ethics.