Altruistic donation of organs from living donors is widely accepted as a virtue and even encouraged as a duty. What is the Jewish legal (halachic) position on this issue? The conclusion is that altruistic donation is praiseworthy but in no way obligatory.
There are three fundamental problems concerning the halachic aspects of transplantation from living donors: 1) The danger to the donor; 2) donation under coercion; and 3) sale of organs and tissues. I will address the first of these and offer the others for your consideration.
(ה) וּשְׁמַרְתֶּ֤ם אֶת־חֻקֹּתַי֙ וְאֶת־מִשְׁפָּטַ֔י אֲשֶׁ֨ר יַעֲשֶׂ֥ה אֹתָ֛ם הָאָדָ֖ם וָחַ֣י בָּהֶ֑ם אֲנִ֖י יְהֹוָֽה׃ {ס}
(5) You shall keep My laws and My rules, by the pursuit of which man shall live: I am the LORD.
(יז) דְּרָכֶ֥יהָ דַרְכֵי־נֹ֑עַם וְֽכׇל־נְתִ֖יבוֹתֶ֣יהָ שָׁלֽוֹם׃
(17) Her ways are pleasant ways, And all her paths, peaceful.
אֲבָל לְהַחֲיוֹת — אֲפִילּוּ מֵעַל מִזְבְּחִי. וּמָה זֶה, שֶׁסָּפֵק יֵשׁ מַמָּשׁ בִּדְבָרָיו סָפֵק אֵין מַמָּשׁ בִּדְבָרָיו, וַעֲבוֹדָה דּוֹחָה שַׁבָּת — קַל וָחוֹמֶר לְפִקּוּחַ נֶפֶשׁ שֶׁדּוֹחֶה אֶת הַשַּׁבָּת. נַעֲנָה רַבִּי אֶלְעָזָר וְאָמַר: וּמָה מִילָה שֶׁהִיא אֶחָד מִמָּאתַיִם וְאַרְבָּעִים וּשְׁמוֹנָה אֵיבָרִים שֶׁבָּאָדָם דּוֹחָה אֶת הַשַּׁבָּת — קַל וָחוֹמֶר לְכׇל גּוּפוֹ שֶׁדּוֹחֶה אֶת הַשַּׁבָּת.
but to preserve a life, e.g., if the priest can testify to the innocence of one who is sentenced to death, one removes him even from on top of My altar, even while he is sacrificing an offering. Just as this priest, about whom there is uncertainty whether there is substance to his words of testimony or whether there is no substance to his words, is taken from the Temple service in order to save a life, and Temple service overrides Shabbat, so too, a fortiori, saving a life overrides Shabbat. Rabbi Elazar ben Azarya answered and said: Just as the mitzva of circumcision, which rectifies only one of the 248 limbs of the body, overrides Shabbat, so too, a fortiori, saving one’s whole body, which is entirely involved in mitzvot, overrides Shabbat.
(ויקרא כה, לו) וחי אחיך עמך אהדר ליה כי היכי דניחי ורבי יוחנן האי וחי אחיך עמך מאי עביד ליה מבעי ליה לכדתניא שנים שהיו מהלכין בדרך וביד אחד מהן קיתון של מים אם שותין שניהם מתים ואם שותה אחד מהן מגיע לישוב דרש בן פטורא מוטב שישתו שניהם וימותו ואל יראה אחד מהם במיתתו של חבירו עד שבא ר' עקיבא ולימד וחי אחיך עמך חייך קודמים לחיי חבירך
“And your brother shall live with you” (Leviticus 25:36), from which it is derived: Return the interest to him so that he may live. The Gemara asks: And Rabbi Yoḥanan, what does he do with this verse: “And your brother shall live with you”? The Gemara answers: He requires the verse for that which is taught in a baraita: If two people were walking on a desolate path and there was a jug [kiton] of water in the possession of one of them, and the situation was such that if both drink from the jug, both will die, as there is not enough water, but if only one of them drinks, he will reach a settled area, there is a dispute as to the halakha. Ben Petora taught: It is preferable that both of them drink and die, and let neither one of them see the death of the other. This was the accepted opinion until Rabbi Akiva came and taught that the verse states: “And your brother shall live with you,” indicating that your life takes precedence over the life of the other.
וְרוֹצֵחַ גּוּפֵיהּ מְנָא לַן? סְבָרָא הִיא: דְּהָהוּא דַּאֲתָא לְקַמֵּיהּ (דְּרָבָא), אֲמַר לֵיהּ, אֲמַר לִי מָרֵי דּוּרַאי: קִטְלֵיהּ לִפְלָנְיָא, וְאִי לָא — קָטֵילְנָא לָךְ. אֲמַר לֵיהּ: נִקְטְלָךְ וְלָא תִּקְטוֹל. מַאי חָזֵית דִּדְמָא דִּידָךְ סוּמָּק טְפֵי? דִּילְמָא דְּמָא דְּהָהוּא גַּבְרָא סוּמָּק טְפֵי!
The Gemara asks: And with regard to the murderer himself, from where do we derive this halakha that he should be killed rather than transgress the prohibition against murder? The Gemara answers: It is derived through reason, as it was told: A certain person came before Rava. He said to Rava: The master of the village where I live said to me: Kill so-and-so, and if you do not do so, I will kill you. What should I do? Rava said to him: Let yourself be killed, and you should not kill. Rava reasoned: What did you see to make you think that your blood is redder and more important than his? Perhaps the blood of that man is redder, and he is more important than you. If so, it is logical that one must not kill another person to save himself.
וקתני החובל בעצמו אע"פ שאינו רשאי פטור הכי קאמר ליה לא מבעיא בושת דאדם רשאי לבייש את עצמו אלא אפי' חבלה דאין אדם רשאי לחבל בעצמו אחרים שחבלו בו חייבין ואין אדם רשאי לחבל בעצמו והתניא יכול נשבע להרע בעצמו ולא הרע יהא פטור ת"ל (ויקרא ה, ד) להרע או להטיב מה הטבה רשות אף הרעה רשות אביא נשבע להרע בעצמו ולא הרע אמר שמואל באשב בתענית
and it teaches: With regard to one who injures himself, although it is not permitted for him to do so, he is nevertheless exempt from any sort of penalty, indicating that the prohibition is in effect even with regard to humiliation. The Gemara answers: This is what Rabbi Akiva said to the man: It is not necessary to say with regard to humiliation, where it is permitted for a person to humiliate himself, that someone else who humiliated him is liable. But even with regard to injury, where it is not permitted for a person to injure himself, others who injured him are liable. § The Gemara discusses whether it is permitted to injure oneself. And is a person not permitted to injure himself? But isn’t it taught in a baraita: One might have thought that if one takes an oath to do evil to himself and did not do evil he will be exempt from bringing an offering for having transgressed this oath. Therefore, the verse states: “Or if anyone swear clearly with his lips to do evil or to do good” (Leviticus 5:4), which teaches that just as taking an oath to do good for which one is liable is referring to an optional activity, as opposed to taking an oath to perform a mitzva, so too, taking an oath to do evil is referring to an optional activity, as opposed to taking an oath to transgress. I can therefore include within the category of one who is liable if he transgressed his oath the person who takes an oath to do evil to himself and did not do evil. It is clear from this baraita that doing evil to oneself is permitted. The Gemara answers: Shmuel says: The ruling of the baraita is not referring to one who takes an oath to injure himself but is stated with regard to one who takes an oath stating: I will sit in observance of a fast, which it is permitted to do.
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A donor who gives a kidney in order to prolong the life of another or to improve his quality of life fulfills a mitzvah of great merit.
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Nevertheless, even though the donor’s life is not thereby shortened, there is no halachic obligation to donate a kidney.40–43
Organ Transplants from Living Donors – Halachic Aspects*
Mordechai Halperin, M.D.**
40. Rabbi Waldenberg EY. Tzitz Eliezer 10:25, ch. 7.
41. Rabbi Yosef O. Kidney transplants. Diney Israel. 1976;7:25–43. Hebrew. [Google Scholar]
42. Rabbi ha-Levi CD. Organ transplants. Assia. 1983;4:255–7. Hebrew. [Google Scholar]
43. Abraham SA. Nishmat Avraham: Medical Halacha for Doctors, Nurses, Health-care Personnel and Patients. Vol. 2. New York: Mesorah Publications; 2003. p. 349. Yoreh De’ah. [Google Scholar]