Machberes: Inside The Chassidish And Yeshivish World
By Rabbi Gershon Tannenbaum
Amongst the many chesed organizations serving the observant community, a singular place is occupied by Renewal, the organization dedicated to helping kidney donors and recipients. The towering work of Hatzolah, Misaskim, etc. are not to be ignored. Words cannot describe and praise enough the holy services of Renewal in its literally giving life to those that would perish without the gift of a kidney.
The history of successful kidney transplants began with Ruth Tucker, a 49-year-old lady in Illinois in 1950. The donated kidney was rejected by her immune system ten months after the operation. Nevertheless, the original kidney recovered during its ten months of recuperation. Heaven granted her an additional five years of life.
The first living donor kidney transplant was performed in Boston in 1954. The donor and the recipient were twins. The operation enabled the recipient to live another eight years. The operation was performed by Dr. John P. Merrill.
Since the development of medication to prevent organ rejection has achieved a high degree of effectiveness, donors do not need to be similar to their recipient. Initially, donors were closely related to recipients, such as twins or siblings. With the significant improvement in medication, the donor base opportunity for someone in need has expanded considerably.
Most donated kidneys come from deceased donors; however, the utilization of living donors in the United States is on the rise. In 2006, 47% of donated kidneys worldwide came from living donors. Currently, approximately a third of all kidney donations in the United States, England, and Israel are from live donors.
Within the expanded potential pool of donors, donations usually come from emotionally related donors, such as spouses, neighbors, and friends. Other donors include acquaintances and even strangers, labeled as “altruistic donors.” When the original intended recipient does not match, the larger pool enables a chain sequence that ultimately comes back to the intended recipient.
In our greater Torah-observant community, halachic issues of living kidney donation are continuously reviewed and updated. Extrapolating the many opinions, the consensus is that kidney donation is permitted today, though not obligatory. While this summary is technically correct, nevertheless—as with every aspect of evolving halacha—historical and halachic context must be reviewed to understand the halachic permissibility of surgically removing a vital organ from one human being and transplanting it into another. Halachic permissibility parallels the evolution of kidney-failure treatment: the first artificial kidney (dialysis) machine was invented in the 1940s and the first kidney transplant took place in 1950, and poskim began discussions about living kidney transplants shortly thereafter.
Unfolding halacha focused on the extent of risk involved for the donor, and of course, to a smaller degree, the recipient. “Do not stand idly by as the blood of your brother is shed” (Vayikra 19:16) obligates one to save the life of another in danger. The question arises as to how much risk one may—or should—undergo in order to save another. In our discussion of kidney donation, both the immediate risk of the surgical procedure and the long-term risk of living with only one remaining kidney need to be considered.
The reviews of poskim evaluated the associated dangers of transplant procedures. In the very early days of kidney transplants, a number of halachic authorities, including Rabbi Eliezer Yehuda Waldenberg, zt’l, (1915-2006), author of Tzitz Eliezer and Rabbi Yitzchak Yaakov Weiss, zt’l (1902-1989), Av Beis Din of the Jerusalem Eidah Hacharedis and author of Minchas Yitzchok, prohibited one to be a living kidney donor due to the high level of risk then involved for the donor.
As with all medical halachic matters, however, updated developments are basic factors in halachic decisions. Living organ donation is now relatively commonplace; the donor risk has been well studied and quantified, and the success rate has significantly improved. The procedure is now well within a halachically accepted risk tolerance. Virtually, no posek today prohibits live kidney donation. They approve, but stop short of encouraging donation, declaring such donation to be an exceptional mitzvah.
Renewal’s recent advertising campaign showed pictures of smiling recipients and glowing pictures of donors. The recipients had been granted the gift of life. The donors have performed the absolute greatest gift possible, that of giving life. They prevent wives from becoming widows, husbands from becoming widowers, and children from becoming orphans.
The giving of a kidney is not simply lying back and telling surgeons to go ahead. Nor is it the simple insertion of one’s hand deep into a pocket to extract $1, or $10,000, for tzedakah. If one is inclined to donate a kidney, he is presented with a long list of patients in extreme need. The potential donor can make a selection. However, depending on test results, the initial selection may not be suitable.
Potential donors must go through a series of medical tests to ensure that they are healthy and physically fit, and the giving of a kidney will not adversely affect their health, neither at the present nor in the future. In addition, potential donors must undergo a series of psychological tests to ascertain their mental wellbeing and their mental resilience.
Needless to say, no donors are paid for their organs. In addition to being improper and indecent, such a practice is illegal. All monies donated to Renewal are used solely to pay for medical procedures and for the recovery of both donor and recipient.
The recipient and the donor do not always meet. Many donors do enjoy meeting those whose lives they saved. So too, recipients often wish to personally thank those who gave them continued life. However, some are uncomfortable with such meetings and decline. When the recipient and the donor do meet, usually together with their families, emotions run high. Some have compared it to celebrating a childbirth. Thereafter, families usually invite each other to simchas, which are exceptionally enjoyed by both sides. One donor was invited to a recipient’s son’s bar mitzvah. Knowing that the father was able to be with his wife and enjoy the bar mitzvah of their son, and that the bar mitzvah boy had a father, gave the donor deeply felt unlimited joy. v
Rabbi Gershon Tannenbaum is the Rav of B’nai Israel of Linden Heights in Boro Park and Director of the Rabbinical Alliance of America. Rabbi Tannenbaum can be contacted at firstname.lastname@example.org.