Living Kidney Donation

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Ezra’s cousin, Sammy, was seriously ill with kidney failure and desperately needed a kidney transplant. Ezra is only 15 years old, but wanted to donate his kidney and save Sammy’s life. His parents asked me if it was permitted to donate a kidney, and if yes, would it be permitted at such a young age. 

 

Live kidney donation involves transplanting a kidney from a healthy person to somebody suffering from kidney failure. According to halacha, saving another person’s life is considered a great mitzvah. In fact, the Talmud states that its equivalent to saving an entire world (Sanhedrin 37a). In this article, we will explore the various aspects of kidney donation in halacha. 

 

Halachic Considerations 

 

The source to permit live kidney donation in halacha is based on the principle of Lo taamod al dam re’echa (Vayikra 19:16), which obligates us to proactively save someone else’s life. On the other hand, the pasuk Ve’chei achicha imach (Vayikra 25:36) teaches chayecha kodmin (Baba Kama 62a), meaning that your own life takes precedence over saving someone else’s. It is therefore forbidden to sacrifice your life in order to save someone else’s life. When it comes to live kidney donation, Ezra would not be sacrificing his life to save Sammy, only putting himself in a small amount of danger. However, the Torah also instructs us, “Guard yourself and exceedingly safeguard your soul” (Devarim4:9). The Talmud interprets this to mean that we are obligated to protect ourselves from potentially dangerous situations (Brachot 32b). The question is, which mitzva takes precedence: the obligation not to endanger your life or to save someone else’s? 

 

Hacham Ovadia, zt”l,  has a fascinating responsa (Yechave Daat 3:84) on this topic. He initially quotes a number of poskim who forbid such a procedure, as they were concerned about the potential dangers to the donor. Hacham Ovadia responds that many years of experience have demonstrated that these procedures are overwhelmingly safe “and [more than] 99 percent of donors have a full recovery.” He then quotes the Radbaz who distinguishes between different levels of danger. Taking on something where “there is a small possibility of risk” so as to save somebody else’s life is permissible, whereas if “there is genuine concern that your life will actually be in danger,” the action is prohibited, even to save a life.  

 

Hacham Ovadia therefore concludes that even though donating a kidney is not required, one is certainly permitted to do so, because the mitzvah of saving a life takes precedence over the prohibition against self-endangerment, so long as the risk is very minimal and after careful medical evaluation. In addition, the donor must give their consent willingly and without coercion, as a person cannot be forced to donate a kidney, even if it means saving another person’s life. 

 

Kidney Donation After Death 

 

Note we have only discussed live donation. Donation after death is much more complex, especially when a ventilated patient has been diagnosed as brain dead and is considered dead by secular law. According to halacha they are still considered alive and therefore procuring organs from these patients would be prohibited. While decades ago there was debate about whether brain death is considered halachic death, due to changes over the years and a host of unaddressed questions by the poskim, I claim that even those poskim who once subscribed to the notion of brain death would not subscribe to it today, as research presented in my book Brain Death in Halacha and the Tower of Babel Syndrome shows. 

 

Back to Ezra’s parents’ question – it is permitted to donate a kidney, but one is not obligated, providing the doctors assume minimal risk. Regarding donations from people under the age of 18, in most countries this is not legal, as they are concerned that minors do not the ability to give full consent. Even though at the age of 12 or 13 one has become an adult in Judaism, some obligations, like getting married, only take effect from the age 18. 

Each transplant center has its own rules for minimum age requirements and a careful decision would need to be made together with the center, a rabbi, and Ezra’s family.