Q&A: Considerations Against Kidney Donation
Considerations Against Kidney Donation
Question
Hello Rabbi,
Can the Rabbi spell out the considerations someone should take into account when thinking about donating a kidney? The benefit is obviously clear, but what should the considerations against it be?
One of the things I thought about, which in my opinion isn’t really being addressed right now, is that I’m not interested in donating to someone who has a family member who could donate but, because there’s some other “sucker” available, that relative doesn’t donate. With charity this is partly solved through organizations that check who really needs help and who doesn’t, but even if there are misses there, it’s not as serious as a miss when it comes to a kidney. By the way, I know someone who told me that his father needs a kidney transplant, and when I asked him why no one in the family was donating to him, he told me that his father doesn’t want them to do it (and I assume here that maybe he’s on the transplant waiting list).
In addition, why isn’t one obligated to donate a kidney משום “do not stand idly by your neighbor’s blood”?
Answer
Hello,
First of all, tremendous kudos for wanting to donate. An amazing altruistic act.
It is agreed that there is no obligation to donate, and several explanations can be suggested for this: 1. Why specifically me? (Though that could be overcome by a lottery.) 2. “Who is to say that your blood is redder,” on the assumption that kidney donation is akin to killing. One could ask why I am forbidden to forcibly take your kidney if I need it, after all the prohibition against injuring someone is not one of the three cardinal sins, and saving a life overrides it. One answer to that is that taking an organ is like killing. (Though to me a different answer seems more plausible: you may not enter another person’s territory, even if you are right.)
As for the considerations, I don’t have a clear answer. If you know that the relative would donate if you did not, that seems like a completely legitimate consideration. But if he wouldn’t donate in any case, then it is less reasonable to decide based on that. If the father is unwilling for them to donate, that is real chutzpah (unless he himself is unwilling to receive donations, in which case the question does not arise). I wouldn’t donate to him. And again, since there is no obligation to donate, any consideration you have is legitimate, and therefore there is no consideration that you are forbidden to make.
Discussion on Answer
I know that’s what you asked. I brought it as an example of the consideration I described.
The cross-match program is well known. It only solves the case where the relative wants to donate but can’t because he isn’t compatible.
I understood that the lottery suggestion was an answer to the question of “do not stand idly by your neighbor’s blood.” So why indeed don’t we hold a lottery and make sure that everyone who needs one gets a kidney?
If a family member doesn’t want to donate, do you think it is still proper to donate? I understand that your consideration is that the recipient is not to blame for the fact that his relative is abandoning him, but the counterclaim is that this will cause the recipient to rely on donors who are not family members.
There are considerations in every direction, and since there is absolutely no obligation to donate, it is clear that every donor has the right to weigh anything he wants. Still, if a person has no donor, there is value in donating to him. He is not to blame for the fact that his relative refuses to donate. One could also say that one should not give charity because it accustoms the state not to care for the weak. There is no end to that line of argument. When there is a tangible danger before us (a sick person lying before us), it is not right to make long-range calculations.
Why, and on what basis, is kidney donation considered like killing? (As far as I recall, one does not desecrate the Sabbath for danger to a limb.)
If it is like killing, how is kidney donation permitted? After all, the reasoning of “who is to say,” etc., is binding, and a person may not kill himself in order to save someone else?
Think of it as a mild form of killing, killing a terminally impaired person or someone with only short-term life expectancy. The Talmud says several times: “What difference does it make whether it is complete killing or partial killing?” For some purposes we view it as killing, and for others we do not.
Therefore, while there is no obligation to give the organ, and certainly it is forbidden to take it by force, a person is permitted to kill himself a little in order to save another. Something along these lines I wrote in my article on organ donation regarding brain death. It is forbidden to kill the person, but he is permitted to donate organs in order to save the full life of another person.
I just saw that there’s a kind of solution for a family member being incompatible for donation; it’s called the “National Cross-Match Program” (https://www.ynet.co.il/health/article/rJkQvwSf8) — if a family member isn’t compatible, you can find someone else with the same problem and pair them up. Seemingly, this mechanism should solve the problem at its root without needing altruistic donors. And that sharpens the suspicion that for every recipient it should have been possible to find a solution from within his own family.
As for my question about “do not stand idly by your neighbor’s blood” — I wasn’t asking why the recipient can’t take by force, but what gives us, the potential donors, permission to ignore it and not donate?