Blood Donations According to Halacha

Blood Donations According to Halacha in a Secular Society: Required, Prohibited or Recommended?

Guest post by Rabbi Aryeh Lebowitz

Rabbi Aryeh Lebowitz has served for the last six years as the Mara D’asra of Beis Haknesses of North Woodmere, a vibrant and growing community on the South Shore of Long Island. Rabbi Lebowitz has also been an eleventh grade rebbe at HALB’s DRS Yeshiva High School for the last eleven years, and serves as the Program Director and Maggid Shiur in HALB’s post high school yeshiva program, Yeshivat Lev Hatorah.

I. Introduction

The Gemara (Yevamos 79a) lists the three “signs”, or distinguishing characteristics, of the Jewish people: We are a merciful, bashful and kind people. Jews have distinguished themselves in America with great philanthropy and genuine concern for the welfare of the less fortunate. Our generosity is not limited to our willingness to give charity, but extends to giving of ourselves physically as well. We will not soon forget the great Kiddush Hashem that was made by the Israeli presence in Haiti following the devastating and tragic earthquake that ravaged the country. At a recent blood drive, one of the technicians remarked that the Jewish people are remarkable in their willingness to donate blood. The technician estimated that Jews give blood at a rate five times the national average. As an example, last year alone Bikur Cholim of Boro Park conducted forty five blood drives raising 5300 pints of blood from the orthodox communities of Brooklyn and Staten Island.[1] However, observant Jews must be careful to distinguish right from wrong, not only with a sense of kindness and generosity, but with a strong sense of the demands of halacha. Recently, some have questioned the halachic propriety of Jews donating blood in America. In this essay we will discuss the relevant issues and seek to demonstrate that giving blood, while not always obligatory is at a minimum, permissible, and more likely a very great mitzvah.

II. Saving Lives

The most obvious reason that giving blood is a thoroughly Jewish thing to do is the value that Judaism places on human life. Indeed, with the exception of the three cardinal sins (Idolatry, Licentiousness, and Murder) one may violate any prohibition in the Torah in order to save a human life (Sanhedrin 74a). Moreover, the torah not only values the good Samaritan who goes out of his way to save a life, but formally obligates every Jew to actively save lives that are in danger (Vayikra 19:16). Several contemporary poskim have noted that Jews must participate in any life saving procedure with negligible risk in order to save a fellow Jew (Nishmas Avraham IV: Even Haezer:80, Responsa Shevet Halevi V:219), and this seems both logical and correct: just like a person must spend small sums of money to save the life of a person, he must inconvenience himself by taking minuscule risk (like the risk of crossing the street). Several poskim have noted that the minimal discomfort of donating blood is certainly halachically insignificant. It therefore follows that if a Jew is in need of blood and one refuses to give, he is in violation of “lo sa’amod al dam re’echa” (Shearim Metzuyanim B’halacha 190)

It should be noted, however, that traditional rabbinic sources point to a clear distinction between our obligation to save the lives of fellow Jews and our attitude toward saving the lives of non-Jews. Specifically, the aforementioned imperative to actively save lives explicitly refers to Jewish lives (לא תעמוד על דם רעך). When it comes to saving non-Jewish lives Chazal (Sanhedrin 57a) were much more ambivalent, and ruled that non-Jews should neither be thrown into a pit nor saved from a pit into which they are thrown. Similarly, Chazal prohibited violating Shabbos in order to save a non-Jewish life (Mishnah Yoma 8:7). Of course, common practice is not only to actively save non-Jewish lives, but also to violate Shabbos in order to do so.[2] Rav Moshe Feinstein (Iggeros Moshe Orach Chaim V:25) explained that the imperative to save non-Jews is critical for Jewish survival in our times. If Jews were to deny treatment to non-Jews the resulting fallout would be nothing short of disastrous, as society would not take very kindly to such discriminatory policies and would rightfully justify such discriminatory practices on their own part. Though the Gemara (Avoda Zara 26a) reasons that non-Jews will surely understand that we may only violate the Shabbos for the sake of those who observe Shabbos, Rav Moshe points out that such arguments are not very likely to be accepted by the gentile society in general.[3] Rav Moshe concludes by emphasizing that there is no need to prove from earlier sources that one may violate biblical prohibitions to save gentile lives because it is “abundantly obvious”. It would seem that similar considerations may exist with respect to donating blood to save non-Jewish lives. A communal refusal to do so is likely to be met with strong criticism and severe anti-semitism.

III. The Potential Issurim

One local rabbi recently suggested that there is a prohibition to donate blood to general blood banks (though he acknowledged that there is a mitzvah to donate blood to Jewish causes). In order to refute any such claim it is important to identify precisely which prohibitions may be violated in the course of blood donations.

The first potential prohibition one may violate when donating blood is the prohibition of wounding human beings (Devarim 25:3). The Gemara (Bava Kama 91) records a dispute whether this prohibition extends to one who wounds himself. The Rambam (Hilchos Chovel 5:1) rules in accordance with the opinion that prohibits injuring oneself. The Tur (Choshen Mishpat 420) rules that it is permissible for a person to wound himself. The Shulchan Aruch (Choshen Mishpat 420:31) rules stringently on this matter. It may therefore be argued that giving blood would involve the prohibition of needlessly wounding oneself. However, there are several reasons to assume that this prohibition does not apply in the context of blood donations. First, Rav Moshe Feinstein (Iggeros Moshe Choshen Mishpat I:103) points out that it is obvious that one may cut himself if such incisions are necessary for medical treatment. For instance, one may clearly undergo a medically warranted surgical procedure even though the procedure involves making an incision. Rav Moshe points to the custom in Talmudic times to go through regular blood-letting sessions in order to maintain proper health (Gemara Shabbos 129). Although we no longer encourage blood-letting as a form of medical therapy, and even by the times of the Rambam the medical effectiveness of letting blood was somewhat minimized (Hilchos Deos 4:18), there still must be some therapeutic value to it. Rav Moshe finds it hard to believe that something considered so healthy just a few centuries ago would fall in the category of chavalah (wounding) nowadays. Indeed, several recent studies suggest that there are health benefits to people who habitually donate blood.[4] Second, it is possible that there is no prohibition of wounding when the wounded permits the other party to injure him. The Minchas Chinuch (mitzvah 48) and Turei Even Megillah 27a rule that the prohibition does not apply when the victim permits somebody to hurt him.[5] While the Shulchan Aruch Harav (V: Hilchos Nizkei Guf V’nefesh:4) does not believe a person has the right to allow another person to cut him, the dissenting opinion of the Minchas Chinuch and Turei Even would serve as an additional lenient consideration in our case.[6] Third, an additional lenient consideration is that the Rambam (Chovel U’mazik 5:1) defines the prohibition of wounding as “derech nitzayon” (in a combative way), which seems to exclude a wound created in the context of a blood donation from the prohibition. Finally, even if one may not cut himself to give blood, there may be no prohibition to have a gentile make the incision. While the gemara (Avoda Zara 6b) rules that one may not aid a gentile in violating a prohibition, the prohibition of wounding does not seem to be one of the seven Noahide laws.[7]

A second potential prohibition associated with donating blood is לא תחנם (Devarim 7:2) which the Gemara (Avoda Zara 20a) understands to include a prohibition to give “free gifts” to gentiles. Obviously this consideration would be a non-factor if the donation were going to a fellow Jew. However, even when donating to general blood banks there are several strong arguments to be made that donating blood does not violate the prohibition of לא תחנם. First, while the Shulchan Aruch (Yoreh Deah 151:11 as explained by Shach ibid 18) applies this prohibition to all gentiles, many great poskim have limited the prohibition to idolaters (Rav Dovid Tzvi Hoffman, Rav Henkin, Rav Ahron Soloveitchik – see also Tzitz Eliezer XV:47 where he demonstrates that this was the opinion of several prominent Rishonim and concurs with their view).[8] Second, the Turei Zahav (Yoreh Deah 151:8) rules that if one knows the gentile to whom he is giving the gift, it is permissible because it is not considered a “free” gift. When there is a reciprocal relationship one can rest assured that the generosity of giving a gift will be repaid by the gentile in one way or another.[9] Similarly, one may argue that even when one doesn’t know precisely to whom his blood is going, there is certainly a sense of reciprocity for blood donors, as Jews who need blood will receive blood as a direct result of the blood banks that we support. Additionally, a person who carries a blood donor card is likely to be treated with greater care should he ever find himself in the hospital. The value to all members of a society in having functional and fully stocked blood banks is immeasurable. Just as a Jew may, and must, pay taxes even if some of the roads paved with the tax money may never be traversed by a Jew, a Jew may give blood that may not be used to help another Jew. The reason that this is permissible is not simply one of a reciprocal relationship, but of fully participating in a system that benefits all of us. Supporting a broad system that benefits countless people, and thousands of Jews amongst them, is difficult to categorize as a “free gift” to gentiles.[10]

A third possible stringent factor may be the application of the rule of majority. One of the primary claims of those who wish to prohibit donating blood to blood banks is that the majority of those who need the blood are gentiles. Assuming that the prohibition of לא תחנם (discussed above) applies to contemporary blood donations to gentiles, one may argue that the prohibition would apply even though there are many Jews who may ultimately receive the blood. This is based on the principle that we follow the majority (Shemos 23:2). There are two reasons that this application of the rule of majority is likely incorrect. First, Chazal (Kesuvos 15b) suspend the rule of majority in situations that involve a threat to life. Certainly the need for sufficient blood supply in hospitals is one of life and death. Therefore, even if one were to accept a prohibition to donate blood to a gentile, the possibility that the blood may go to a Jew is sufficient to outweigh any such negative considerations. Second, Rabbi J.D. Bleich has suggested that since the blood is distributed in a hospital, which is a set location. The law of majority only applies to situations where something is removed from its set location, but regardless of actual ratios the halacha treats anything that is stationary (i.e. in a set location) as a fifty percent doubt (Yoma 84b, Kesuvos 15a and elsewhere). Therefore, even if ninety five percent of the patients in the hospital are gentiles, the halacha treats the situation as if fifty percent are Jewish and fifty percent are gentiles.

Perhaps even more pointedly, Rabbi Michael Broyde has noted that when dealing with a commodity like blood, the whole concept that majority and minority seems mistaken. We live in a society without “Jewish” blood banks and the only way the Jewish community can carry its fair burden of giving blood to save Jews is by donating to the general blood bank. If 5% of the general population is Jewish and Jews donate 5% of the blood, certainly halacha accepts that such a system is proper, as there is no mechanism to designate which blood goes where.

It goes without saying that one cannot assume that if a Jew is in need of blood the Jewish community, even if somehow immediately informed of the need, would have the wherewithal to collect enough blood on their own in a timely fashion. When a person is involved in a major accident there is often a need for massive amounts of blood in a very short period of time. Supplying that blood ahead of time is absolutely critical.

Finally, Rabbi Menashe Klein (Responsa Mishnah Halachos IV:245), after discussing various halachic considerations associated with blood donation, suggests that it is “inappropriate” for a Jew to give of his soul (blood is equated to the soul in Judaism) which is sanctified as Jewish blood and allow it to flow through the impure veins of a gentile. Rabbi Klein poetically refers to the blood of the person “crying out” from the gentile veins. Considering the utter lack of halachic sources to back up what seems to be a frivolous argument it does not seem necessary to rebut this claim in any meaningful way other than to point out that it is most curious that Rabbi Klein does not express any similar hesitation about a holy Jew receiving the impure blood of a gentile.[11]

IV. For Money

Rav Moshe Feinstein (Iggeros Moshe Choshen Mishpat I:103) was asked about the permissibility of giving blood to the blood bank for money. Prior to determining that there is no prohibition of wounding oneself (see above) Rav Moshe argues that there is reason to assume that one may violate the prohibition of self mutilation for monetary gain based on the following logic. The gemara (Bava Kama ibid) associates the opinion who prohibits self mutilation with the opinion that refers to a Nazir as a sinner. If the Nazir is considered a sinner for denying himself the pleasure of wine, the person who mutilates himself is certainly a sinner! However, it is obvious that if one is offered payment to avoid drinking wine, they may refrain from wine and not be called a sinner. Similarly, one may argue that if one were to receive payment to cut themselves, they may do so. However, Rav Moshe points out that Tosafos (ad loc) assume that the prohibition of self mutilation is operative even if one receives compensation for it. The distinction between receiving payment for withholding wine from themselves and one receiving payment for self mutilation is self evident. One who does not drink wine is not actually causing themselves any pain. They are merely withholding a pleasure from their lives. If the money they receive to avoid wine gives them more pleasure than the wine itself no prohibition has been violated. On the other hand, one who mutilates himself is actively causing pain to himself, an act that is prohibited even when done for payment.

As a practical matter the preceding analysis is irrelevant because Rav Moshe rules that giving blood would fall under the category of a therapeutic treatment rather than self mutilation. He therefore concludes that it is permissible to receive payment for blood donations.

V. Conclusion

Aside from the classical halachic issues and challenges, the overarching consideration that should help drive the Jewish policy is the enormous potential for Kiddush Hashem in blood donations by the Jewish community, and the even greater potential for chillul Hashem should we, as a community, not do our part. As observant Jews we have an obligation to sanctify God’s name in every which way possible permitted by the halacha. Considering the halachic arguments over limitations on organ donation, the need to donate what we are without question halachically permitted to donate may be even greater. Indeed, the Orthodox community in America has taken this responsibility extremely seriously. There is a longstanding practice for Orthodox shuls and institutions running blood drives and supporting blood banks. Any ruling to the contrary would constitute a significant departure from minhag yisrael, across the entire spectrum of orthodoxy, over the course of several decades. In the merit of fulfilling the great mitzvah of saving lives and sanctifying the name of God, we should all merit good health and long life.[12]

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[1] http://www.theyeshivaworld.com/article.php?p=54493
[2] See Chazon Ish Yoreh Deah 2:16 s.v. v’nireh that we no longer discourage saving gentile lives.
[3] See also Responsa Chasam Sofer Choshen Mishpat #194 who makes the same point.
[4] “Donation of Blood Is Associated with Reduced Risk of Myocardial Infarction” Jukka T. Salonen, Tomi-Pekka Tuomainen, Riitta Salonen, Timo A. Lakka, and Kristiina Nyyssonen in American Journal of Epidemiology 1998. “Possible association of a reduction in cardiovascular events with blood donation” D. G. Meyers, D. Strickland, P. A. Maloley, et al. in Heart 1997 78: 188-193 The author thanks Dr. Michael Oppenheim for bringing this information to light. Dr. Oppenheim pointed out that “these are not definitive studies so the official medical stance is that there are some studies to suggest there might be a benefit but larger scale trials would be needed to prove the benefits.”
[5] The Turei Even however does not extend this permissive ruling to a parent allowing a child to draw blood.
[6] The opinion of Minchas Chinuch and Turei Even is difficult to accept in light of the prohibition for a person to wound himself.
[7] See, however, Meshech Chachmah Bereishis 34:22, who assumes that gentiles are also prohibited from wounding other people. Also, the role of the blood donor in aiding the technician to remove the blood may play a role. See Taz Yoreh Deah 198:21 and Nekudas Hakesef there.
[8] It should be noted that the majority of poskim assume that this prohibition applies even to gentiles who are not idolaters. This is most relevant with relation to the prohibition of selling land in Israel to gentiles, which is also derived from the passuk of “Lo Sechaneim”. The use of heter mechira to circumvent shemittah prohibitions may hinge on the permissibility of selling land in Israel to non idolatrous gentiles. Rav Shalom Yosef Zevin (L’or H’halacha pages 124-125) demonstrates that one may not sell land in Israel to any gentile, even non idolaters. It is also important to note that whether Christians are considered by the halacha to be idolaters is the subject of some debate. The Noda B’Yehuda (Yoreh Deah Tinyana #148) clearly demonstrates that gentiles are prohibited from believing in the trinity.
[9] For similar idea see Gilyon Maharsha Yoreh Deah 159.
[10] For a similar point see Responsa V’yashev Moshe I:94.
[11] See Responsa Vayashev Moshe I:94 in footnote who similarly dismisses Rabbi Klein’s argument as completely nonsensical.
[12] Rabbi Michael Broyde wrote: “I have read this essay closely and I note that I completely agree with its conclusion: Although halacha does not generally require that a person donate blood, as the life saving act is not imminent, halacha views the act of donating blood as a mitzvah and pious healthy people should run to fulfill this righteous deed when they can. The Orthodox Jewish community should continue to sponsor blood drives, as has been the minhag have for decades.”