Approach to Kidney Donation

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by R. Daniel Mann

Question: Is it a requirement, a proper thing, or an improperly exaggerated act of chesed to donate a kidney to someone with whom the only connection is that you both are Jews?

Answer: [People often ask whether our questions are sent in or whether I make them up. Actually, the great majority are sent in. However, this question is one I asked myself for myself. Also, I did not answer it in our usual style. A little background: after deciding I wanted to donate a kidney, I asked my posek this question. His conviction is that while one is not required to donate, it is a very big mitzva to exceed one’s chesed obligation and do so. He also ruled that if I donate, I am obligated to share this fact with as many people as possible to encourage others (very healthy middle-aged men and women) to consider it. I have decided that after a very brief discussion of the halachic issues, I will share a unique Torah-based approach (not ruling) that motivated me (intellectually).]

The Radbaz (III:627) was asked whether one who can save a Jew’s life by agreeing to sacrifice a limb should do so. He responded that one is not required to make such a life-altering sacrifice but that doing so would be an “act of chasidut.” He continues that if giving the limb endangers his life (as he assumes), only a “chasid shoteh (crazy)” would agree. There seem to be differing opinions within Chazal about endangering oneself to save someone in great danger (see S’ma 426:2).

There are decades-old teshuvot (Minchat Yitzchak VI:103; Tzitz Eliezer IX:45) that discourage kidney donation due to perceived dangers. However, the present consensus encourages it, as Rav Yisraeli did decades ago (Chavot Binyamin 109). All surgery has some danger, but these days it is negligible for healthy people. There are slight disadvantages to having one kidney. It can be life-threatening, but uncommonly so for those who pass the rigorous pre-donation testing. However, it is unclear, based on what we have learned (so far) in the last few decades, whether the Radbaz would consider a donor a chasid shoteh. Poskim (see Pitchei Teshuva, CM 426:2; Mishna Berura 329:19) and the Radbaz elsewhere (see Chavot Binyamin ibid.) urge people not to exaggerate self-concern when others need saving.

When there is a communal danger from attackers, Jews are expected to come, even on Shabbat with weapons, to defend their counterparts (Eruvin 45a; Shulchan Aruch, OC 329:6-7). Considering that there must be some danger to the defenders, doesn’t this contradict the Radbaz?

The following approach is based on the way I was taught at Eretz Hemdah and by Rav Yisraeli to view communal needs, especially in the State of Israel. Members of Israeli society face many dangers – hostile countries, criminals, national disasters, etc. People (soldiers, policeman, firefighters, etc.) risk their lives to protect society. Nationally, we are far better off with an apparatus of protection than to have everyone fend for themselves. But who should risk his life? We draft, appeal to, and/or provide incentives for people to take these positions. I believe that no posek would forbid being an Israeli soldier or policeman based on the Radbaz.

Similarly, if society, as guided by doctors, lawmakers, and poskim, has to decide whether to encourage healthy people to accept difficulties and minor risks to save recipients from extended dialysis and/or death, the logical answer is, “Yes!” It is just a matter of finding the right number and profiles of donors. The government provides incentives (including modest “financial gratitude”), the most important being that the donor’s family goes to the top of the list of future recipients if needed. It also ensures careful screening. When organizations (e.g., Matnat Chaim), rabbis, and others (I am hereby trying) succeed in presenting the matter to the public eye, our philanthropically-minded nation will respond appropriately. We’re getting closer to providing the desired number of donors but need more work. If Israel is not the world leader yet, let us be soon!

About Daniel Mann

This column is produced on behalf of Eretz Hemdah by Rabbi Daniel Mann. Rabbi Mann is a Dayan for Eretz Hemdah and a staff member of Yeshiva University's Gruss Kollel in Israel. He is a senior member of the Eretz Hemdah responder staff, editor of Hemdat Yamim and the author of Living the Halachic Process, volumes 1 and 2 and A Glimpse of Greatness.

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