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Organ Transplants from Living Donors*

Published online by Cambridge University Press:  04 July 2014

Rabbi Mordechai Halperin
Rabbi Mordechai Halperin
Affiliation:
Director, the Dr. Falk Schlesinger Institute for Medical-Halakhic Research at Shaare Zedek Medical Center, Jerusalem.
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Extract

I. Survey of Transplant Techniques

The kidney is one of the few organs which today can be successfully transplanted from a living donor to an ailing recipient. A healthy donor can function satisfactorily with a single kidney; therefore the removal of one kidney for transplantation does not significantly endanger the donor's life. However, removal, or even partial removal, of other organs, such as the heart, lungs, or pancreas, will present a serious risk to the health and life of the donor.

In addition to organs, skin, bone marrow, blood and other body parts can be transplanted from living donors.

A. Kidney Transplants

The kidneys function to regulate the body's electrolyte and water balance and eliminate various wastes. Severe kidney dysfunction endangers the patient's life, and requires treatment by dialysis or kidney transplant. Up until a decade ago, the life expectancy of patients treated by dialysis exceeded that of patients who underwent kidney transplants. Over the past decade, the life expectancy of patients who have undergone kidney transplants from deceased donors has increased to a point where it is now comparable with the life expectancy of patients on dialysis.

Type
Bioethics and the Law — Organ Transplants
Information
Israel Law Review , Volume 27 , Issue 4 , Autumn 1993 , pp. 566 - 587
Copyright
Copyright © Cambridge University Press and The Faculty of Law, The Hebrew University of Jerusalem 1993

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References

1 Tapson, J.S., “The Risk of Donor Nephrectomy” (1985) 8 Int'l J. Artif. Organs 13–16Google ScholarPubMed; Weiland, D., et al., “Information of 628 Living-related Kidney Donors at a Single Institution with Long Term Follow-up in 472 Cases”, (1984) 16 Transp. Proc. 6Google Scholar; Vincenti, F., et al., “Long-term Renal Function in Kidney Donors: Sustained Compensatory Hyperfiltration with No Adverse Effects”, (1983) 36 Transplantation 626.CrossRefGoogle ScholarPubMed

2 Skin is an example of a tissue which is vital for preserving life.

3 Black, D. and Jones, N.F. (eds.), Renal Disease (Blackwell, 4th ed., 1979) 528.Google Scholar

4 Vollmer, W.M., et al., “Survival with Dialysis and Transplantation in Patients with End-Stage Renal Disease”, (1983) 308(26) N.E.J. Med. 1553–1558.CrossRefGoogle ScholarPubMed The main factors in improvement are selection of donor candidates by tissue typing (MHC), use of blood transfusion, and new methods for suppression of the recipients's immune system.

5 Combined Report on Regular Dialysis and Transplantation in Europe (1985) vol. 16 offered by Hospal Ltd. Basel, pp. 58–61.

6 Levey, A.S., et al., “Kidney Transplantation from Unrelated Living Donors”, (1986) 314 N.E.J. Med. 914CrossRefGoogle ScholarPubMed; Weinstein, T., et al., “Kidney Transplantation from Related Donors”, (1988) 115 HaRefuah 403–404.Google Scholar

7 Schwartz, A.I., et al. (eds.), Principles of Surgery (McGraw Hill, 4th ed., 1984) 278–279.Google Scholar

8 Shuck, J.M., “Biologic Dressing”, in Artz, C.P. et al. (eds.), Burns, A Team Approach (Saunders, 1979) 211–223.Google Scholar

9 Or, R. and Slavin, S., “Bone Marrow Transplant”, (1987) 30 Madda 96–101, 117.Google ScholarPubMed

10 Ibid.

11 Ibid.

12 Ibid.

13 An example would be certain severe leukemias (ANLL). See Harrison, , Principles of Internal Medicine (10th ed., 1983) 807.Google Scholar In aplastic anemia, on the other hand, 50% of all patients die within four months of diagnosis. Only 10–20% recover without bone marrow transplant (ibid., at 1886–1894).

14 See Arnon, R., “Karl Landsteiner, Discoverer of Blood Groups”, (1969) 14 Madda 177.Google Scholar

15 Yoma 85b.

16 Thia principle was adopted by the Israeli Supreme Court and emphasized by Bejeid J. in Joseph Kortus v. State of Israel (1986) 40(iii) P.D. 673, at 696.

17 Yoma 82b., Pesachim 25a-b, and Sanhedrin 74a.

18 See Yomo, ibid., according to Rashi.

19 Mishneh Torah, Rotseach 2:2.

20 Issur ve-Hetter, 59:38; Sefer Chassidim 674.

21 Haggahot Maimoniot quoting the Palestinian Talmud in Kesef Mishneh, Rotseach 1:14; Yosef, Bet, Choshen Mishpat 426.Google ScholarCf. Berlin, R.N.T.J., Ha'amek She'elah 147Google Scholar:2 and Sofer, A.S., “Lifesaving”, (1982) 22 HaMa'yan 31–40.Google Scholar

22 Sefer Me'irat Einayim 426:2.

23 In war one is obligated to endanger oneself to save others. Therefore it is halakhically prohibited to abandon a battle field. See Mishnah Sotah 8:6 and Tsits Eliezer 12:57.

24 Resp. Gaon, R. Hai in Sefer Ha-Eshkol, Hilchot Sefer Torah (ed. Auerbach, ) 11:49Google Scholar; ha-Rif, Piskei, Eiruvin; Erets Yisrael beSifrut ha-Teshuvot 1:18–26.Google Scholar

25 Toseftá Terumot (ed. Lieberman, ), VII:20.Google Scholar

26 Mishneh Torah, Yesodei ha-Torah 5:5.

27 Talmud, Palestinian, Terumot 8:4.Google Scholar

28 S. Atlas quoted in a footnote in Weinberg, J.J., Resp. Seridei Eish 2:78Google Scholar; Gesher ha-Chayyim 2:2 (note 3); Jakobovits, I., Jewish Medical Ethics (Mosad HaRav Kook, 1966, in Hebrew, translated from an original English edition) 152Google Scholar; See also R. Weinberg's response, ibid., sec. 4, p. 199.

29 According to the well-known principle of set theory there are no fewer points in a line of length “a” than in a line of length “2a”.

30 Radbaz, , Leshonot ha-Rambam, 1582 (218)Google Scholar; Pitchei Teshuvah, Choshen Mishpat 426:2; Mishnah Berurah 329:19; Tsits Eliezer 8:16, ch. 10(13); 9:17, ch. 5.

31 Radbaz, ibid.Cf. Zilberstein, R. I., “Endangering Physicians' lives”, (1986) 41 Assia 5–11Google Scholar; Minchat Chinnuch 296;

32 See Tapson, supra n. 1.

33 Supra n. 23.

34 See Nebenzahl, A., “Shortening Life”, in Assia Book, vol. 5 (1986) 259–260.Google Scholar

35 See Tapson, supra n. 1.

36 Resp. Radbaz 1052 (627).

37 Proverbs 3:17. Cf. Sotah 32a, Yevamot 15a, 67b.

38 Only a kidney donated from a living relative lengthens life expectancy. Cf. supra nn. 4, 5. In contrast to removal of a kidney which does not cause disability (See Tapson, supra n. 1), removal of a limb does cause a substantial disability.

39 Radbaz, ibid.; Tsits Eliezer 9:45; Minchat Yitschak 6:103.

40 Tsits Eliezer 10:25, ch. 7; See Yosef, R. O., “Kidney Transplants”, in (1977) 7 Dine Israel 25Google Scholar; Halevi, R. C. D., “Organ Transplants”, Assia Book, vol. 4 (1983) 255–257Google Scholar; Nishmat Avraham, Y.D. 349:3(3)1.

41 The guardians consent is valid only when it is in the interests of the ward.

42 Leviticus 19:13; see Bava Metsi'ah 61b.

43 Deut. 25:3.

44 Yonah, Rabbenu, Comm. on Pirkei Avot, 1:1.Google Scholar

45 Talmud, Babylonian, Ketubbot 33aGoogle Scholar (cf. Rashi on Deut. 25:3).

46 According to Yonah, Rabbenu, Sha'arei Teshuvah 3:139Google Scholar, personal injury may be considered part of the prohibition of killing, therefore it would not be suspended even in life saving situations.

47 According to the unique opinion of R. Moshe ibn Chabib (Tosafot, Yom ha-Kippurim 82b, quoted in Jakobovits, I., Jewish Medical Ethics, supra n. 28, at 120Google Scholar) one may save one's own life by injuring another when there is no alternative.

48 See Ketubbot 19a and Ramban in Shittah Mekubbetset; Palestinian Talmud, Shabbat, at the end of ch. 14; Avodah-Zarah 2:2; Talmud, Babylonian, Bava Kama 60b.Google Scholar Raahi, Tosafot, and Rosh, , Bava Kama; Shittah Mekubbetset Bava Kama 117bGoogle Scholar; Resp. Rashba 1:17; Resp. Binyan Tsion 167, 168; Sho'el u-Meishiv 1:2 (174); Iggerot Moshe Y.D. 1:214; Sedei Chemed, Ma'arechet Alef, sec. 16; Resp. Chatam Sofer Y.D. 319; Nishmat Avraham Y.D. 349:3(2)2. Cf. Yalkut Shim'oni, II Samuel 168; cf. Bava Kama 60b.

49 Cf. Rabbenu Yonah, supra n. 46.; Ran Pesachim 25a; Rema, Y.D. 157:1.

50 Rabbenu Yonah, Ran, and Rashba. Cf. Talmud, Palestinian, Avodah Zarah 2:2.Google Scholar But according to Maimonides in Mishneh Torah, Yesode ha-Torah 5:2 only the actual violation of the three prohibitions calls for sacrificing one's life. Unlike Ran, Maimonides does not extend the obligation to sacrifice one's life to include acts related to the three prohibitions. Cf. Tosafot, Pesachim 25a, s.v. Chuts me-atsei asheira.

51 Cf. Assia Book, vol. 3 (1982) 295–325.

52 See supra nn. 46, 49 and 50. Cf. Nishmat Avraham, YD. 157:4(1).

53 Deut. 4:9. Cf. Halperin, M., “Smoking”, Assia Book, vol. 5 (1986) 238Google Scholar, note 7.

54 The power to enforce compliance might be limited to the court Cf. Netivot ha-Mishpat 3:1 and Meshovev Netivot.

55 Jewish law places certain limitations on the rights of a person. For example, suicide is prohibited. See also Bava Batra ch. 2 regarding the damager's obligation to remove the source of damage. In essence the rights of the individual are limited in accordance with the law.

56 Supra n. 16.

57 See Nishmat Avraham, Vol. 4 - Addenda, E.H. 80:1 (quoting R. Shlomoh Zalman Auerbach; Nishamat Avraham, E.H. 80:1 (quoting Resp. She'eilat David).

58 Mishnah, , Nedarim 9:5.Google Scholar

59 Nedarim 65b.

60 Talmud, Palestinian, Shabbat 6:1.Google Scholar

61 Bava Kama 91b. There is a difference of opinion among contemporary authorities regarding the question whether a person is considered to own his body. According to Rabbi Shlomo Yosef Zevin a person does not own his body (see “Mishpat Shylock” in his Le-Or ha-Halakhah). Rabbi Saul Israeli, on the other hand, is of the opinion that a person does own his body (see the addenda to Rabbi Zevin's article).

62 Deut. 20:19. According to Rabbenu Yonah the Torah prohibits waste of money (see his Sha'are Teshuvah 3:82 and compare Maimonides, Sefer ha-Mitsvot Neg. 57). But in Hilchot Melachim 6:10 Maimonides wrote that the prohibition is of rabbinic origin. This would seem to indicate that the Torah does not prohibit it. There is also a difference of opinion regarding the prohibition of injuring one's self. According to Meiri (Bava Kama 91b) the Rabbis prohibited injuring one's self. But Rashba (Resp. 616) wrote that the Torah prohibits this. See Resp. Yabbia' Orner I Y.D. 8:6.

63 Bava Kama 91b.

64 See Tiferet Yisrael, Mikva'ot 2:7, Bo'az 7.

65 Mishnah, Bava Kama 8:6.Google Scholar

66 Bava Kama 91b, Tosafot s.v. “Ella hai tanna.”

67 Penei Yehoshua.

68 Cf. Mishnah, supra n. 65.

69 Penei Yehoshua, supra n. 67.

70 Shittah Mekubbetset, Bava Kama, supra n. 48; Tur Ch.M. 420.

71 Torah, MishnehChovel u-Mazzik 5:1.Google Scholar

72 Choshen Mishpat 420:31.

73 Iggerot Moshe Ch.M. 1:103.

74 See n. 69.

75 Nedarim 37a; Torah, Mishneh, Talmud Torah 1:7.Google Scholar According to Tur Y.D.221, nowadays it is permissible to accept payment for teaching Torah.

76 Mishneh Torah, cf. Rosh, Nedarim, ibid.

77 Chazan, R. David, Ma'archei Lev 29dGoogle Scholar (quoted in (1977) 7 Dine Israel 87).

78 Y.D. 336:1.

79 Ramban, Torat ha-Adam Sha'ar ha-Sakkanah. Cf. Kottek, S., “Payment for Medical Services”, in Assia Book, vol. 5 (1986) 34–39.Google Scholar

80 Ramban, ibid.Cf. Y.D. 336:2.

81 According to Mishnah Bava Kama 8:1 and the Talmud, Bava Kama 4b.Google Scholar

82 “Tsa'ar” according to Bava Kama, ibid.

83 Resp. Mahari mi-Barona 114.

84 Y.D.

85 Efraim, Machaneh, Sechirut 17Google Scholar; Resp. Rivash 476.

86 Regarding the amount which the donor may demand see Ramban, ibid.; Ch.M. 264, Y.D. 336, and Bi”ur ha-Gra, sec. 11.

87 Cf. Ta'amei Massoret ha-Mikra le-Rab Judah ha-Chasid, end Ki Teitsei. Cf. Malbim on the Sifrei 134. Cf. Ramban, Comm. on the Torah, Sefer ha-Chinnuch 580.

88 Mishne Torah, Introduction.

89 Ch.M. 2; Sedei Chemed, Kelalim, Tav 26.

90 Quoted in Karmi, A. and Saggiv, E., Medical Malpractice in Judaism and Israel (Tamar, Haifa, 1986, in Hebrew) 150.Google Scholar

91 Ibid., at 153–154.

92 See Halperin, M., “Consent for Surgery on Shabbat”, (1988) 11 Assia 31–32.Google Scholar

93 Rashbam, , Bava Batra 48aGoogle Scholar, cv. Modeh Shemu'el. Cf. Ch.M. 205:4.

94 Rashbam, ibid. s.v.

95 Attorney General v. A (1988) 42(ii) P.D. 661, at 667.

96 Ibid., at 703.

97 Mishneh Torah Nahalot 10:5; Ch.M. 290:27.

98 Ramban Gittin 52b; She'eltot 139.

99 Netsiv, Ha'amek She'eilah 139:2.

100 Eiruvin 81b; Kiddushin 42a.

101 Ramban, ibid.; She'eltot, ibid.

102 Ritva, Gittin 52a.Google Scholar

103 Gittin 52a.

104 Mishneh Torah Nahalot, ch. 11; Ch.M. 290.

105 Resp. R. Moshe Alsheich, end 38.

106 Mishnah, Makkot 2:2.Google Scholar

107 Emden, Rabbi J.Mor u-Ketsi'ah 328.Google ScholarCf. M. Halperin, supra n. 92; as well as supra n. 51 Assia Book.

108 See supra nn. 48–50.