Organ Meets: The Changed Landscape of Living Kidney Donation

Adapted from the writings of Dayan Yitzhak Grossman

March 18, 2022

Kidney Donor Athletes, an organization promoting kidney donation, has announced:

To promote the gift of life through living donation, 22 kidney donors will represent Kidney Donor Athletes (KDA) with a summit of Mt. Kilimanjaro…KDA is using this climb to bring awareness to living donation, demonstrate what is possible post-donation, and to launch initiatives which inspire, support and educate people about the experience of living donation…[1]

One of the climbers, Tracy Hulick, explains:

There’s a false narrative out there that you’re sickly after your surgery, and that’s not true. In fact, most of us actually became healthier after we donated. We pay more attention to our diets, and we get more exercise.[2]

The first successful living-donor kidney transplants occurred in the early 1950s, and within about a decade, poskim had began to address the permissibility of the procedure. Their analyses revolved around a debate among earlier authorities over whether it is obligatory, permissible, or prohibited to risk one’s own life in order to save that of another.[3]

In 5761 (1961), R’ Yitzchak Yaakov Weiss (the Minchas Yitzchak), after briefly referring to this earlier debate, expressed concern for the danger to the donor, though he did not reach a definite conclusion about the permissibility of the procedure:

And in our situation there is certainly danger from the operation itself, and also in the future from [the donor’s] missing kidney…

And all this should be clarified, and at this time I have written only to raise the issues, and if Hashem wills, I will return to the matter in the future, with the help of Hashem Yisbarach.[4]

R’ Eliezer Yehudah Waldenberg (the Tzitz Eliezer) initially ruled, in an analysis published in 5727 (1966/7), that such donations are generally prohibited, with the possible exception of the case where a team of expert physicians is convinced that the procedure poses no danger to the donor:

Where there is certainly (vadai) a chance (safeik) of fatal danger, we should incline to the view that one is prohibited to donate one of his organs to transplant it into the body of another [even] to thereby save him from certain danger, and one who does this is a pious fool (chassid shoteh)…

And based on what the physicians told me when I presented this issue to them, removal of a kidney and similar internal organs from a person, even if he is healthy, generally involves a chance of danger (safeik sakanah), and therefore one should not generally donate such [organs] and a physician should not perform this [procedure], unless a staff of expert physicians decides, after careful analysis, that the matter does not involve a chance of danger to the life donor, and even then it is not entirely certain (that it is permitted).[5]

In another discussion, published in 5730 (1969/70), he seems to adopt a more moderate stance, ruling that although it is prohibited to donate an organ where this entails a chance of danger to the life of the donor, nevertheless:

Where the anticipated danger from the removal of the organ is not certain, and medical science says that the likely outcome is that both of them (the donor and the recipient) will remain alive, in this case there is basis to rule leniently…[6]

As medical science advanced and the safety of the procedure improved, poskim became more favorably disposed toward living-donor kidney transplants. R’ Moshe Sternbuch, in a responsum published in 5743 (1982/3), writes:

But I have heard from physicians that there is absolutely no danger to the life of the donor, and this has been demonstrated many times, and it is primarily only an issue of temporary pain, and perhaps some minor inconvenience and warnings for the future, and with the transplant there is a good expectation that he can save her (the recipient) from a difficult life and pain all the days of her life, I do not see a prohibition in this…[7]

Similarly, R’ Ovadia Yosef, in a responsum published in 5762 (2001/2), concludes a lengthy analysis of the question as follows:

And now, in our situation, where according to what the expert physicians say, the danger to a donor of one of his kidneys is a very small percentage, and more than ninety-five percent emerge from the operation healthy and whole and live long lives, it appears that it is certainly permissible to donate in order to save the life of a Jewish person who is experiencing real danger to his life, and it is a mitzvah as well…[8]

R’ Ovadia subsequently cites Rav Waldenberg’s stringent view but rejects it as based upon incorrect (or perhaps outdated) information:

But according to [information] we have received from expert, G-d-fearing physicians, that in general there is no danger in the removal of a single kidney from a healthy person, only to a very small percentage…it appears that the normative position is to permit a healthy person to donate a single kidney in order to save the life of a Jewish person who is experiencing danger to his life from kidney disease, and it is a mitzvah as well…

Rabbi Dr. Edward Reichman summarizes the shift in halachic attitudes as follows:

In the very early days of kidney transplantation, a number of rabbinic authorities, including R’ Eliezer Waldenberg and R’ Yitzchak Weiss, forbade one to serve as a living kidney donor due to the intolerable level of risk involved for the donor. As with all medical halachic matters, however, updating the information is essential. Living organ donation is now commonplace; the donor risk has been well studied and quantified, and the success rate has significantly improved and is well within the halachically accepted risk category. In fact, no posek today forbids live kidney donation, and many, though stopping short of declaring it obligatory, encourage donation and consider it to be an extraordinary mitzvah…

[1]One Kidney Climb of Mt. Kilimanjaro on World Kidney Day. Kidney Donor Athletes.

[2]Cathy Free. A group of organ donors is climbing Mount Kilimanjaro this week. They each have one kidney. Washington Post. https://www.washingtonpost.com/lifestyle/2022/03/02/kidney-donor-kilimanjaro-climb/.

[3]See our discussion of this question in Ill, Prepared: Avoiding Something like the Plague, Part II.

[4]Shu”t Minchas Yitzchok cheilek 6 siman 103 os 2.

[5]Shu”t Tzitz Eliezer cheilek 9 end of siman 45 os 13

[6]Ibid. cheilek 10 siman 25 end of perek 7 #1,6.

[7]Shu”t Teshuvos Vehanhagos cheilek 2 siman 733 p. 586.

[8]Shu”t Yabia Omer cheilek 9 C.M. end of siman 12 os 10. An English summary of R’ Ovadia’s position and reasoning is available here.