Pikuach Nefesh – Where Are the Exceptions?

Life takes precedence over almost everything – but what are the actual exceptions, using organ donation as the test case?

Q. When considering the halachic ramifications of Pikuach Nefesh (saving a life), what are the exceptions to the rule? For example, organ transplant donation before or after death? One has the opportunity to donate a kidney or a partial liver lobe donation (the liver is one of the few organs that will grow back if partially removed from a live donor within 3 months). The other part of the question having to do with an after death scenario. A very young person dies suddenly in an accident, if all their organs are intact, it is possible to save many lives. Each kidney, liver, heart, pancreas, lungs, nerves, veins, cells, and even limbs have the potential to save many people, if the body parts can be harvested and transplanted within a 4 to 5 hours turn around time. Is their a difference in halacha for the donor versus the recipient? In all surgeries there can be very high risk of infection to both the donor and the recipient.

It’s difficult to summarize such big questions in the brief scope of this framework. In short, life supersedes the honor of the dead, so after death, it’s a great mitzva to donate one’s organs to save and benefit the living. The problem is heart transplants where it must be so fresh that sometimes the doctors may take a heart from one who is still halachically living (thus killing him), in order to save another. But if the person is halachically dead, then it’s no problem. The mainstream decision regarding living donors is that it’s an altruistic mitzva but not obligatory, for there is an element of danger. On the other hand, as procedures are perfected, the element of danger is lessening, so we find many more kidney donors, especially among religious-Zionists in Israel who have by far the highest rate of donors in the world.