Heart Transplants - Igrot Moshe Yoreh Deah 2:174

In this teshuva from 1968, Rav Moshe Feinstein offers an in-depth analysis of the issues involved with heart transplants. Bear in mind, as mentioned in the last teshuva, that this was written in the early days of heart transplants, when success was not assured.

Rav Moshe begins by flatly prohibiting heart transplants on the grounds that it involves the murder of two people - the donor and the recipient. The donor is deemed a murder victim since his heart was still beating when it was removed from him, and the recipient is deemed a victim since he is sure to die soon as a result of the transplant and he is condemned to a brief life of pain and suffering in the interim.

The bulk of the teshuva is divided into four sections, in which Rav Moshe makes the following main points:

1) It is forbidden to shorted someone's life by even the smallest amount, and thus so long as someone's heart is beating, removing it in order to give it to someone else constitutes killing that individual.

2) We are not experts in determining the exact time of death, and even once breathing has stopped it is still possible for someone to be alive.

3) Giving someone a heart transplant does not qualify as healing the recipient per se, but rather as prolonging his life. Since that life is likely to be one of suffering, it is forbidden to inflict such a situation on another person. [ed note - does anyone know Rav Moshe's opinion about hooking someone up to a life support machine? Wouldn't that seem to be the same thing?]

4) Rav Moshe's final point discusses the limits of the requirement of לא תעמד על דם רעך - that we are not required to actually cut off a limb in order to save another individual. Certainly in this case, where we are asking someone to give up a major organ for the purpose of possibly saving someone else for a small amount of time there is no requirement to do so.

[My hope is to continue to find teshuvot on this topic that were written as the medical science continued to advance. Stay tuned.]

Suppositories on Yom Kippur - Igrot Moshe Orach Chaim 4:121

Rav Moshe Feinstein was asked about a woman who reacted to Yom Kippur by becoming faint. Her doctors suggested that she take some form of vitamin suppository that would prevent her from having such a condition and would thus allow her to continue her fast. Are such suppositories allowed on Yom Kippur?

Rav Moshe begins his response by analyzing the seriousness of the condition. According to the Gemara, someone who is seized by bulmus can eat - the question is what exactly that condition is and whether this condition is comparable. Rav Moshe reasons that bulmus is a state of illness that afflicts an otherwise healthy individual as a result of the fast, and that bulmus can be perceived by a marked change in a person's eyes. However, if such a change does not occur then we would simply say that the individual is having a difficult fast, which is a normal occurrence and does not lead to permission to eat. This case of the fainting woman may be similar in that we might allow her to eat given her condition.

That being said, can the woman opt to continue to fast by take vitamins rectally? Rav Moshe considers the possibility that since the vitamins are not actually curative they might run afoul of the Rabbinic prohibition of שחיקת סממנין, grinding medicinal plants, which is the source for our general prohibition of taking medicine on Shabbat. However, Rav Moshe reasons that since an individual would be allowed to take food through a passageway other than the mouth, then certainly this vitamin capsule should be allowed without worrying about violating the decree of שחיקת סממנין.