Heart Transplants continued - Tzitz Eliezer 5:25.6

In this teshuva that is the next subsection of the compendium that included the previous teshuva on heart transplants, Rav Waldenberg considers the case of assisting in the death of someone who is a goseis (is close to death) and would be better served by being put out of his misery, and perhaps is even requesting to be put out of his misery.

On a simple level, Rav Waldenberg rules that we may not do so, based on the Gemara in Shabbat mentioned in the previous teshuva and as codified by the Aruch HaShulchan, with the logic that we are not masters of our own bodies, and therefore none of us have the right to request the death of another, or even of ourselves.

Rav Waldenberg cites two cases that prove this. The first is the death of Rabi Chanina ben Teradyon, who was burned alive by the Romans while wrapped in a Torah, and with wet wool put over his heart to slow his death. Rather than let his students remove the wool to hasten the death, Rabi Chanina had the Roman officer remove it, since his students were not allowed to do anything to speed up his death, even though doing so would shorten his agony. The second case brought is that of David HaMelech killing the Amaleki who had killed Shaul HaMelech. Even though Shaul had requested that the Amaleki kill him so as to bring his death about quickly, nevertheless David held the Amaleki (who according to several commentaries was actually Jewish – see Shmuel Bet 1) liable for the murder.

Furthermore, based on a Gemara in Sotah we learn that prolonging someone’s life is considered to be meritorious, even if that life is a difficult and painful one. As such, no one has the right to take his own life or allow someone to do so in order to put himself out of his misery.

Heart Transplants - Tzitz Eliezer 5:25.5

In this teshuva from 1967 (even earlier than those from Rav Moshe Feinstein), the Tzitz Eliezer begins by stating that removing a heart that is still beating in order to transplant it into someone else is tantamount to murder, based on the Gemara in Shabbat 151b that rules that any action which hastens death is considered to be murder.

However, Rav Waldenberg then raises the possibility that the donor is considered to be a treifah, since he is unlikely to live, and perhaps this avenue needs to be explored in terms of potential room to permit taking the heart from someone who is not yet clinically deceased. However, he rejects this position on the grounds that while a court cannot condemn someone as a murder for killing a treifah, that person nevertheless has the status of being a murderer. Furthermore, Rambam in Hilchot Yesodei HaTorah rules that one may not kill another Jew for the purpose of healing another, which would seem in modern times to apply to such a case.

However, the Minchat Chinuch comments on that Rambam that if non-Jews are threatening to kill a group of Jews unless they hand someone over, they are allowed to hand over someone who is a treifah in order to save the rest of the group. While this seems to be another avenue that could lead to permitting taking a live heart to save someone else, Rav Waldenberg rejects this for three reasons. First, as stated before and as pointed out by the Noda BiYehuda, we may not actively kill a treifah, and thus the inference of the Minchat Chinuch is incorrect. Second, it could be that only the person who is himself a treifah is allowed to hand himself over, but no one else is allowed to do so. Finally, whereas Rambam is discussing a case where the non-Jews specifically asked for someone to kill, in this case the doctor is not looking for this particular person per se, but rather for anyone who could serve as a donor, and thus the logic of “whose blood is redder” kicks in.

In terms of the recipient there is a problem as well, since the chances of survival with the new heart are not guaranteed, and thus there is the potential problem that removing his diseased heart and replacing it with someone else’s heart will result in the death of the recipient. Even though every surgery carries with it the potential of danger to the patient, such surgeries are permitted so long as the chances of death are minimal. However, since in the case of heart transplant surgery the chances are death are quite great, it is not permitted under the general heter that is given to surgery.

Rav Waldenberg concludes by speculating whether such a surgery, the likes of which was never envisioned in earlier times, should even fall under the rubric of ורפא ירפא, which is the source allowing physicians to practice their craft. [ed. Note – I am not sure what he means by this, since taken to its logical conclusion, this reasoning would forbid using any innovation in medicine. If anyone can shed light on this, I would be most appreciative.]

Heart Transplants - Rabbanut HaRashit - Techumin 7

In what amounts to a policy paper published in volume 7 of Techumin (1987), the Chief Rabbinate of Israel outlined their position on heart transplants. They begin by acknowledging the position of Rav Moshe Feinstein and Rav Isser Yehuda Unterman, who forbade the practice when it was still relatively new. They then note that over the decade and a half since heart transplants first came on the medical scene, the science had progressed so significantly that now roughly 70% of recipients were living at least five years. They noted as well as letter from Rav Moshe Dovid Tendler, son-in-law of Rav Moshe Feinstein, stating that Rav Moshe had changed his views on heart transplants in light of the advances made in science since the time of his original teshuva.


As such, the Chief Rabbinate was willing to allow heart transplants to take place in hospitals in Israel provided that certain criteria were met. With regard to the donor, there had to be a clear establishment of the death of the donor, as determined by confirmation of brain stem death and cessation of respiratory activity. There also had to be written consent from the donor's family as well as the presence of an agent of the Chief Rabbinate present as part of the team that determined death. Note that there is no longer a concern that the transplant would qualify as killing the recipient, as most recipients did succeed in living somewhat normal lives after the procedure.


The article concludes with a list of clinical indicators that brain stem death has, in fact, taken place.

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.]