I was admittedly caught off guard recently when a friend pointed out that I am probably the first—and, likely, only—rabbinic organ donation professional. Approximately a year ago, after a very rewarding 20+ years as a synagogue rabbi, I accepted a position as vice president for Jewish Community Engagement at LiveOnNY (www.liveonny.org), the nonprofit organization tasked with overseeing deceased organ donation in the greater New York City area. In this role, my primary responsibilities include: 1) providing pastoral and rabbinic support to Jewish families of ICU patients with grave prognoses and presenting them with the opportunity to save lives through organ donation, and 2) educating the NYC-area Jewish community about organ donation through the lenses of Jewish thought and law.
All Jews agree that pikuach nefesh, saving life, is a supreme Jewish value. As a result, Jews across the denominational spectrum take great pride in the leadership roles our community plays in modernizing emergency response and globalizing humanitarian relief. Sacred as the Sabbath day may be, the sight of a Hatzalah volunteer EMT speaking into a two-way radio is instinctively understood as a noble expression of pikuach nefesh and not an act of chillul Shabbat (desecration of the Sabbath).
Yet, when it comes to Judaism and organ donation, instead of the discussion starting with the supreme importance of pikuach nefesh, it almost always begins with a list of religious obstacles that potentially stand in the way of donation. I’ve been an advocate of Jewish organ donation for more than 20 years. But after being fully immersed in both the halachic and medical aspects of organ donation over the past 12 months, I’ve also become aware of just how poorly informed our Jewish community is about this matter of life and death.
Every 18 hours a New Yorker dies waiting for a lifesaving transplant because not enough people say yes to donation. When consent for donation is provided, the recovered organs are immediately transplanted into the sickest patients on the waiting list maintained by the United Network for Organ Sharing (UNOS). This combination of dire need and immediate impact make organ donation a paradigmatic case of pikuach nefesh. Manifestations of kavod hameit (honoring the deceased) such as expedient burial and body integrity are very important Jewish values; but just as Shabbat yields to the EMT, so too kavod hameit poses no obstacle to organ donation.
But even though a single donor can save up to eight lives—a sublime act of pikuach nefesh—very few Jews donate organs after death. In the past, reports of low donation rates in the American Jewish community have been entirely anecdotal because religious data is not collected by UNOS. However, as part of our Jewish Community Engagement initiative, LiveOnNY now tracks potential donors in the NYC area by religion. The resulting data tells us exactly how many Jews in New York—the largest Jewish community outside of Israel—consent to donation. This data also indicates denominational affiliation and the reasons why some Jews decline to donate.
The data we’ve collected is both confirmatory and surprising. On one hand, it confirms what has long been suspected: Jews generally decline to donate organs after death. While the national consent rate in the U.S. is around 75%, NYC-area Jews agree to donation approximately 30% of the time. Surprisingly, though, this number is based primarily on the responses of Jews who identify as Modern Orthodox, liberal and secular, thereby debunking the myth that the Jewish consent rate is suppressed by the ultra-Orthodox community’s rejection of deceased donation. What makes the low consent rate even more confounding is that a number of Modern Orthodox rabbis, and almost all Conservative and Reform rabbis, have expressed unequivocal support of deceased organ donation.
The Jewish reluctance to donate organs after death is nothing short of a communal crisis in which lives, both Jewish and gentile, are being lost as a result. Based on the average number of organs transplanted per donor, Jewish declines over the past 12 months alone translate into approximately 50 lives that could have been saved, but weren’t. As a community, we stand in blatant violation of the biblical injunction “Do not stand idly by the blood of your fellow“ (Lev. 19:16).
To address this communal crisis, each movement must identify realistic opportunities for improvement. Ultra-Orthodox rabbinic authorities categorically reject brain death on religious grounds, effectively eliminating the primary pathway to deceased donation, a principled stance that must be respected. In New York and New Jersey, this religious objection is also legally protected. However, if the ultra-Orthodox community continues to accept life-saving organs transplanted from gentile deceased donors, it has a moral obligation to expand its commendable success in the area of live-kidney donation to benefit critically ill recipients outside of the Jewish community.
Responsibility for increasing the Jewish deceased donation consent rate lies with the Modern Orthodox, Conservative and Reform communities, whose respective core principles should advocate strongly in favor of organ donation. Modern Orthodoxy’s commitment to synthesizing Jewish law with new scientific discovery and medical advancement should galvanize that community to follow the lead of numerous Religious Zionist poskim, roshei yeshiva and Israel’s Chief Rabbinate in embracing brain death as halachically valid and organ donation as a great mitzvah.
The goal of LiveOnNY’s new Jewish Community Engagement initiative is certainly an ambitious one, and I look forward to partnering with rabbis, doctors and community leaders across the spectrum of our community in this exciting and sacred work. Together, we can—and will—save thousands of lives while fulfilling the biblical mandate “uvacharta vachayim—and you shall choose life!” (Deut. 30:19).
Rabbi Ari Perl is vice president for Jewish Community Engagement and Multicultural Education at LiveOnNY, the federally designated non-profit organization that oversees all deceased donor organ donation in NYC and the surrounding NY counties. During his 20 years as a congregation rabbi, Rabbi Perl also served as VP of the Rabbinical Council of America, president of the Rabbinical Association of Greater Dallas and as a federation board member. He can be reached at [email protected].
