Ask the Rabbi: Every drop counts

Is one obligated to donate blood or bone marrow to save someone’s life?

Bone marrow and blood transfusions are miracles of modern medicine and gifts from God which impose upon us grave responsibilities. They further raise important questions regarding the obligation to endanger oneself to save others. The sages compared saving a life to salvaging an entire world and causing someone to perish to destroying an entire world (Sanhedrin 37a). Yet to what extent must we go to perform this great act?
The Talmud cites two biblical passages that obligate us to save lives (Sanhedrin 73a). The first (and less obvious) verse comes from the general commandment of restoring another’s property, including his body (Deuteronomy 22:2). The second verse, “You shall not stand idly by the blood of your fellow” (Leviticus 19:16), mandates going beyond general assistance to committing financial resources to saving the lives of others.
Rabbinic authorities have debated if these commandments mandate even risking one’s own life. When the sage Rav Ami was abducted and faced execution, his colleagues disagreed whether a daring rescue attempt was appropriate (Yerushalmi Trumot 8:4). While Rav Yonatan answered negatively, Resh Lakish insisted on attempting an (ultimately successful) rescue mission. Based on this story, some have determined that if someone will definitely die, one must make all efforts to save him since the threat to the rescuer remains uncertain (Kesef Mishna, Rotzeah 1:14).
The vast majority of scholars, however, have rejected this position. In one famous responsum, Rabbi David Ibn Zimra (16th century, Egypt) ruled that a person does not need to volunteer to have a limb amputated by a despotic ruler to prevent him from arbitrarily killing another Jew (Shu”t Radbaz 3:627). Alluding to the talmudic dictum that one’s life takes precedence over another, he further claimed that dictating such self-endangerment would immorally go against the notion that the Torah represents “ways of pleasantness and peace.” With the exception of committing three cardinal sins, the Torah commands us to preserve our lives, even if means not fulfilling commandments such as “you shall not stand idly by the blood of your fellow.” As such, one does not have to endanger himself to save someone from imminent death (Shulhan Aruch Harav OC 329:8).
One extreme formulation of this principle was adopted by R. Meir Simha of Dvinsk (Latvia, d. 1926), who applied this principle even when many Jews or the entire nation faced an imminent fatal threat (Or Sameah, Rotzeah 7:8). This position was challenged by others (Tiferet Yisrael, Makot 2:2), and in a lengthy treatise, Rabbi Avraham I. Kook contended that under those circumstances, such self-sacrifice remains meritorious and at times mandatory (Shu”t Mishpat Kohen 143).
In general, many scholars have recognized that there exists a range of life-endangering actions, and that somewhere along that continuum, certain actions become meritorious or mandatory, given the circumstances (Aruch Hashulhan CM 426:4). Decisors debate, for example, whether a person must endure various forms of non-life threatening pain to save others (Nishmat Avraham YD 157:4). Ibn Zimra himself ruled in a different responsum that one should act if the potential threat to the rescuer is unlikely to occur (5:218). In cases of distinct but nonetheless distant threats, many decisors, like Rabbi Moshe Feinstein, deem it permissible and meritorious to risk one’s life to save another, as long as the rescuer’s action are not suicidal (Igrot Moshe YD 2:174).
Under normal, hygienic circumstances, donating blood entails incredibly minimal pain and risk, with the missing blood regenerating itself within the donor. As such, scholars including Rabbi Shmuel Wozner (Shevet Halevi 5:219) and Rabbi J. David Bleich (Tradition 27:3) contend that one must donate blood when a sick patient requires an immediate transfusion. Donating to blood banks, especially in times of shortages, also represents a definitive mitzva (Nishmat Avraham YD 349:3).
While bone marrow naturally regenerates, donors do undergo general anesthesia and get hospitalized for a couple of days. While Rabbi Moshe Shternbuch does not obligate donation, even as he deems it extremely meritorious (Teshuvot Vehanhagot 5:387), Rabbi Shlomo Auerbach believes that a potential donor should be cajoled into donating, especially if he does not fear the surgery (Nishmat Avraham EH 80). Yet rabbis Mordechai Willig and J. David Bleich obligate one to donate since the dangers represent common and minimal risks regularly performed for less pressing needs.
Gaining consent from minors to donate bone marrow for family membersremains ethically complex. Auerbach believes that an older, mentallycompetent child can consent, but remains conflicted regarding youngeror mentally incompetent children. Bleich, however, argues that parentalconsent remains sufficient in these cases.
In our next column, we will discuss live organ donations (kidney andliver) and the propriety of commercializing these transplants.
The author, on-line editor of Tradition and its blog, Text & Texture, teaches at Yeshivat Hakotel.