Conflicts of Reciprocity in Heart Transplantation After Brain Death: Impetus in Orthodox Communities

Abstract: The acceptability of heart donation from brain dead individuals varies within Jewish thought, particularly among Orthodox sects.
Jewish law prohibits removing vital organs from living patients, equating such acts with murder. Consequently, the acceptance of “brain death” as a legitimate definition of death by many Jewish authorities facilitates the permissibility of heart transplantation under Jewish law, at least under neurological death criteria. However, dissenting opinions, which advocate for irreversible cessation of heartbeat or other clauses as markers of the end of life, challenge the legitimacy of heart transplants, framing them as ethically impermissible.
Despite subscribing to this impermissibility and the concept that one may not trade one life for another, some Orthodox Jews are willing to accept organs obtained in this prohibited manner. The principle of pikuach nefesh, which permits the transgression of certain prohibitions to save a life, is invoked by some. Alternatively, many may be motivated by a sense of desperation to save a loved one’s life. These motivations, conflict reconciliations, and implications for clinical practice are underexplored.
In this presentation, we use a case-based approach to consider how these perspectives influence the willingness of families to donate organs, affecting organ donation availability and medical resources. We then explore the hesitancy of some Orthodox Jews to consider heart donation while simultaneously being open to receiving such organs, ostensibly a conflict of reciprocity, and provide recommendations that the interprofessional healthcare team can use to navigate these issues and support decision-making within Orthodox communities.

Bilal Irfan – University of Michigan, Harvard Medical School; Lori-Jene Brazier, MDiv – Michigan Medicine; Janice Firn, PhD, LMSW, HEC-C – University of Michigan Medical School, Center for Bioethics and Social Sciences in Medicine