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Leviticus 25 :25B’OR HA’TORAH 8 (1993)A Pound of Flesh?On Selling Tissues and Organsby Rabbi Mordechai Halperin, MDIntroductionMedical and technological advancement in organ transplantation is improving the quality and duration of human life. Often the most suitable organ donors are healthy people. This brings increasing attention to the problem of selling tissues and organs. There are many parts of the body that can be transferred from a live donor to a suffering patient. In the present state of technology, the kidney is the only organ suitable to betaken from a living donor for transplantation . The existence of two kidneys in the body ofthe donor creates a large functioning reserve and enables very low risk kidney removal.1. 2 , 3 The situation differs, of course , in other organs , such as the heart, lungs, liver, and pancreas, the (partial or entire) removal of which is liable to cause death or serioushealth risks. We could add to our list parts of the body that are not defined as "organs"4 but are so important that their transplantation into the body of the recipient could save his life and/or significantly improve its quality. This group includes, in addition to the kidney : skin, bone marrow, and.plain blood.1 J.S. Tapson , "The Risk of Donor Nephrectomy,"Int. J. Artif . Organs, 8:1 (1985), pp. 13-16.2 D. Weiland et al., "Information on 628 Living? Related Kidney Donors at a Single Institution w ith Long-Term Follow-up in 472 Cases,' Transp. Proc., 16:5 (1984} .3 F. Vincenti et al., " Long-Term Renal Function in Kidney Donor: Sustained Compensatory Hyperfiltration with No Adverse Effects." Transplantation, 36:626 (1986) .For example, skin. There is no doubt that skin is vi? tal to the preservation of human life. Indeed the meaning of the term ever, "organ ' in Hebrew, has changed. In the Mishna, "organ " means a part of the body that includes bone in it (Ohalot 1:8; Aduyot 6:3), as distinguished from "organ heads", which include also boneless parts of the body ( Nega’im 6:7; Kidu? shin 25). In a later period we find the term “organ” ex? tended to include boneless parts of the body , such as eyes (Maimonides, Torat ha'Adam, at the end of the section on pain.) But even after the definition has been extended, skin almost certainly has not been in? cluded as an "organ .'The idea of selling organs arouses strong feelings. It invokes wretched victims exploited by insensitive charlatans and live organs cut off in irreversible surgical pro? cesses - in exchange tor paper money. On the other hand, sometimes human lite depends on obtaining donations of dis? pensable organs; and in our materialistic world a bill of sale can save human life. We cannot ignore these strong feelings, but we also cannot allow them to prevent halachic (Jewish legal) discussion on the subject.I shall preface the following halachicdiscussion with a short tactual description of kidney transplants, based on the medi? cal technology of 1989. For the sake of clarification, I shall compare the sale of kidneys with that of two other types of tis? sue: hair and blood.Medical BackgroundThe kidney has a number of vital tunc? tions in the human body. Among them is keeping the acid-alkaline balance, main? taining electrolytic balance, keeping the liquid balance of the body, and disposing of various waste materials accumulated in the body. Serious renal dystunctioning en? dangers lite and requires dialysis (homodi? alysis as well as peritoneal dialysis) or kid? ney transplantation in order to prevent im? minent death. In the past decade, the life expectancy of patients treated by dialysis was longer than that of patients who underwent kidney transplantations.Recently, the life expectancy of trans? plant patients has improved to the pointDouglas Black and N. F. Jones, eds., Renal Dis? eases, 4th edition (Blackwell Scientific Publications, 1979), p. 528.that a patient with a transplanted kidney (from a dead donor) is expected to live as long as a patient treated by dialysis .s An even more significant improvement has occurred in the case of renal transplants where the kidney was donated by a living relative, and today this life expectancy has risen substantially above that of dialysis patients.6, 7 Renal transplant patients with a kidney from dead donors are also likely , in some cases, to gain a substantial im? provement in the quality of their lives as opposed to dialysis patients. However, those patients who reject the transplanted kidney suffer many months and in the end return to dialysis.The success of a kidney transplant from a living donor not related by family to the recipient is equal to or more than that of a transplant from a dead donor.8,9 This arrangement helps till the gap in Western society between the availability of kidneys from dead donors and the number of pa? tients needing a transplant.In summary, it is possible today to op? erate on a healthy person with two goodW.V. Vollmer et al., " Survival with Dialysis and Transplantation in Patients with End-Stage Renal Disease, " N. E. J. Med., 308:26 (1983) , pp. 1553-1558. The major causes of improvement are :classification of donors by MHCblood transfusionsuppression of recipient's immune system by cyclosporine7 Combined Report on Regular Dialysis and Trans? plantation in Europe XVI presented by Hospal Ltd. (Basel: 1985), pp. 58-61.A. S. Levey et al., " Kidney Transplantation from Un? related Living Donors," N.E.J. Med., 314 (1986), p. 914 .Talia Weinstein et al., "Kidney Transplantation from a Related Donor – Yes! From an Unrelated Donor - No?” Ha'Rifuah , 115:12 (1988) , pp. 403-404 .kidneys and to remove one of them for transplantation into the body of a patient suffering from end-stage renal dysfunction. Danger to the life of the donor does not substantially exceed that of the small risks of the anesthesia process and a simple operation.1Kidney DonationAs the immediate mortality risk of kid? ney removal is small.1 donating a kidney cannot be forbidden because of long-term risk. On the other hand, no one can be ob? ligated to donate a kidney from his body because nobody can be obligated to do? nate any organ to save someone else. There is no obligation here, but permission is granted. Furthermore, saving life under these conditions constitutes a mitsva (To? rah Commandment). In this paper we are considering the mitsva of saving life through the heroic sacrifice of an organ from a living body10 to be on the highest level of performing the law.Ill. Hair versus Kidney SaleSelling hair is mentioned in the Mish? na11 as a legitimate way of making money:Responsa of the Radbaz 1:42 . The only difference is that in the loss of an organ such as a hand, ampu? tation causes damage and permanent discomfort, whereas after the removal of a kidney , pain and sur? gical complications persist for six months at the most. See note 1, p. 1; Eliezer Waldenberg , Tsits Eliezer 18, 25:77. See also Ovadya Yosef, " Permission for Kidney Transplantation,' Dinay Yisrael, 7 (5736), 25:43; Chaim David Ha'Levy, 'Organ Transplantation from the Dead and the Living in Halacha,' Sefer As? sia, vol. 4, pp. 255-257 ; Avraham S. Avraham , Nish? mat Avraham, Yoreh De 'ah 349, 3 (3) 1.Mishna Nedarim 9:5....a man vowed not to receive any enjoyment whatsoever from his wife , and the ketubba [alimony stip? ulated in the marriage contract] was 400 dinars .He came to Rabbi Akiba , who ob? ligated him to give her the ketubba.He said to him: "Rabbi, my fa? ther left 800 dinars . My brother took 400 and I took 400 . Wouldn't it be enough if she got 200 and I got 200?"Rabbi Akiba said to him: "Even if you have to sell the hair off your head, you're giving her the ketub? ba."In its discussion of this Mishna, the Tal? mud12 explains that selling hair was per? mitted. It is told (in the Jerusalem Talmud) that Rabbi Akiba's own wife used to sell her braids to support the family.13Thus, it can be concluded that a person has the right to cut off tissue from his body and sell it.In principle, it makes no difference whether the buyer uses the purchased hair as dead tissue in a wig or if he trans? plants it as living tissue with pieces of skin into the scalp. The only difference lies in the process of removing it from the body. Clipping off only hair violates no halachic prohibition, but cutting off skin together with hair is liable to cause "self-mutila? tion."The difference is clear between clipping oft hair with no liability of mutilation and re? moving a kidney with the liability of it being halachically considered "mutilation."The principal halachic question there-Talmud Nedarim 658.Jerusalem Talmud Shabbat, chap . 6, halacha 1.fore is whether a person is allowed to "mu?tilate" himself, and under which conditions.The Self-MutilatorUnnecessary self-mutilation causing ir? reversible damage is forbidden by all the Jewish legal opinions14 and furthermore by the Torah prohibition of bal tashchit (don't destroy).15 The Tana'im (the Sages of the period of the Mishna, around the secondBaraita and also Talmud Baba Kama 91 B. The halachic authorities of the past 300 years have been divided over the question of whether man is the mas? ter of his body. In the opinion of Shlomo Yosef Zevin (L'Or ha'Halacha, "Mishpat Shylock”) - man is not master over his body. In contrast to him, Shaul Yis? raeli (ibid., additional comments on " Mishpat Shy? lock”) thinks that man is master over his body and or? gans, and that the halacha is the only source that limits their use.Deuteronomy 20 :19.In the opinion of Rabbenu Yonah , Sha'aray T'shuva 3:82, any waste of money is forbidden by the Torah ("even a penny's worth "). This is also the opinion of the Rambam in Sefer Ha 'Mitsvot, Negative Com? mandment 57. Indeed, in the Mishneh Torah, " Laws of Kings" 6:10, the Rambam wrote that ruining mon? ey is punishable by rabbinic injunction. The Torah does not forbid ruining money; the Torah forbids ruin? ing food. The prohibition against ruining money was made by the Talmud Sages.Also regarding the prohibition against self-mutilation,the Rishonim (the halachic authorities of 1000-1500 CE) were divided over whether the prohibition came from the Torah or from the Talmud. In his comments on Baba Kama 91 B, Ha'Me'iri claims that this prohibi? tion comes only from the Talmud (which used what was written in the Torah on the subject as a peg upon which to hang its own opinion) . But the Rashba, in responsum number 616, writes that the prohibition comes directly from the Torah. Other opinions agree? ing with the Rashba include the Ran in Shavuot 27, number 616, and his responsum number 32. See also Ovadya Yosef, Responsa Yabi'a Omer, part I, section Yoreh De'ah 9:6.century CE) were divided in their opinions as to when mutilation is useful to the muti? lator.In a baraita16 (an article of the Oral Lawthat was not included in the Mishna) Rabbi Akiba holds the opinion that a person is entitled to injure himself if he has a need for it, inasmuch as the prohibition against bat tashchit doesn't apply in the case of need.17 In contrast to this, in the Mishna1a itself Rabbi Akiba holds the opinion that it is forbidden for a person to mutilate him? self even out of need,19 except if there is a "great need."20Financial profit is described as a normal need, for which self-mutilation is not per? mitted, according to Rabbi Akiba in the Mishna,21 whereas preventing great pain is defined as a great need.22 As to what the halacha (law) should be, the Rishonim (the halachic adjudicators of 1000-1500 CE) were divided in their opinions : Rabbi Meir Abulafia (a leading Jewish authority of that period) ruled that "a person is entitled to mutilate himself,"23 whereas the great Mai-16 Talmud Baba Kama 91A.17 See Tiferet Yisrael on Mishna, Mikva 'ot 2:7; andBoaz, note 7 on this mishna.18 Mishna Baba Kama, 8:6, according to the conclu? sion of Talmud Baba Kama 91A .Talmud Baba Kama 91B. See Tosafot there, s. v .starting "ella hi tanna.”Pne Yehoshua on Tosafot, Baba Kama 91B.Mishna Baba Kama.8 : 6 describes self-humiliation done to prevent financial loss.According to Pnei Yehoshua (see note 20) .23 Shita M 'kubetset on Baba Kama 91 B, reference to Meir Abulafia; Tur, Choshen Ha'Mishpat 420, refer? ence to Moshe lsserlis.monides before him had ruled that "it is forbidden for a person to mutilate either himself or his fellow,"24 and this is also how the Shulchan Aruch (the Code of Jew? ish Law compiled by Rabbi Joseph Caro about 350 years after Maimonides) rules.In view of this ruling against self-mutila?tion, it is forbidden to donate organs or tis? sue for outright commercial purposes. Therefore, donating a kidney for the pur? pose of research and industry is forbidden even if the donor is said to be supporting himself from his "donation."25 This stands in contrast to cutting hair, which is not pro? hibited on grounds of "mutilation" and therefore is allowed for commercial pur? poses. Blood donation is located some? where in between these two forms of sell? ing. Under modern conditions, a blood do? nor suffers only slight discomfort. There? fore there is room to doubt if its status is like that of haircutting or like that of kidney removal for transplantation. For this rea? son, the late, righteous ga'on (genius) Rabbi Moshe Feinstein tended to allow blood donation for commercial purposes.26Despite the prohibition of kidney remo? val for commercial purposes, there is no prohibition of kidney removal for the pro? longation of another's life. Even if the pur? pose of the transplant is not to prolong but rather to improve the quality of the recipient's life, then here too, the prevention of acute suffering is defined as "great need," allowing "mutilation."22When the prohibition of "mutilation" isMaimonides, Mishneh Torah, " Laws of Mutilation and Damage" 5:1.Yosef Caro, Shulchan Aruch, Choshen Mishpat420:31.26 Moshe Feinstein, /ggeret Moshe, Choshen Mish? pat, responsum 103.deferred or cancelled and a living donor is permitted to have an organ or tissue cut out of his body, then we must discuss his right to demand payment - or, in other words, to sell his organs. At first glance, we cannot stop anyone from being com? pensated for donating a part of his body for transplantation, just as we cannot stop him from selling his hair. Nevertheless, there are four reasons for limiting his right to sell:the prohibition of receiving payment for performing a mitsva;2. the law against the rich ex? ploiting the poor;3. the chance that the dubious nature of the donor's "conscious consent" to the results of his opera? tion can cause an illegal transaction; 4 . absence of the "totally willing attitude" necessary for a sale to bevalid.The Prohibition of Receiving Pay? ment for Performing a MitsvaIn principle, it is forbidden to demand or receive payment for teaching Torah.27 This is derived from the well-known drasha (study of the halacha from the Torah vers-Talmud Nedarim 37A; Maimonides, Mishneh To? rah, "Laws of Torah Study " 1:7. Indeed, in the opin? ion of the Tur, Yoreh De'ah 221, referring to the Rosh, in our times one is allowed to be paid for teaching Torah. The reason for this is given in the Shulchan Aruch, Yoreh De 'ah 246 :5, according to the Talmud, B'chorot 29A and Tosafot there s.v. "ma ani b'chinam."A person with no income is entitled to be paid forteaching Torah . And even if he has an income, he is entitled to receive compensation for the money that he could be earning while teaching Torah.es) comparing the teaching of Torah in the days of Moses with that in later genera? tions:28 "If I [Moses] am for free, then you [the later generations] also are for free ." This principle is not limited only to the mitsva of teaching Torah , but applies also to the performance of any mitsva for other people.29Healing is considered a mitsva,30 and it is forbidden to be paid for the act of heal? ing itself.31 Ostensibly , a prohibition could be derived from this principle that forbids payment for organ donation conducted solely for the mitsva of saving life, for char? ity, and/or for replacement of loss.Examination of this problem, though , shows that there is nothing in this principle to prohibit paid organ donation . Certainly a doctor, performing a mitsva by treating pa? tients, is entitled to payment for his ex-See the Rosh on Talmud Nedarim 37A. Indeed, in the opinion of the Rambam in the Mishneh Torah, "Laws of Torah Study,” ma ani b'chinam refers to Moses as the people 's teacher (rather than G-d' s stu? dent) . If Moses taught Torah for free , so then we , his students , must teach for free.David Chazan , Ma 'archei Lev21(Salonika:1821), 29:74, referred to in Yosef Pe'or Ha'Levy, "The Right of the Doctor to Receive Payment in Jewish Sourc? es,' Dinay Yisrael 7, p. 87. Indeed, from the discus? sion in the Tur, Orach Chaim 585, on the halachic difficult ies in being paid for blowing the shofar on Rosh Hashana, the issue originates from the problem of the "Shabbat wage " payment and not from the problem of payment for performing a mitsva. Thus there is no general prohibition of receiving payment for a mitsva, except for learning Torah.Shulchan Aruch, Yoreh De 'ah 336:1.Maimonides, Torat Ha'Adam, section on danger, compare with : Sefer Chassidim (Bologna : 1518), p. 295, or in the Panna edition (1924), p. 810 . See alsoS. Kutik, " Medical Practice and Halacha” in Safer Chassidim: “Payment for the Doctor's Efforts,” Sefer Assia , vol. 5, pp. 34-39.penses , time, and the price of the medical practices that he prescribes for his pa? tients.32 In other words , a mitsva between man and his fellow requires action but not expenditure of money or a financially valu? able object . Since the donation of an organ indisputably causes 1) the loss of a mone? tarily valuable body part33 and 2) suffering, which also has monetary value,34 there is no reason to prevent payment for the dam? age and pain that the donor suffers.An additional reason, a kind of socialreform, is brought forth in rulings permit? ting the payment of a midwife on the Sab? bath, "because of the danger that if she knows that she's not going to be paid, then perhaps she won 't come or will be negligent in the mitsva."35 This reason apparently exists in every medical act which saves life and depends , in fact , on the decision of the rescuer . This reason certainly exists also in the case of organ donation.There is a major difference, though, between a donor and a doctor. The doctor has taken upon himself the mitsva of heal? ing and is not entitIed to exempt himself from this mitsva.36 There is an opinion that one who is not entitled to refuse has no32 Maimonides and Sefer Chassidim (see note 31). In Maimonides 's opinion, it is pennitted to be paid for services rendered and not just for one's time . This is also the ruling in the Shulchan Aruch , Yoreh De'ah 336:2.33 According to Mishna Baba Kama 8:1 and Talmud Baba Kama 48 , in the passage starting “tne Rav Ho? shaya."34 "Suffering," according to Baba Kama (see note 33).Responsa of the Mohari of Verona (Shtetin: 1860) no. 112, p. 498.Shulchan Aruch , Yoreh De'ah 336 :1.right to demand payment for his action.37 In contrast to him, the donor is not obligat? ed to give an organ from his flesh to heal or save another human being;38 because he is free to decide, the fact that he is do? ing a "mitsva" cannot deny his right to de? mand payment.In summary, the general prohibition oftaking payment39 for carrying out an ac? tion that contains a mitsva does not pre? vent the donor from demanding and re? ceiving payment for the donation of or? gans.Preventing Exploitation of the Poor by the RichIn Deuteronomy there is a special pro? hibition against taking back a divorced wife who "left and was married to another man"....then her first husband, who di? vorced her, cannot remarry her ... and you must not bring immorality toMachaneh Efraim, "Schirut," 17; Responsa of Ri? bash, no. 476, according to Rav Pappa in Talmud Yevamot, 106A.38 See Radbaz, responsum 1:32 (1867) and the ad?ditional sources indicated there .There is room for discussion on how much money a donor is entitled to demand. Is there an upper limit? What is the law for the donor who demands an exor? bitant amount by accepted criteria? See note 31, Shulchan Aruch, Choshen Mishpat 264; Tur, Yoreh De'ah 336 ; Shulchan Aruch, Yoreh De'ah 336:3 and explanatory note 11 of the Vilna Ga'on.Indeed, as said above , the situation of the donor ispreferable because he has no obligation to sacrifice one of his organs even to save a life, and therefore he is apparently entitled to set his own price for his donation, while the rest of the process is dependent upon supply and demand.the land that G-d your L-rd is giving you as a heritage.40There are several reasons41 for this Negative Commandment.For our discussion Rabbi Yehuda He? Chassid's explanation is pertinent:..."then her first husband [who di? vorced her cannot remarry her]" - if she were allowed him, then wealthy men would hire the poor to divorce their wives and then they would take them and when they were sated, would divorce them and return them to their husbands.42Thus, fear of the wealthy class exploit? ing the bodies of the poor lies at the bot? tom of this Torah writ. Just as the Talmud Sages learned the principle of building a "fence" around the Torah from the restric? tions that the Torah imposes on the nazir? ite and later applied it in legislation,43 so can we learn from the verse "her first hus? band, who divorced her , cannot remarry her" the principle of prohibiting commerce in human organs in order to prevent de-Deuteronomy 24: 1-4.Ramban on this passage in the Torah; Seferha 'Chinuch, Commandment 580.Yehuda He' Chassid , Ta'amay M'soret ha 'Mikra (according to manuscripts in Moscow and Oxford , references by Yitzchak Shimshon Langa, (Jerusa? lem: 1981), end of Torah portion Ki Tatsay; or under the title Perushay ha'Torah L'Rabi Yehuda he'Chas? sid(Jerusalem : 1975). The Malbim brought up a sim? ilar idea, attributed to the Rishonim , (the Sages of 1000-1500 CE) in his commentary on Sifray, Deute? ronomy 24 :4.Moshe Chaim Luzato, M 'silat Yesharim, ch. 11, "On Purity," s.v. "We shall now talk about forbidden relationships."generate exploitation of the bodies of the poor by the wealthy.Hazal (the Talmud Sages) had the au?thority to legislate in the spirit of building a "fence" around the Torah for the entire people of Israel, but this authority was granted only to the Sages of the period of the Talmud.44 No one today is authorized to make new laws or to proclaim new de? crees for the entire Jewish people. The only authority which can be exercised to? day is local authority by local rabbis, "the good men of the city"45 and their corollar? ies.In summary, there is no prohibition -neither in the Torah nor in the legislation of the Talmud Sages - against receiving pay? ment for donating organs. Therefore, as long as there is no law enforced on this subject, it cannot be said that the halacha prohibits paid organ donations whether to prolong human life or to substantially im? prove the quality of life of the recipient.Can Dubious Consent be Consi? dered an Illegal Transaction?In secular Israeli law, the health laws (on consent forms) state that before being operated upon a person must sign his agreement to the operation,46 and that the consent form must be worded according to the second amendment of these laws.47Maimonides, introduction to his Mishneh Torah, according to Talmud Baba Metsia 86A, s.v. "Ravina v'Rav Ashi sot hora'ah," but not according to Rashi.Shulchan Aruch, Choshen Mishpat 2; Sdeh Chemed, Klalim, ma 'arechet tav, klal26 .Article 3 is referred to in A. Carmi and A. Sagiv, Medical Negligence in Judaism and in Israel (Haifa: Tamar Publishers, 1986), p. 150.Article 1, ibid.The doctor who explains the content of the consent form to the patient must certify by signing on the margins that he orally explained everything written on the form to the patient. The doctor must further certify that the patient signed consent in his pres? ence, after he was convinced that the pa? tient entirely understood his explana? tions .48This requirement, of the patient's full understanding in advance of the necessity and consequences of the operation, is not carried out in a significant part of all cases, and in actuality is conducted in an extreme minority of hospital operations. Usually, the patient possesses neither the faculties nor the rational decision-making powers that the doctor does, and the doctor's sig? nature vouching that the patient "under? stands" everything does not change the situation.Indeed, from a halachic point of view, an operation that saves or prolongs the life of the patient does not need conscious consent,49 and therefore its practical ab? sence is not serious. But as soon as the operation is meant not to save the patient himself, but rather to remove an organ for the sake of another patient, then con? scious consent is required by halacha . An illegal transaction could result from the lack of this consent . There are not many people donating organs for the sake of Heaven, and therefore their doctors should devote the time and patience required to enable their conscious consent and total willingness even if they are receiving mon? etary compensation for their pain and bodi? ly loss.48 Ibid., pp. 153-154.49 See the authors, "Consent to Surgery - Signing on Shabbat, " Assia 44 (11, 4), pp. 31-33 and in the sources cited there.On the other hand, it is doubtful wheth? er it is possible to secure true conscious consent from the commercial donor, whose main motive is an urgent need for cash. The anticipated reward is liable to distort the donor's judgment vis-a-vis the consequences of his action in a way somewhat similar to how the possible pay? off distorts the gambler 's judgment. It is possible, then, that there is a problem of an illegal transaction here.Without Total Willingness is a Transaction Valid?Examination of this problem indicates the lack of a necessary condition for a val? id transact ion - and that is total willingness on the part of the donor. When a person is ready to sell one of his organs because of financial pressure, in effect he enters into a forced agreement in which his willing? ness is not totally voluntary. The payment for the organ does not create total willing? ness except in the case in which the seller receives the full equivalent of the sold or? gan and does not lose anything.50 Since remuneration does not constitute a full re? placement for a human organ, and since50 Rashbam on Talmud Baba Batra 48 (on the prob? lem of a forced sale) says that Rabbi Huna reasons that suffering causes the forced seller to decide with all his heart to sell, for two reasons: the suffering it? self and the money he can get, so he doesn't lose anything .The definition of irreparable loss in the case of ampu?tation can be seen in the question starting "atoo b'shuftene askinan" in Talmud Baba Kama 85A , which sets the price for the pain of having a hand amputated. The price is set according to the sum that a person is willing to receive as compensation for having his hand amputated without painkillers. On the difference between a hand and a kidney , see note 10 above .indeed the donor does "lose something," the sale of the organ lacks a necessary element for its legal-halachic enforcement, and has a legal status similar to that of a forced gift which is not a gift - a concept called in the Talmud tlayuhu v'yaheeve.51The lack of total willingness in selling organs out of financial pressure necessi? tates distinguishing between the situations in which the transaction is valid and those in which the transaction is invalid. There is reason here for setting limitations by re? quiring all prospective paid organ donors to be reviewed by a halachic-medical ap? proval committee .SummaryThere is no halachic source forbid? ding payment for an organ donated for the sake of doing a mitsva.Selling organs out of financial dis? tress is sale by force without full compen? sation, similar to tlayuhu v'yaheeve, wherein a gift is not a gift. Thus the sale lacks the basis of total willingness necessary for the validity of the transaction.It is possible that insufficient under? standing of the consequences of having an organ removed creates a situation of an il? legal transact ion.. In view of the differences betweenthe various cases, paid organ donations ought to be limited and made conditional by a public review commitee that will try to51 Rashbam on Baba Batra 48 , s.v . "Shmuel agrees ... but tlayuhu v'yaheeve is not a gift." Shulchan Aruch, Choshen Mishpat 205 :4.See Beit Yosef on article 12 of the above citation tounderstand the reason why there is a difference between coerc ion imposed by others and coercion imposed upon oneself, but this reason does not per? tain to the sale of organs.prevent criminal exploitation in the ab? sence of valid, full understanding, con? scious consent , and total willingness .5 . It is self-evident that the approval committee should be independent and not amenable to pressure .Translated from Hebrew by Ilana Attia ................
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