Concerning Heart Transplants

[This teshuvah, written on Rosh Chodesh Adar II, 5 March 10 (1978), was addressed to Harav Kalman Kahana, of Chofetz Chaim Kibbutz in Eretz Yisroel, one of the famed talmidim of the Chazon Ish. The question concerns a patient referred to in Israel as a tzemach, i.e., a person in a persistent vegetative state (p.v.s.). The questioner asked whether a donor organ from this patient might be transplanted into someone in need of a healthy heart. At the time of the writing of this responsum, there was a moratorium on cardiac transplants in the United States because of the unsuccessful results of such operations.]

Regrettably, my physical health caused me to delay answering your question for a few days. However, I did send a short telegram to say that in my opinion [a heart transplant] would involve a double murder, killing the recipient as well as the donor, as I already stated in 1968; see Iggeros Moshe, Yoreh De'ah II:174.

It would surely be unwise to engage in extensive analysis, since people may make the mistake of thinking that some way exists to permit this action. I write now to clarify the matter further.

The information [on which my decision was based] was provided by my son-in-law, Rav Moshe David Tendler, שליט"א, who reviewed the medical journals to date and concluded that there is no basis for assuming that the recipient's condition would be improved [by a transplant]. All the evidence indicates that no [transplant recipient] survives for [even a few] years, and those who survive for less than a year suffer months of intense pain and anguish. In America transplant operations are forbidden, except for one state [California], where one doctor [Dr. Shulman of Sanford University] has been permitted to continue his work, although I do not understand the reason for this.¹

footnotes: ¹ By attending to the problem of immunological rejection, which others had neglected, Dr. Shulman ultimately proved that successful heart transplants were possible.

Many other countries have forbidden heart transplantation on the grounds that it is equivalent to murder [of the donor] and provides no benefit to the recipient. Therefore, I believe that the doctors were not truthful with you when they said that the heart transplant would result in an improvement of the recipient's condition. The donor's status is also in question, for they have not proven that he was dead [when the heart was removed]. The survey of the literature showed that all recipients suffered massive strokes within a few weeks [of the transplant] and died within a few months. Doctors who undertake heart transplants are in violation of the prohibition of murder, since they are unable to demonstrate that the transplantation procedure is successful.