kidney transplant list – cutting in line

The poskim discuss whether pikuach nefesh supersedes mitzvot bein adam lachaveiro, such as stealing a life-saving medicine. The halachic consensus is that it takes precedence, but the endangered person is legally liable to pay. However, if the theft will cause the death of another person – it is not allowed. (See Nismat Avraham Y.D. 157:1(5)1; Encyclopedia of Jewish Medical Ethics, Danger to Life, Vol. I, p. 275; Encyclopedia Hilchatit Refuit, Pikuach Nefesh, vol. VI, p. 455, citing Chazon Ish C.M., B.K likutim #20 daf 62b.)

There is room to debate whether "purchasing a spot," i.e., "jumping the line," is considered stealing from those waiting on line, since the line is not a fixed, first-come first-served, system, but has many factors involved. Thus, no one has a predetermined "right" to the available organ.

Even so, in a famous response during the Holocaust, Rav Oshri records a heart-wrenching question posed to Rav Tzvi Hirsch Meisels in Auschwitz. A parent whose child was taken to be killed asked whether he could bribe the officials to release his child, which would cause them to take another child, instead. Rav Meisels could not provide a definitive answer to allow it, so that parent left his child, "shev v'al ta'aseh adif."

Furthermore, the rules of organ donation are critical for the system, and are highly monitored. It is not likely that the attempt will pass unnoticed. Allegations of bribery and unfair play cause major scandals that can lead to tremendous chilul Hashem for which even death does not atone. It also adversely impacts the medical institution involved in the transplants, endangering others.

Therefore, one may not "purchase a spot on the line" in an unfair manner. However, since the "list" is dependent partially on medical recommendations, one can ask the doctor to advocate the case in its most favorable light in a truthful manner.

Rabbi Meir Orlian