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Giving Life

Of all the repugnant images of Jews accompanying the recent arrests of rabbis and others accused of money laundering and public corruption, none was as repellent as the charges against Levy Izhak Rosenbaum for trafficking in human organs. Worse, federal authorities alleged, his business of buying and selling body parts had gone on for a decade from his home in Brooklyn, undoubtedly with the tacit knowledge of some in his Orthodox community.

Rosenbaum is the first person ever charged in the United States with trafficking in live human organs. What a great distinction for the Jewish people.

But Rosenbaum’s alleged market flourished because there is real, urgent, aching human need. More than 80,000 people are waiting for a kidney transplant in America, and every year about 4,500 die while waiting, according to the National Kidney Foundation. Americans are quick to want a transplant if they need one, but reluctant to return the favor — only 30% to 40% say they have designated themselves as donors on their driver’s licenses or on state-run donor registries.

Israelis are even less compliant, and as a result, Israel has one of the lowest (legal) organ donor rates in the developed world. And, as we’ve learned in this latest scandal, it has become a hotbed of illegal international trafficking.

The tragic imbalance between supply and demand gives way to heartbreaking stories like the one told by our Rebecca Dube this week of an Israeli man who came to America in search of a kidney because he wasn’t able to obtain one back home, and was approached to purchase one on the black market. There are, literally, thousands of tragic stories in this country of those seeking life-saving organs, and this growing need has prompted renewed calls to allow financial incentives to encourage organ donation. Pennsylvania’s new Democrat, Senator Arlen Specter, is considering legislation that would give government entities the ability to provide material compensation to donors.

This idea, while outlawing the sale of organs, still raises troubling moral and logistical questions and, for Jews, religious ones as well. One religious question that has been answered, though, is that Jewish law permits — indeed, encourages — organ donation upon death as way of fulfilling the mitzvah of pikuach nefesh, saving a life. There is some dispute about defining the time of death, and cultural reluctance to tamper with a dead body, but the notion that organ donation in general violates Jewish law must be put to rest. Every effort should be made to encourage Jews, and all Americans, to make it clear in life that their deaths can help save others.

But critics argue, with some justification and great emotional punch, that voluntary donation at death will never meet the crushing demand for kidneys that prompts some to take the kind of desperate measures referenced in the federal indictment. And so Specter’s legislation would permit government incentives — such as tax credits or coverage of funeral expenses — that fall short of direct payment, but still compensate the donor when alive, or his or her family upon death.

This is dangerous moral territory. Once financial incentives of any sort enter the equation, people are reduced to merchandise, their body parts just another consumer product to be traded and devalued. Despite assurances to the contrary, it’s difficult to see how such incentives wouldn’t prey on the poor and desperate, and push aside voluntary giving in favor of more coercive strategies.

As the ethicist Arthur Caplan wrote: “Calls for markets, compensation, bounties or rewards should be rejected because they convert human beings into products, a metaphysical transformation that cheapens respect for life and corrodes our ability to maintain the stance that human beings are special, unique, and valuable for their own sake, not for what others can mine, extract or manufacture from them.”

It is difficult for the well to stand in the way of the sick. If we haven’t personally faced these wrenching choices, they are not hard to imagine. Wouldn’t we all do anything to potentially save our own lives, or the lives of loved ones?

Policy and law, religious and secular, cannot be driven simply by satisfying individual needs, however. In this and so many other life-and-death dilemmas, the long-term consequences to a nation’s health and values must be considered. We are more than the sum of our parts

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