YU Medical Ethics: The Halachik Hero- How Far Must One Go To Save Another's Life?

These notes are unofficial and unedited. Any and all mistakes are mine.

(Incidentally, I named this event. Although I know how to spell halakhic correctly. The reference is obviously to Halakhic Man.)

Yehuda Leeder and Rivka Wieder: On behalf of the YU Student Medical Ethics Society, like to welcome all of you to tonight’s lecture. Exciting to see the familiar faces that have joined us for past events- please be sure to sign up on our email list- the Student MedEthics society is a student run society with goal of promoting. Make Yeshiva University a globe center for- educational resource for laymen, Rabbis, patients, doctors and others in other professions.

Been given esteemed pleasure and honor to introduce Dr. Reichman. Dr. Reichman received smikha from RIETS, prizes, Associate Professor of Emergency Medicine, Assosciate professor of Philosophy and History of Medicine ….Tonight Dr. Reichman will focus on the halakhic perspective of living organ donation

Second speaker Mr. Jay Feinberg- executive director and founder of Gift of Life Donor Foundation- member of worldwide registry Bone Marrow Donors Worldwide- facilitates Bone Marrow transplants around the world- publically recognized for – Charles Brothman prize and National Organ …award, Hadassash award, Honory Doctorate from YU alongside Senator Hillary Rodham Clinton. Thanks…please join me in welcoming Dr. Reichman. Kindly turn off your cell phones now.

Dr. Reichman: I guess I should turn off my cell phone also- good evening, thank you for the intro- wonderful to be here at another extraordinary event- tell story of a student of course not at YU who approached his professor at end of semester and says “Professor, I want you to know that if I am ever told I have one hour left to live, want to spend it in your classroom.” Why? “Because hour in your classroom seems like an eternity”- hour hopefully won’t seem like that to you- discuss opportunity to possibly save life- extraordinary opportunity to be a so-called halakhic hero.

Wanted to recall 2 years ago when inaugurated- November 30, 2005- at that time we spoke about stem cell research- update you for those of you who have not seen reports over last week- New York Times on November 23, 2007 that said to our many reasons for thankfulness we can now add the pioneering brilliance of Shinya Yamanaka and James Thomsons- scientists who may this week have joined a short list that includes Gregor Mendel and Marie Curie. The breakthrough is stunning- four genes introduced into normal skin cells, enticing them to act like embryonic stem cells, which can be transformed into the 220 cell types of the human body. Somehow a piece of skin after a few weeks of lab work, can become the cell of a beating heart. Discussed this at first event- interesting that 2 weeks after our discussion many developments in frontier of stem cell research, this is just one of them which obviates the need for stem cell harvesting- renders discussion of almost 2 years ago almost moot. Field of medical halakha everchanging, abreast of current developments and advances in science as they are occurring- society for Jewish Medical Ethics, think it was appropriate that we began with stem cells- stem cells can ___- infinitely- think society has shown over past 2 years, can have tremendous development and advance of human willpower and human mind- so commend all those who are involve din tonight’s events and past two years events- hope that our discussions will all be moot but hope we will have many discussion together for many years to come.

Like to begin our discussion this evening which will focus mostly on living human organ donation- living human being to donate something to another living human being that will facilitate their survival. Begin with this real case, case study of Renada Daniel-Patterson, teenager girl whose parents became estranged from one another and whose father landed himself in prison. She developed kidney disease and needed to go on dialysis, in effect artificial kidney, needed to go to hospital 3 times a week and artificial kidney- in absence of that would die- better to receive donation of kidney rather than artificial kidney. Father agreed to donate his kidney to his daughter. She was a teenager at the time- one of the requirements at the time is that she needs to take immunosuppressants- we discussed this in one of the conferences- if you do not take these medications to suppress immune system to prevent body from rejecting kidney and in effect this young girl neglected to take her medicines that would allow her to keep the kidney. So lo and behold she rejected that kidney. Her father, upon hearing this news, made following offer- allow me to donate 2nd kidney to my daughter and I will go on dialysis rather than have my daughter go on my dialysis.

Two questions:

1. Is it halakhically appropriate to serve as a donor of a kidney?
2. Is it halakhically appropriate to be a donor of a second kidney?

Now we turn to case 2

LB suffers from leukemia and a bone marrow donation is recommended by hiss doctors- the gift of life holds a bone marrow drive at a local university. MJ reads the sign at the elevator and wonders whether he should join the drive- might be painful, doesn’t know anyone with leukemia- should he join the drive?

2 cases we’ll discuss

To begin with medical aspects, list of different types of organs that can be donated:

1. Blood
2. Bone Marrow
3. Kidney
4. Liver
5. Lung

Blood is an organ, largest organ in body. Blood can be donated- Bone marrow can be donated from one human being to another. Other organs that can be donated- impact halakhically also is that blood regenerates in the body. When you donate bone marrow, bone marrow also regenerates in yoru body. A kidney however does not regenerate. Liver can also be donated from a living person to another- lung can also be donated- obviously only a section of the lung.

These are the organs that can be donated from one human being to another- now like to begin the halakhic anaylsis:

Why should we donate from one person to another person? What is the halakhic basis?

Leviticis 19: pasuk tes-zayn

“Lo Saamod al dam Reacha”
Do not stand idly by as the blood of your brother is being shed

IT is the analysis of this pasuk, parameters of this obligation that we involve ourselves in to discuss-

Gemara explains the origin of our obligation to save life- Gemara Sanhedrin Daf Ayin-Gimmel 73

“How do you know,” the Gemara asks, “that if someone is drowning in the river or attacked by wild animals or attacked by band of marauders that you have an obligation to step in and save that person? You know that from this famous phrase- do not stand idly by as the blood of your brother is being shed.” So Gemara continues “Is this th eorigin? We have another source in the Torah! How do you know that you have eto restore somebody’s health, somebody’s body? It says that you have to return a lost object to someone.” What is most prized lost object to any individual? Their health, their life- you have an opportunity to save that life, have to seize that obligation. So Gemara continues “But if only had obligation to save a life from idea of returning lost objects, obligation would be pretty limited” because halakha is that if someone loses an object, laptop or palm pilot- you have obligation to restore it physically or put up a sign, send a mass email- but your obligation is pretty limited. You do not for example have to spend any money out of your own pocket to return that.

Now there was an interesting case a few years ago where person was passing through JFK and lost pair of tefilling- sent out mass email, no name on tefillin- within 24 hours this person received their tefillin back. Obviously wouldn’t have happened without advances over last decade- that perhaps an obligation. But that’s pretty much it! But to actually expend financial effort and to spend money to save life of another human being- that’s why the Gemara concludes there’s a twofold obligation to save life of human being 1. bodily/ physical and 2. financial

But there’s a dimension that the Gemara doesn’t address- question of how much risk someone has to take in order to save another person’s life- but what if that rescue is involved with a certain amount of risk. How much risk do we have to take to our own bodies to save life of antoher person?

Bais Yosef says in Choshen Mishpat siman Taf-Chaf-Vav- if there is a questionable risk to your life, you are obligated to perform that rescue- so even if you would be involved in a serious bodily risk the Bais Yosef says that you are obligated to incur risk in order to save somebody else’s life.

They learn it out from passage in Talmud Yerushalmi

Ben Issi was in captivity in city of Safsufa. How to rescue him? This rescue involve sentering foreign city, serious risk. How much risk do we incur? Rabbi Yonasan says “Wrap him in his shrouds”- basically saying it is too risky- we just have to allow him to die. R’ Shimon ben Lakish says “I would rather die than let him die!” And indeed the postscript to the Gemara is that R’ Shimon ben Lakish went into city, deal/ negotiated with foreign enemy and saved Ben Issi.

This passage only found in Jerusalem Talmud, not Babylonian Talmud.

Now Beis Yosef wrote the Shulkhan Aruch- he reads as follows;

You see somebody drowning in the ocean, robbers attacking him, either you yourself physically or you can hire somebody else to perform the rescue- and neglected to perform the rescue- you have violated the obligation of “do not stand idly by on your brother’s blood.” What’s missing here? The obligation to incur risk! Many mefarshim say that they do not include this phrase because not included by Rambam or Rif so in essence says we don’t pasken, we don’t hold you have to put yourself at extraordinary risk in order to save someone else’s life.

Famous responsum of the Radbaz- Chelek hey Siman Reish Yud Ches- this is something that is used even today:

The tragic, horrific circumstances reminiscent – soldier stands in front of two Jews and says to one Jew “Allow me to amputate your finger and if you don’t, I will kill Jew next to you.” What is this Jew’s possibility? Three possibilities!

1. Obligation to incur this risk in order to save his fellow Jew
2. Maybe risk too high- maybe lose his life from this obligation- maybe prohibited from performing this rescue
3. Neither obligated nor forbidden from embarking on this rescue but permitted to do so if he so chooses

Radbaz choose option 3- permissibility. Says person who has wherewithal to perform this kind of rescue is a tremendous tzaddik. But is he obligated to do so? Radbaz says no. Radbaz says Torah is deracheha darchei noam- ways of pleasantness- no system of law that would obligate someone to incur that risk.

He lays out parameters in a number of lengthy responsa- he says limited risk- say 10-20% though difficult to quantify- even lower, 2-5%- risk that is over 50% you might lose your own life, you are clearly forbidden from embarking on such a rescue. Person who embarks on such a rescue is a chassid shoteh- a pious fool, who embarks upon such a risk. Between two polar extremes, 20% to 50% that is within realm of not obligatory but permitted to do so and choice is of the rescuer- individual can decide for himself.

So how does this apply to our contemporary circumstance? We set up basic parameters per halakha- bodily/ financial obligation. There is a risk that is involved- how does that risk now apply to every form of living donation?

We’ll ascend ladder of donation in incremental form and see where chips fall for each donation-

We’ll start with blood donation. How risky is it to be a blood donor? Now in order ot assess that risk- we’re living in an age of scientific study- there is data that is accumulated to be able to determine with statistic stuff-

This is from November 19,2007- apologize that I couldn’t get fresher data for you (laughter)

They studied 2,575, 264 donations- of all these the complications are people who get needle infections or who faint while giving blood. What will save you from fainting? The famous Stella Dora cookies. In old days it was always Stella Dora cookies you got to prevent you from fainting.

So according to this interpretation, are we obligated to serve as a blood donor? The answer might be indeed yes!

What’s an example? Surgeon operating on someone who has AB- blood; surgeon nicks guy. So say only one other person in town who has AB- blood so people run over and say “Chaim, someone dying on operating table- come and help!’ and he says “You know what, we need blood.” So question is – can we bring him and tie him down and force him to bring blood? In America, no. But there are poskim who say we could indeed force him! Not only does he have an obligation of “lo saamod al dam reacha” but we have to enforce that obligation! Risk to him is so little with advantage so high, could maybe tie him down and bring him.

What about bone marrow donation? That’s a step above- we always have to see the risk at the time that the discussion is occurring- because risk changes with advancements of science. So number of years ago, bone marrow donation always required harvesting marrow from bones of body in multiple sites and always involved general anesthesia- more risky procedure at the time- more risk for infection because more sites involved. But how is it now in latter years? Number of developments.

1. For conventional marrow harvest, you don’t need to harvest from as many locations as you did in the past

2. New development over the past few years that does not even require harvesting the marrow from the individual- relates to discussion on stem cell research of two years ago- in discussion two years ago, many different kinds of stem cells, cardiac stem cells, brain stem cells, blood stem cells. It had been thought that blood stem cells were restricted to blood system. So what you can do now in many circumstances- I’m sure you’ll hear about this also from Mr. Feinberg- now don’t need to harvest marrow but just harvest cells from peripheral blood- in your blood stream are blood stem cells that can regenerate bone marrow in other patient.

So not just a regular blood draw, because actually need to take certain medicines to stimulate blood to do certain things- blood also needs to go through machines. Research from last year here that was assessing the risks of G-CSF administration (fancy term for drug that stimulates blood to make stem cells), leukopheresis and standard marrow harvest: ethical and safety considerations for normal pediatric hematopoietic cell donors.”

So skip to conclusions- short term administration of G-CSF and leukopheresis appear to be safe and effective.

Not so risky.

So where does this fall on parameters of R’ David ben Zimra? Is one permitted to be a donor of bone marrow? Absolutely yes. But let’s say you sign up for drive and are found to be a match, are you obligated to be a match? Once you sign up you’re on there for perpetuity- are you obligated to serve as a donor?

So Rabbi Bleich in his halakha sefer “Bnetivot HaHalacha” he argues that you might indeed be obligated. So one could indeed make a compelling argument that one might be obligated.

If you have opportunity to be a bone marrow donor, not an opportunity you want to forego lightly- if such an opportunity presents itself, I urge you to seize it with all vigor- won’t have ability to save a lie so easily before.

Here you have front page of “Gift of Life” and have tremendous luxury of having gift of life founder here tonight.

What about kidney donation? In 1960s when kidney donation first came out, this was the statement of the Tzitz Eliezer, one of the giant poskim of 21st century, just passed away this year- he wrote:

“Removing a kidney, one of these internal organs, even though the donor is healthy at the time- is a risky procedure- and therefore one should not be a donor and a physician should not participate in this process.”

So if we were to look at this and guess halakha is in 2007 not allowed to be a kidney donor, that would be a misapplication of halakha. Because he is applying statistics of risk at his time- back in 1960s. Wasn’t clear how risky procedure would be going forward.

But he qualified his statement and said:

“But if physicians get together and 5/10/20 years from now decide that it’s not a risky procedure, it would indeed be permitted to do.”

And here you have November 2007 from Nephrology, Dialysis and Transplantation and American Journal of Transplantation- so you have huge studies about the risks of kidney donation to the donor. Two dimensional risk in kidney donation:

1. Risk in procedure itself
2. Risk of living rest of your life with one kidney

Both of those have to be assessed in order to do it.

Now kidney donation can be done with laproscopic surgery and not full surgery- minimizes the list- and these studies prove, following these patients for decades, not just donors but another population- population of military personnel- young soldiers who lose a kidney on the battlefield- see whether they have a greater likelihood of diabetes, kidney failure, etc- very slight increase but not so significant.

So to serve as a kidney donor not so risky- clearly risk, not minimizing but-

Here is a Teshuva of Rabbi Eliezer Yehudah Waldenberg – says clearly muttar to serve as kidney donor. No one would asser it today. So muttar to serve as kidney donor? Yes. Are you obligated to do? Already a question- harder to make

Isn’t a week where you won’t find in Jewish Press a handful of these ads requesting people to serve as kidney donors? also in newspapers, Doctor Stuart Greenstein, surgeon in Montefiore performed kidney transplant. In shul close to my house, someone put up an index card, if anyone wants to be a kidney donor please call- within a week eight people had called, one ended up donating to another rperson in shul- held gala Kiddush for this.

Entire sefer devoted to following question- Kliyos Yoatzos. Member of Knesset who needed a kidney donation and needed a living donation. So there are five sons- one son goes, gets tested and finds out he is a suitable donor for his father. His other four brothers said “What gives you the right to be a kidney donor to our father? We want to be the kidney donor to our father!” One of the other four was a bechor. So they fought tooth and nail about this-this entire sefer was published as a teshuva to this question- how they would halakhically decide who the donor would be- will share with you the conclusion of this analsysi.

On the one hand the bechor has rights, but on other hand the first son who began the process is maskil – so said these two have a greater obligation so held a lottery between bechor and first one who tested. So bechor won the lottery- won opportunity to save his father’s life. Know it was successful because you see recipient on front pages embroiled in things in Knesset so doing fine.

Liver Donation- may remember tragic fatality in Mount Sinai, closed down because thought it was too risky for donor. In September 2006 “Live Donor Liver Transplantation in Adults”- they decided it is getting safer and getting better because 11 deaths from this in the world- time will tell, maybe one day liver donation will be accepted.

So in answering questions of our case study:

1. Is he permitted to donate his first kidney to his daughter? Yes
2. Is he permitted to donate second kidney? Might indeed fall into category of Radbaz that would be too risky- dialysis has attendant risks- would probably be assar and in any case, no transplant surgeon accepted his kidney

Now again, are you allowed to participate in bone marrow drive? Yes
Are you obligated? Technically you might be! Such an easy mitzvah to fulfill- everyone should run to fulfill this.

Now Aruch HaShulchan has this Yerushalmi we talked about- obligated to incur risk to save a human life and says we don’t pasken this way. but don’t be so quick because a) who knows that you might not need a transplant in the future? and b) saving but one life is tantamount to saving an entire world

And thus concludes my remarks this evening and have tremendous pleasure and honor to hand over microphone to Mr. Jay Feinberg whose efforts and achievements are world-renowned- pleasure and honor to share podium with him.

Mr. Jay Feinberg: Thank you Dr. Reichman and all of you- I guess tonight I’m wearing two hats. 1. Hat of leukemia survivor and bone marrow transplant recipient and 2. Director of bone marrow registry- one of three that ____.

Number of heroes in this room tonight- quite a few bone marrow donors here. Can our bone marrow donors please stand up- please rise and show yourselves- (clapping)

And I know they don’t like standing and they don’t like being called heroes. My bone marrow donor when I met her a year after my transplant- my bone marrow donor can’t stand being called donor. Also have Shana Lichtenstal tonight- also here tonight because of the kindness of a stranger. Thank everyone for inviting me here tonight and want to tell you story of what happened to me when I was just a year out of college and started working in Lower Manhattan as Foreign Exchange Analyst in Federal Reserve Bank and about a year out was accepted to law school- was about to embark upon fantastic future, nothing could stop me, life was amazing and then diagnosis of leukemia sort of hit me like a truck- I was living in New Jersey, was taken to emergency room and was told by emergency room technician that I would need bone marrow transplant.

Now this was all relatively new and I had no idea what was involved except that I would need a donor. What I didn’t know was that 70% of patients who need donors can’t find one in their families. Only 30% can find in their family. ¼ chance to match a sibling. I have two brothers but neither matched me, though coincidentally matched each other. search of registry- couldn’t’ find a match. Didn’t know at time, is that tissue is inherited, ethnic background- same holds true if you’re Jewish- Ashkenazi, Sephardic- best chance lies within those populations. We have bio____ people who work for us and have done studies- so really all ethnic and racial groups need to be well represented in international donor pool. So when they told me I wouldn’t find a match because I was a Jewish- less than 5% chance- disease runs its course for three years and then goes into Blast Crisis- accelerated phase of diseases- we can give you drugs to make you comfortable. Hit me like a truck. One good thing I had that most of you can relate to was a Jewish mother who wouldn’t take no for an answer. And very supportive family who decided to put Jews into registry- so we started with a few drives in West Orange, New Jersey where I’m from. And then soon I had requests from all over the world to hold bone marrow drives.

This was being run out of my parents’ living room and then had some office space donated and before we knew it we were running this gigantic campaign- people might have been motivated from face on flyer- this is a flyer of our very first drive at YU- Chaim Mosdin who is now on our Board. During years it took us we tested 60,000 people and to this day over 1500 patients have had transplants from drives that took place for me and subsequent drives. Amazing process how people here give unreservedly of themselves to save life of someone they may never meet.

After four years of searching, best I had was donor with major mismatch- mismatch on two antigens- so we prepared to go with the mismatch. You know, at a time of crisis like this, you really learn who your friends are. People like Sharon over here- amazing the people who come forward to help save your life- they become your friends; they’re the ones who really come out for you and I was just really, really fortunate. One of those people lived in Chicago and decided to mismatch wasn’t good enough- we’ll run one more drive. He was insistent though family said we’re getting ready to work with mismatch. So ran it in Milwaukee with one extra passenger in card, young lady who wasn’t planning on going- her sister was going to go but her sister was sick so she went to run it. She was the very last person tested at the drive and she turned out to be my match.

so thankfully one year later I had the opportunity to meet my donor- she’s from Chicago- met her at the gate back when they used to let people go to the gates at O’Hare- she actually used to live here in New York and used to teach at SAR in Riverdale. Has now moved back to Chicago- has husband, family and baby- amazing she did this for a complete stranger.

So I got a phonecall- this is a little over four and a half years after being diagnosed with leukemia- got phonecall from admissions director at law school who said he had been holding my position for that time. Are you going to come back- we’re glad to have you? Really wasn’t much of a decision. Had met all these people who were willing to donate, give back- how could we let this end? So we decided to transform this grassroots effort into organization that now helps people around the world- the Gift of Life, organization that you’ll shortly have opportunity to donate to at drive.

About one in a thousand actually donate their bone marrow/ blood stem cells every year. About 1/100 get called for confirmatory typing. You’re a potential match- would you like to proceed? And of those, 1/10 end up donating their blood marrow/ blood stem cells. It’s quite remarkable because international average is 1/ 2500. So why in Gift of Life are numbers so astronomical? Two reasons. 1. We focus on what used to be underrepresented group- Jewish community and based on our data that we’ve accumulated, gone through from time that I was diagnosed, which was less than 5% chance of finding a match for a Jewish patient to 70% chance. So our target- do we need a 1,000,000 people in registry? We know that with 300,000 donors we’ll find matches for about 85%. Also today have benefit of stem cells found in blood in umbilical cord. Dr. Reichman told us about blood stem cells collected from peripheral blood. So for those patients, that 15% we can’t find exact match, can use umbilical cord stem cells because don’t need to be a perfect match for that.

Last thing I wanted to talk about was one of our newest donor initiatives in donor recruitment- in 2004 we made a strategic decision to focus our recruitment – in students. Students through Hillel, AEPi, Birthright trips, Richard Joel, your President here made this possible- over breakfast, he called up Abraham Infeld and said “My esteemed predecessor, I have a request for you” – he made it possible. Since he started that recruitment- 181 transplants possible.

So why focus on college students? Less likely to be deferred due to medical problems, transplant centers tend to prefer younger donors and from Jewish community’s perspective, we don’t just come on college campus to run a drive. Avi and his team here did that- we didn’t have to do anything- we just gave the resources, campus recruitment guide and some videos – but it’s you guys who took the initiative to make it happen. You took a leadership role to make this drive a success. And that’s what we want to teach- want to teach Jewish values- want to teach tikkun olam.

Ran a drive a couple weeks ago at Syracuse Hillel- marketing idea of “You Got Swabbed.” So t-shirts all over the place. GW- George Washington – so they said “We like Got Milk- can we have Got Marrow?” And they got permission and they did it and it was in the media. So you’re making this possible- you’re taking those skills on to your future careers and endeavors.

That’s really what I wanted to cover- the description of bone marrow and blood stem cell donation that Dr. Reichman covered was pretty effectively. In early years gold standard indeed bone marrow was harvested from pelvic region using needle aspirations- changed now only 20% donate marrow, 80% donate peripheral stem cells. If you’ve ever seen anyone donating platelets in stem cells- very similar to that- needles in each arm, running blood through centrifuge, running through and spitting back into other arm. By day five you feel like you have a little case of the flu, goes away after the donation is done- it’s a little discomfort but you have the opportunity to save a life.

So that’s really what I wanted to cover. I would love it if we could possibly call on some of our Gift of Life heroes to get up- I see Rachel is smiling- call up to podium and share a few words on what it was like to become a donor and save a life.

Don’t mean to take over but I think nothing greater than hearing from the heroes themselves so thank you and I’ll be available for questions afterwards.

Rachel: Hi everyone. My name is Rachel Hirsch. I was a bone marrow donor in 2002. Jay’s going to be in big trouble of this- just letting you know now. I was called by a friend who said that she was working at a place where having a bone marrow drive-need volunteers- so your type of thing, Sunday morning- who else wants to wake up Sunday morning? Drive was for Dr. Spector- I wasn’t her donor but she found a match. About six months later I got a phonecall from someone who said you’ll get a phone call tomorrow for someone who is a possible match- can you do a blood test? So I was elated- found out that woman had acute blast leukemia, very common thing- literally easiest thing I ever did. Donated, went back to work the next day- that was it. Really had no second thoughts about it- Gift of Life was amazing, had coordinator named Elizabeth Shai. The nurse was actually a counselor of mine from camp, Shifra, so she was there with me the whole time- I moved to Israel during that period of time- a year later I was called and asked if I wanted to meet the person I had donated my bone marrow to. So they flew me to New York- and on a stage in front of a whole bunch of people I got to meet the woman whom they actually also flew in from Israel (laughter)- she lives in Petach Tikva- originally from Romania. My mother’s very into genealogy- trying to find a connection to us but hasn’t succeeded in that thus far-

Cute story- first thing she said to me after we got off the stage “Before I had cancer, I had straight hair. Now I have curls. I didn’t know where I’d gotten the curls from” and she touches my hair- “-now I know!”

Biggest tzedaka you can do is not knowing who your recipient is and if that’s the end of it.

If anyone has any questions for Dr. Reichman/ Mr. Feinberg, they can ask:

QUESTION: This question is for Dr. Reichman. All those halakhic qualifications that you were giving before- do any of them change if the recipient is a non-Jewish person or is halakha the same across the board?

Dr. Reichman: Excellent question. Not so easily answered. In halakhic analysis, “reacha” usually understood as “reacha b’mitzvos” – your fellow Jew. But having said that, there are clearly supra- halakjhic issues, potential Kiddush Hashem, eivah- recommend read article by Dr. Bleich who addresses this specifically- he shows that it still will facilitate donation to Jewish people also. So in short answer specifically in respect to bone marrow donation, still falls under parameters to save a life. Parameters may change for kidney/ liver donation.

Any other questions?

Thank you all very much. I’ll be around for a few minutes.

Who knows how many more people will be standing up when Jay Feinberg asks for the halakhic heroes? May there be many more of us who merit to be halakhic heroes!