The New York State Health Department on April 9 released the proposed regulations for a long-stalled program to reimburse kidney donors up to $14,000 in costs incurred as a result of the procedure. This was first reported by New York Focus, which has been reporting on and championing the law that created the program since 2022. New York would be the first state to have such a program, and health department officials estimate that it could be used by as many as 500 New Yorkers a year. In the current timeline, the program would begin accepting applications this month, and anybody who donated since April 1, 2023, when the program was originally supposed to start, is eligible. (As of this writing in late June, the Health Department was still in the public comment phase. Regulations had been publicly posted, but the program had not yet started.)
Hundreds of New Yorkers die each year waiting for kidney transplants, as finding a match is very hard, especially if the patient is looking for a living donor, whose organs usually last longer and are less often rejected by the recipient. This reimbursement (and a potential $10,000 tax credit, championed by Governor Kathy Hochul for inclusion in this year’s budget, for which one could apply, instead of the Department of Health program, if it passes) may be the incentive needed to find more donors and save hundreds of lives.
The procedure itself is covered by medical insurance. This program is for ancillary costs, such as lost income, travel expenses, lodging, food, child and elder care, and medical aides not covered by insurance.
“They did a study that found that the average cost for a kidney donor is $6,000, in travel expenses and the like,” said Rabbi Josh Sturm, director of Outreach at Renewal, a frum non-profit that supports people with kidney disease. He said this program, which is still in the public hearing part of the rule-making process, will be a game-changer.
Rabbi Sturm added that Renewal already has a similar program set up to help those who donate through them, but the proposed state program is certainly a good thing and may even take a little financial pressure off Renewal.
There are two main halachic questions in regard to kidney donation: whether it is allowed, and whether one may receive remuneration for it. In a 2007 Tradition article, Rabbi Ronnie Warburg gave an overview of the issues involved.
To begin with, the Gemara in Sanhedrin (73a) makes clear that there is a mitzvah to save somebody’s life; this is derived from hashavas aveidah and from “Lo taamod al dam reiecha.” Together, they make one personally responsible to save another’s life, even at a financial cost. Rashi says that the personal responsibility extends to where the savior will endure pain. Rabbi Shlomo Zalman Auerbach applies this to the pain of kidney surgery.
The Radvaz, based on a Yerushalmi, defines the limits that apply to saving another’s life if there is a doubt as to whether the savior will himself die. As long as it is more likely that he will survive, he must do what he can. There is a dispute as to whether the danger is judged based on the objective possibilities determined by the doctors or by the willingness of the general public to undertake the risk of the procedure. Interestingly, Rabbi Shlomo Dichovsky and Rabbi Shaul Yisraeli say that kidney donation is permitted when the donor will be compensated and needs the money for livelihood (more on that in a moment). Another possible issue is the prohibition of self-injury. Most poskim rule that giving a kidney is a midas chasidus, and some, such as R’ Ovadiah Yosef, say it is even a mitzvah.
Paying for organs is a controversial topic. Selling body parts seems wrong to many people, as it seems to commodify people and lower human dignity. On the other hand, the very action that is being undertaken is already a testament to human dignity. An interesting argument is that payment would be halachically warranted as compensation for the donor’s injury, if indeed kidney donation is really a forbidden form of self-mutilation. The real reason to forbid selling kidneys and other non-regeneration body parts is the concern that it would lead to the creation of a black market for body parts and abuse of the less fortunate. Rabbi Warburg discusses ways around these issues.
It should be clarified that New York’s proposed program does not pay for kidneys, only for expenses involved in the donation. Assuming it is a mitzvah, this is comparable to the payment of teachers and especially of doctors. In an article in Journal of Halacha and Contemporary Society (Fall 2006), Rabbi Alfred Cohen discusses these issues. He notes that the Gemara forbids both Torah teachers and doctors to receive payment for their services, but the Shulchan Aruch in Yoreh Deah 336 permits it as s’char batala, paying them for the money they lose out on by doing these jobs instead of another occupation. Reimbursing external costs of kidney donations would be similar.
Whether payment for kidneys or associated fees is problematic or not, the feeling of accomplishment and joy of those who donate kidneys – who have given a literal part of themselves to change another’s life for the better – is enough.
My own great-uncle, Mark Mittel, recently donated a kidney.
“There was an event in my neighborhood,” he said, referring to the Renewal organization. “They were swabbing to find a match for one specific person.” And while he wasn’t a match for that patient, my great-uncle received a telephone call around four months later that he was a match for a different patient, a woman for whom Renewal had been struggling to find a donor due to her high antibody count.
“It’s extremely gratifying,” he said, “to know I helped.”
