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correct, for if a person committed a sin once because of temptation he
has not lost his status as your brother thereby.”

I put the above to my father-in-law, Rav Y.S. Elyashiv zt”l, and he
commented:

“It should be considered whether this sinner may be a shoteh [im-
becile], whose mind is deranged and who may be unable to exercise
free will. He cannot be considered a criminal but a fool and it may
therefore be a mitzvah to allow him to live if he is locked up in prison
and cannot endanger anyone’s life. The matter needs more study.”

See the Ibn Ezra (Vayikra 3:4) who writes that the Hebrew term
for kidneys is klayos, because the kidneys are associated with the de-
sire for marital relations, the word being related to the term in the
passuk, “Nichsefah v’gam kalsah nafshi (my soul yearns and desires)”
(Tehillim 84:3).

According to this, we should consider whether transplanting a kid-
ney into him might heighten his desire for relations. Giving him the
transplant would thus be actively stimulating his desire. Should we
decide that he is a criminal and not an imbecile, it would be incorrect
to give him a kidney transplant.

All this notwithstanding, I would suggest speaking to him and
warning him that according to Torah law he is not entitled to receive
a kidney transplant and we are giving him a three month trial period
to see if he starts weaning himself off drugs. If he does some honest
soul searching such that a psychiatrist testifies that he has now put
himself on the proper path, only then, after three months, will he be
added to the waiting list for a kidney transplant. This is clear from
the Shulchan Aruch (Choshen Mishpat 425:5): “Shepherds of [i.e.
who graze] small livestock (sheep, goats) in a place where the fields
belong to Jews, and [sinners] similar them – their deaths should not
be brought about but [at the same time] it is forbidden to save them.
To whom does this apply? To a sinful Jew who continues in his ways
and sins repeatedly, like shepherds of small livestock who behave with
abandon in regard to stealing and who are set in their sinful ways.
However, a Jew who has sinned but does not lead a sinful life, rather
he sins for his own pleasure, e.g. he eats non kosher food for enjoy-

278 1 Medical-Halachic Responsa of Rav Zilberstein