THE NEW YORK TIMES: Pig organ transplants may pose a dilemma for some Jews and Muslims

The sacred texts of Judaism and Islam are in absolute agreement when it comes to the pig: It is taboo, unclean and unfit for human consumption.

For Jews, pork is “treyf,” the very opposite of kosher. Pigs have one of the characteristics needed to be kosher (split hooves) but lack the other (they don’t chew their cud).

For Muslims, the pig is also forbidden, or “haram,” along with carrion and blood. The Quran mentions the proscription repeatedly.

Now biotech companies are raising genetically altered pigs to transplant their organs into patients whose own kidneys have failed. Experts in the field are only beginning to grapple with the question: Will Jews and Muslims accept a transplanted organ from a pig if it saves their lives?

It has not always been entirely clear whether the religious prohibitions on pigs apply strictly to consumption, and neither of these religions has a supreme authority, like the pope, who would issue a decree applicable to all.

Questions of religious acceptance of cross-species transplants came up at the Congress of the Transplantation Society in Istanbul, where scholars from a variety of faiths met last year.

For Jews, the short answer is a clear and unequivocal yes. It is one of the exceedingly rare instances in which the maxim “two Jews, three opinions” does not apply.

“It’s 100 per cent permitted,” even for the most observant and Orthodox Jews, said Rabbi Pamela Barmash, a professor of Hebrew Bible and biblical Hebrew at Washington University in St Louis.

Judaism teaches that in cases of life and death, the obligation to preserve life trumps all other religious commandments and obligations. And in the modern era, the prohibition against the pig applies only to eating it, according to Rabbi Moshe Hauer, the executive vice president of the Union of Orthodox Jewish Congregations of America.

“A Jew can do everything from having a heart valve that comes from a pig to playing professional football with a football made of pigskin,” Rabbi Hauer said in an interview.

Muslims, too, believe in the sanctity of human life, and Islam offers doctrinal leeway if it means saving lives. Still, the bar for overcoming the pig taboo is higher.

Islam answers the question with questions: Is there a dire necessity? And is an alternative treatment available? People with failing kidneys, for instance, can be maintained on dialysis. But patients who receive donated organs have a better quality of life and live longer.

“We can use something that’s not halal if we have to save someone’s life, but the doctor has to decide if the person can be saved any other way,” said Ahmed Ali, a Sunni imam at the Iqra Masjid in New York City.

While the Quran addresses pork consumption, the text has been broadly interpreted to mean that “the animal itself is filthy or corrupt, so it is not permissible to use it for any purpose” unless the need is dire, said Dr. Aasim I. Padela, a physician and professor at the Medical College of Wisconsin who focuses on Islamic bioethics.

Some Muslim religious groups have issued fatwas, or decrees, permitting the use of the organs in limited circumstances.

A Taboo’s Origins

No other mainstream religions single out the pig in quite the same way, and scholars are somewhat mystified about the origins of the Jewish, and later Muslim, pork proscription.

Pigs were domesticated in the Middle East 9,000 to 10,000 years ago, around the same time they were first domesticated in China, said Max Price, a zooarchaeologist at Durham University in England.

Pig bones are found at archaeological sites in the Middle East dating to the second century B.C., indicating they were both raised and consumed.

“At sites in Syria, a big center of urbanism between 2500 and 2000 B.C., pork reigns supreme — it is the most common bone that one comes across,” Price said. Even at sites in what is modern day Israel, “pig bones are everywhere.”

But societies often “instigate new taboos that don’t necessarily have material benefits,” said Julia Rhyder, an associate professor of Near Eastern languages and civilizations at Harvard University.

Other regional sects had restrictions on what could be eaten or offered in sacrifice to their gods, but the rules were applied narrowly to specific deities, temples or days of the year, Rhyder said.

The ancient Jewish prohibition on pork was different — it was absolute.

“Deuteronomy and Leviticus are saying, ‘We’re not going to have lots of different temples,’” Rhyder said. “They are saying, ‘We only have one God and one central temple in Jerusalem, so we have only one set of prohibited foods, as there is only one religious divinity whose preferences we need to consider.’”

By the end of the first millennium B.C., “it was very much an ethnic differentiation — Jews don’t eat pork,” Rhyder said.

But religion is about a lot more than just, well, religion. It’s also about food and family and community.

The aversion to pig’s meat became deeply ingrained in the culture and traditions of Judaism and, later, Islam. Muslims today, regardless of how tightly they adhere to other religious customs, generally avoid pork, experts said.

“Pork is the last frontier,” said Rumee Ahmed, a professor of Islamic law at the University of British Columbia. “People might not pray or fast, and they might engage in activities most would consider prohibited, but they won’t eat pork.”

He added: “Even if you’re not particularly religious, your identification with this religious group leads you to have a certain — not revulsion, necessarily, but you don’t like it, and you don’t like it near you even if you’re not eating it.”

Over time, pork consumption came in some ways to represent Western culture — “something that other people do,” and “something that you define yourself against,” Ahmed said.

The ‘Yuck Factor’

In a survey that asked 5,000 Americans of different religions if they would feel more comfortable if a transplanted organ for a loved one came from an animal other than a pig, about half of Muslims said they would prefer an organ from a monkey or a cow, and 40 per cent said they would feel better if the organ came from a dog.

“We did not find that among members of other religions,” said Daniel Hurst, a bioethicist who conducted the survey in 2023.

One of the pioneers of animal-to-human transplants, Dr. Muhammad M. Mohiuddin, is a practicing Muslim who said he had grappled with these questions since he started working in the field 30 years ago.

As a child, he said, he was scolded if he even said the word “pig” out loud. (Many Jews also avoid saying “pig,” referring to it with Hebrew words meaning “the other thing.”)

“My father was the first one to ask me, ‘Could you not find any other animal to work with than a pig?’” Mohiuddin said.

But having spoken to many Islamic scholars, he is convinced that while other options for treatment should be tried first, a pig’s organ can be used as a “last resort” to save a life.

And even though many unobservant Jews eat bacon and pork chops freely, some more traditional Jews may be squeamish about fake bacon made from vegetarian protein, which carries a rabbinical seal of kashrut.

“It’s the ‘yuck factor’ — something we call moral repugnance in bioethics,” said Laurie Zoloth, a professor of religious ethics at the University of Chicago.

“There are things that are permissible but not socially approved, and we’ve been raised to think of them as yucky and socially disturbing,” she added.

In Judaism, however, the obligation to save life overwhelms other commandments. Jews are allowed to violate the Sabbath to drive someone to the hospital, and they are allowed to eat on Yom Kippur, the day of atonement, if it will compromise their health to fast, experts say.

Islam offers flexibility, as well — to skip fasts during Ramadan, for example, or to not pray if one is unwell.

Cross-species organ transplantation is still experimental, and a clinical trial of porcine kidney transplants is underway. But if it is proven safe and effective, Jews who need a transplant “will not only be permitted but obligated — you are obligated to do things that extend your life,” Zoloth said.

This article originally appeared in The New York Times.

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