Q, Dear Rav Bartfeld.
I hope this finds you well. I’m wondering if Rav Miller Shlita has a position on organ donation, specifically regarding the Ontario driver license option of listing oneself as a donor and being able to exclude certain organs for donations. I’d be grateful if you could provide me with any teshuvos or piskei halacha.
Thank you, kol tuv,

A. The Halacha view on organ donation is as complex as the issue of determining life and death.
On the one hand, we have a sacred obligation to preserve human life and pikuach nefesh overrides other mitzvos. On the other hand, due to the need of harvesting organs that are fresh and fit, we may end up rushing and terminating the donor’s life, trying to save others.
The Organ and Tissue Donor Registration form associated with the Ontario driver license, provides an option to except eight different organs, such as heart, kidneys, eyes, liver or skin. However, the decision to determine that the donor has died, rest with the medical team available at that critical time, and is likely to be contradicting the Halacha definition of death. Therefore, excepting those organs, is of no help.
There are other Halacha issues involved besides taking someones life. Such as the prohibition of deriving benefit from the death, that many Poskim maintain is Biblical. However, there are a number of heterim that do apply to different body parts – to mention only a few; Shevet M’Yehuda (p. 314) asserts that the successfully transplanted organ has revived and now being alive it does not maintain that prohibition anymore. In regards to the eye cornea, Har Tzvi (Y.D. 276) opines that it is less than a shiur kezais and should be permitted. He also argues that it may be considered; shelo kederech hanooso or not your regular use. (See also Igrois Moishe Y.D. 1: 229: 3).
There are also issues of nivul hames or desecration of a dead body. Then again Poskim argue, that in cases of great need, such as permitting an aguna to remarry, we override that prohibition (Shoel Umeishiv 1: 1: 231, Maharil Diskin Y.D. 31).
On the prohibition of not bringing the body to burial, which many maintain is only rabbinical, Poskim are also lenient in cases of great need. (Yabia Omer Y. D. 3: 22, et. al.). Yet, all the above all heterim and authorizations, apply only when they are really needed and by the right recipient. A condition that is often neglected when left to the unsupervised hand of the Halacha-uncaring medical team.
Horav Shlomo Miller’s Shlit”a opinion is that as mentioned above, due to the complexity of establishing the time of death and confirming the true necessity and need of the use of the harvested organs, according to the Halacha, one should refrain from signing an overall open consent that his family members may not be able to control anymore after his demise. Rather, he should leave the necessary instructions in the hand of a competent and experienced rabbi, that the family can trust and consult with a clear conscience.

Rabbi A. Bartfeld as revised by Horav Shlomo Miller Shlit”a