National Association of Chevra Kadisha

Handling Blood During a Tahara

The Torah tells us that blood has special significance, as compared to other bodily fluids: hadam hu hanefesh — the blood, it is the life (Devarim 12:23). Blood is therefore an integral part of the body, and all chevros kadisha take great care to bury a person with all of the blood required according to their minhag. However, not all blood has the same status. There are, in fact, three categories of blood.

Dam Nefesh: blood that flowed at the time of death and contributed to the death

This is the blood through which the nefesh may have left the body. Dam Nefesh is the most stringent category of blood. 

We most commonly see dam nefesh when the death resulted from trauma such as an accident, a long fall, or a wound from a gunshot or knife. Moreover, any time bleeding leads to death, for example, in the case of a hemorrhaging varicose vein, or a severe bleed, the blood is considered dam nefesh. 

All poskim agree that dam nefesh should always be buried. This is why organizations such as Hatzalah and ZAKA, in Eretz Yisrael, take such heroic measures to collect all blood. If dam nefesh has soaked into carpeting or car seats, that material should be cut out and buried. If it seeps into earth or concrete, we make every effort to break the concrete, or to dig up the earth in order to be able to bury every drop of it. 

Dam L’achar Misa: blood that flows after death and did not contribute to the death

This is the most common type of blood that chevros kadisha encounter in the process of a tahara.

There is a difference of opinion among the poskim about what we do with this type of blood. The Gesher Hachaim and the Tzitz Eliezer are clear that blood after death need not be saved and many chevros in Eretz Yisroel follow this general practice. On the other hand, the Maharsham writes that dam achar misa must be saved and buried. This is also the minhag followed by The Procedures of the Jewish Sacred Society of Chicago, which has the haskamah of a number of contemporary poskim. This is, in fact, the minhag in most US communities and in most Chassidic communities worldwide.

All opinions agree that:

  1. Blood in the amount of a revi’is (about 3 ounces) or more has special significance. If there is pooled blood in this amount, or if this amount has soaked into clothing or sheeting, even if it definitely flowed l’achar hamisa, it must be buried. 
  2. A bandage, tube or stitch should not be removed if doing so will definitely lead to uncontrollable bleeding.
  3. A bandage, tube, or stitch should be removed if it is unlikely to lead to bleeding, or if bleeding, should it occur, would be easily stemmed.
  4. Any bleeding which may occur after the tahara (tisha kabin/mikvah) should be stopped and/or covered to avoid soiling the tachrichim, or even worse, dripping from the aron.

The different opinions impact the following cases:

  1. When a bandage or wound, if left as is, might lead to a loss of blood when water is poured at the rechitza or tahara. 
  2. When, despite the best efforts of the chevra, there is still a possibility that some blood will be lost in the
    tahara (tisha kabin/mikvah) process.
  3. When encountering blood that came with the nifter which clearly did not contribute to the death, and is
    less than a revi’is. This is often found on sheets or clothing.

The poskim who are strict with blood will insist that a chance of losing dam never be taken, even if this means that tisha kabin/mikvah will be forfeited. Of course, in such cases, we still make every effort to perform a full washing and dressing of the nifter, taking care not to lose any blood or soil the tachrichim

I personally heard from both Rav Yaakov Kamenetsky, zt”l, and Rav Moshe Feinstein, zt”l, that we forfeit performing the tahara (tisha kabin/mikvah) even if only a drop of dam l’achar misa may be lost. Rav Yaakov expressed himself by saying in Yiddish, “A Yid’s blut is nisht billig — a Jew’s blood is not worthless.”

A Distinction Between Dam Nefesh & Dam L’achar Misa: There is a stringency when dealing with dam nefesh that does not apply to dam l’achar misa. Dam nefesh is saved in all circumstances. On the other hand, when dam l’achar misa is in a disgusting state, for example if it is heavily mixed with bodily waste or mucus, if it’s putrid from a bedsore, or mostly mixed with dirt, then it should be discarded. Of course, if there is clean blood which can be separated or cut away from the area which is mixed, that should be done.

Dam Kodem Misa: blood that flowed prior to death, but did not contribute to the death

This includes blood from a sore, puncture, incision, or non-fatal wound. This blood does not technically need to be saved at all. However, if a chevra generally saves dam l’achar misa, it is good practice to save any blood that is encountered during the tahara process. Examples include blood found on clothing, bandaids, bandages, bedsheets, or on the skin, whether dry or fresh. The only exception to this is if the blood is in a state of bizayon (a disgusting state) as described in the paragraph above.

 

Type of blood When did it flow? Did it contribute to the death? What do we do with it? Are there exceptions?
Dam Nefesh At the time of death Yes This blood must be buried, according to all opinions No

Dam nefesh is buried under all circumstances, even if it is in a state of bizayon, a disgusting state, mixed with other substances, such as earth or waste matter.

Dam L’achar Misa (This is the most common type of blood encountered during a tahara) After death No  Most US chevros and Chassidic chevros worldwide bury it. 

Minhag Eretz Yisrael does not require its burial.

Yes

If dam l’achar misa is in a state
of bizayon, a disgusting state, it is
not buried.

Dam Kodem Misa Before death No Dam kodem misa does not technically need to be saved, but it is good practice to
do so.
Yes

If the dam kodem misa is in a state
of bizayon, a disgusting state, it is
not buried.

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