A statement made by a live donor in a July 10 life-saving kidney swap involving three recipients prompted quick, explanatory responses from the Health Ministry, Israel’s main transplant hospital and the Israel Medical Association’s ethics committee.
The Ynet news site quoted journalist Arnon Segal as saying that he was willing to altruistically donate his organ, but only if it was given to a Jew.
“My sole condition is that the kidney go to a Jew. This is my nation and my community,” Segal said in explanation.
“Altruistic organ donations” implies a lack of strings attached, but in Israel, live donors are able to make certain stipulations about the recipient. Though it is not officially possible to limit one’s altruistic donation to Jews only, there are organizations that will help a person locate a recipient who matches their desired criteria.
Segal, a 43-year-old father of eight from Jerusalem, is a right winger and Temple Mount activist. In 2022, he ran for Knesset on the Religious Zionism slate, but was placed 20th and missed out on a seat in parliament.
He hails from a staunch religious Zionist family — his father Hagai Segal, editor of the Makor Rishon newspaper, was convicted of causing bodily harm and membership of a terror organization for his activities in the Jewish Underground in 1980. His brother Amit Segal is a well-known journalist with Channel 12 news.
Segal was quoted as saying that he would be fine with his kidney going to a leftist or an LGBTQ individual. “I respect everyone,” he said, but the recipient did have to be Jewish.
His comments published by Ynet led the Israel Medical Association’s ethics committee to issue a statement that all organ transplants in Israel are done fairly and without discrimination.
“Saving lives is the highest value, and decisions as to who will receive organs for transplant must be done professionally and with transparency, as is done by the National Transplant Center. The ethics committee is against any discrimination based on religion, race, nationality, or any reason that is not related to a person’s medical condition,” it said.
Beilinson Medical Center in Petah Tikva, the hospital where 70 percent of the country’s organ transplants are performed, also issued a statement saying: “The hospital is the agent that performs the transplant, and is not involved in choosing the donors and their preferences, other than to determine their medical viability.”
The Health Ministry also issued a statement emphasizing that the state’s healthcare system does not discriminate on any basis and that organ donations are allocated by the National Transplant Center according to a waiting list.
“The [list’s] mechanism is based on professional medical parameters and everything is done equitably… and setting conditions or asking for the identity of the donor is prohibited,” it said.
National Transplant Center director Dr. Tamar Ashkenazi told The Times of Israel that absolutely no conditions can be put on donations of organs from the deceased.
“Unfortunately there are cases where we can’t save lives because the family of the person who is brain dead imposes stipulations. We have to turn down these organs,” Ashkenazi said.
Matches made directly through the National Transplant Center registry between live donors and recipients must similarly involve no conditions about the recipient.
However, matches made independent of the national registry give the donor the legal right to decide to whom they want to donate.
There are different categories of such donors. The first is a family member who donates to a patient who needs an organ (usually a kidney). The case is medically, psychologically and ethically evaluated by the hospital involved. After that, the file is passed on to the National Transplant Center, which checks that risks have been presented, that there is informed consent of everyone involved, no pressure has been put on the donor, and that no money has exchanged hands. Finally, the case is sent to the Health Ministry for final approval.
The process is similar in the event of non-related live donors. These cases involve a donor giving to someone they do not know at all, or to a friend, neighbor, or co-worker, for instance. The only significant difference in the process is that the middle step involves the deliberation of the national transplant committee at the Health Ministry, with coordination by the National Transplant Center.
When choosing to donate to an individual one does not know, it is not possible — officially — to place stipulations on the identity of the recipient. However, it is possible to get around this through non-profit organizations like Matnat Chaim, which find healthy volunteers to make altruistic kidney donations and pairs them with those in need.
Founded in 2009 by the late Rabbi Yeshayahu Heber and now run by his wife Rachel, the organization has organized more than 1,470 kidney donations.
Rabbi Heber died of COVID in April 2020. His wife received the 2023 Israel Prize in recognition of the couple’s work with Matnat Chaim. Many attribute the fact that Israel has the highest number per capita of altruistic kidney donations in the world to Matnat Chaim’s success.
The organization identifies a suitable person in need of a kidney from its lists and makes the match. The donor and recipient must still go through the requisite procedure involving the hospital, National Transplant Center and Health Ministry.
This is apparently what happened with Segal.
A position paper posted on the organization’s website on its ethical and legal guidelines states that “the assumption behind Matnat Chaim’s activity is that it is the right of a donor to choose the characteristics of a patient and to donate according to his preference… Choosing the donor according to independent criteria is a legitimate choice, similar to giving charity according to the donor’s inclination. A kidney donation is truly a ‘gift of life,’ and it is a donor’s right to give his gift, a functioning kidney, to whomever he chooses.”
“Experience shows that the policy of allowing the donor to express his preference regarding the recipient significantly increases the number of kidney donations, and we, therefore, have no doubts regarding this policy, which serves our goal of saving as many lives as possible,” the paper said.
Segal donated his kidney at Beilinson for the benefit of a patient named Raphael Yisrael, who is hospitalized at Soroka Medical Center in Beersheba. Yisrael’s son Sagiv donated a kidney at Soroka for Batsheva Krif, a patient with renal insufficiency at Beilinson. Her daughter, Orli Lozover, donated a kidney to yet another patient, Ilan Assulin, who was born with only one under-functioning kidney.