On a recent Saturday in Jerusalem, 130 men and women gathered with their spouses at the Ramada hotel for a special Shabbat event.
Most of the 130 were religious Jewish men in their 30s and 40s, some graying, some not, sporting beards long and short and hats that denoted the various ultra-Orthodox Jewsh sects to which they belonged.
The women wore colorful headscarves, long skirts and their finest jewelry. It was, after all, a joyous gathering, and they’d traveled from cities and smaller communities all over the country to attend.
These 130 perfectly healthy men and women had each, over the past year, undergone surgery to remove a kidney to donate to a stranger in need.
The event that Shabbat was hosted by Matnat Chaim (Gift of Life in Hebrew), an organization that facilitates voluntary kidney donations in Israel.
The non-profit is the brainchild of Rabbi Yeshayahu Heber, himself a kidney recipient. He founded the organization 10 years ago following a tragic encounter that changed his life.
While undergoing dialysis at the Shaare Zedek Medical Center in Jerusalem — three times a week, four hours a day — Heber, then a 42-year-old father of two working two jobs, met a young man named Pinchas Turgeman.
Turgeman, 22 at the time, had already received a donated kidney, but he needed another. Without one, he would die.
The two struck up a friendship, meeting three times a week, four hours a day, in a hospital room, talking the time away and briefly forgetting about the machine that was keeping them alive.
Undergoing dialysis could potentially prolong the two men’s lives by five to seven years, but the treatment takes a toll on the immune system and is physically and mentally exhausting. Recuperation usually takes days. The only real solution is a kidney transplant.
Heber was lucky. He soon found a compatible donor.
When he shared the news with his friend, Turgeman responded teasingly, “What about me?” well aware that it was probably already too late.
The comment stayed with Heber. A short time later, Yeshayahu succeeded in finding a donor for Turgeman, but it was too late: Two weeks before the transplant was due to take place, the young man died.
Heber was devastated. He isolated himself, stopped eating, and spent hours thinking. He wanted a change: to stop working two jobs, have more children and find purpose to his life. But, more than anything, he never again wanted to go to the funerals of young people such as Turgeman, who had done nothing to deserve his terrible fate.
He wanted to be useful to others who spend their days in hospital rooms — three days a week, for hours a day — waiting for a machine to filter their blood, those patients who constantly think about the disease gnawing at them and their loved ones and the day when their kidneys will give out completely.
A day after Turgeman’s funeral, after some 24 hours of isolation and reflection, Yeshayahu set up Matnat Chaim to sign up suitable individuals for voluntary kidney donations.
Over the course of the first year, he found four donors; during the second year, eight; and after another eight years, the total number was 406.
To him, that means 406 lives changed and destinies altered; 406 instances in which the dialysis machine was vanquished, life prevailed and hope retook its rightful place, when families could enjoy their loved ones, and friendships were born between donors and recipients — all thanks to that first connection between the rabbi and the young man in the hospital room in Jerusalem.
Those 406 donors, men and women in perfect health, chose to undergo surgery, to take a risk, because, like Heber, they wanted to give new purpose to their lives by helping others.
The decision to donate
Assembled in the dining hall of the Ramada hotel that Shabbat, those men and women — each now living with one kidney, sporting the scars to prove it, and forced to monitor their creatinine levels — shared their experiences.
Asked why they chose to donate their kidneys, most of them shot back, “Why not?”
Some of those donors weren’t strangers to the people they donated to. Some were family: mothers and sons, wives and husbands, brothers and sisters.
Rehovot resident Judith Abrahams, 68, said she was terrified when her son decided that he would follow her example and donate a kidney of his own to a stranger.
“It’s my son. How can I explain it?” she said.
In 2001, then Knesset member Avraham Ravitz saw his 12 children fight over who would donate their kidney to him, going so far as to consult a rabbi on the question. Thus they could fulfill two mitzvot (good deeds) — both saving a life and honoring their parent.
In that case, the firstborn, Moshe Ravitz, had the honor, and his sacrifice likely gave his father several more years of life (Ravitz died in 2009 of heart problems).
Years later, one of Moshe’s sons announced that he too wanted to carry out the mitzvah, and donated a kidney to a stranger.
In fact, some 80 percent of organ recipients are strangers to their donors.
Imagine those strangers in need, those people whose paths haven’t crossed yours but for whom you are “the solution,” said Rivkah Moriah, a donor from the settlement of Efrat raised in a family from New Hampshire where, she explained, giving of yourself went without saying.
Yehuda and Raheli Livman, parents of 10 in their 40s from Migdalim in the West Bank, put their decision to donate another way: “We’ve always done things together,” they told Matnat Chaim when signing up.
Donors provided a variety of reasons for their decision, including stumbling upon a blog post on the topic; an unexpected meeting with a friend who had already donated; pure chance; and a car accident from which the driver miraculously emerged unscathed but which claimed the lives of the grandparents in that same vehicle, sparking a desire to give back a little of the gift of life.
And there’s Avi Appelbaum, a 34-year-old resident of the West Bank settlement of Eli originally from Antwerp, who watched a TV show about a man desperately in need of a kidney who — just like Pinchas Turgeman — died before the transplant could be completed.
Appelbaum, a computer scientist and father of six, ended up donating a kidney to Ilanit, a woman from the upscale Tel Aviv neighborhood Ramat Aviv who had difficulty finding a compatible donor and who had been undergoing dialysis for seven years.
What the procedure is like
For those reasons and others, 406 donors made their way to the offices of Matnat Chaim in the Jerusalem neighborhood of Givat Shaul at some point over the past 10 years to embark on a long, arduous journey.
First, they underwent a number of tests to determine if they could part with one of their kidneys. Blood-type tests, morphology and a round of psychological and physical exams followed.
Matnat Chaim employs a team of six people working with five hospitals across the country: Rambam Hospital in Haifa, Beilinson Hospital in Petah Tikva, Ichilov in Tel Aviv, Hadassah Ein Kerem in Jerusalem and Soroka in Beersheba.
The extraction operation takes between one and two hours, and thanks to medical advances and the use of laparoscopic surgery — a technique that allows surgeons to operate from an image transmitted to a screen through a tube fitted with an optical camera, pioneered in France — scarring can be minimal or nonexistent. In women, the kidney can be removed through the vagina and in men, through the navel.
The risk of a donor’s body rejecting the transplant exists but it has been reduced considerably due to the high quality of immunosuppressive treatments. The rate of rejection is low and chances of a transplanted organ successfully functioning 10 years later is over 90%, according to Professor Olivier Bastien, the director of removal and transplant at the Agency of Biomedicine in France.
Donors and recipients often meet only moments before the surgery — just enough time to exchange some pleasantries and words of gratitude. Recipients often also share the relief and newfound hope they felt upon hearing the words “we have found a compatible donor” — words that signal the end of the suffering and waiting, and the beginning of a new lease on life.
And most stay in touch with their donors, sometimes daily.
Israel, like France and other countries, has organ donation laws designed to prevent trafficking. It prohibits compensation or the promise of compensation to donors by potential recipients or persons acting on their behalf, but pays the equivalent of over a month’s salary and covers health care costs for a period of time following the organ removal.
Donors are allowed to give their organs to a recipient of their choosing or to an unspecified recipient, provided that “there is a medically suitable recipient for the donated organ,” as determined by the Transplant Center, also known as Adi in Israel.
Donors can also impose certain conditions; many prefer to have children be the recipients and not adults. Others prefer to give to older adults precisely because they are less likely to be recipients.
Avigdor Sharon, a 66-year-old ambulance driver for Magen David Adom and a resident of the West Bank settlement of Karnei Shomron, refused to have the recipient of his left kidney be a smoker.
“Why should I care about their health when they don’t?” he said.
He also refused to have the kidney recipient be an Arab. “I don’t think an Arab would have given me his,” he said in justification.
Judy Singer, a fundraiser for Matnat Chaim and a donor herself, said that she’d met other donors who specifically requested an Arab recipient.
The organization has been criticized by Israeli health officials for allowing donors to set conditions over who receives their kidney.
In a report aired on Israel’s Channel 2 Sunday, the Health Ministry said the policy leads to possible discrimination, noting that at least half of Matnat Chaim’s donors request Jewish recipients.
The ministry maintains the national list of patients awaiting a kidney donation.
A health official told Channel 2 on Sunday that the organization has no oversight and that it was “not clear by which parameters the organization decides who receives a kidney,” as Matnat Chaim keeps its own list.
The official said that these circumstances lead to patients who are in relatively good condition and who are on Matnat Chaim’s list to be matched with donors, while patients in worse condition “who have been waiting and have been undergoing dialysis for four years” remain on the waiting list.
In a statement, Matnat Chaim vowed to continue its work “for all those in need.”
Many of those who donate through the group express no preferences. Moriah, the donor from Efrat, said her only criterion “is that the recipient need it.”
“It did not matter to me who got my kidney, I wanted to do it for the hessed (kindness). Kindness for the sake of kindness,” said Menachem Bakush, 29, a father of four who met his wife, Naomi, 10 years ago when the two worked as shepherds.
“As far as I’m concerned, it’s like giving blood,” he said before someone interrupted, telling him, “It’s not the same.”
“Yes it is,” Bakush shot back “You give, you help, that’s it. It’s the same.”
“You can live with just one kidney,” said Dan Grunewald, 41, a native of Strasbourg in France who is currently a travel agent and a student at the Hebrew University in Jerusalem.
“Why does God give us two? One to give and one to keep,” said the father of four, whose wife, Hila, a psychologist, gave birth to a baby girl just two months before he donated his kidney.
“Also, if ever I need a kidney or if a member of my family needs a kidney, I’m placed high on the recipient list,” he added, in reference to the Israeli system, launched in 2012, which grants first priority to living donors and their relatives. Those who register to donate organs after death have second priority three years after registering, and their family members have third priority.
Grunewald, the son of the famous French rabbi and writer Jacquot Grunewald, participated in the 10k Jerusalem run on Friday — as did others from Matnat Chaim — doing away with the idea that such things would be impossible to do after donating an organ.
Many of Matnat Chaim’s donors also take the time to speak publicly about their experiences, hoping to raise awareness and inspire others to follow their example.
Jewish law versus state law
Kidneys are mentioned over 30 times in the Bible, according to a 2005 academic study titled “The Kidneys in the Bible: What Happened?” published by the Journal of the American Society of Nephrology.
In the Old Testament, the Book of Jeremiah says kidneys were one of the organs examined by God to judge individuals.
“I the Lord search the heart, I try the reins [kidneys], even to give every man according to his ways, and according to the fruit of his doings,” reads the passage (Jeremiah 17:10). In other translations of the Bible, rein becomes the soul or the mind.
Elsewhere in Jeremiah and Psalms, “the human kidneys are cited figuratively as the site of temperament, emotions, prudence, vigor, and wisdom,” according to the abstract of the study.
In Psalms 16:7, according to the King James version, it says: “I will bless the LORD, who hath given me counsel: my reins also instruct me in the night seasons.”
In modern Hebrew, the term “musar klayot,” derived from that passage, denotes remorse or regret.
“There is also reference to the kidneys as the site of divine punishment for misdemeanors, committed or perceived, particularly in the book of Job, whose suffering and ailments are legendary,” it reads.
Kidneys are also referred to in the Bible in terms of happiness. “My reins shall rejoice, when thy lips speak right things,” reads Proverbs 23:16-17. And in the Talmud, Bavli Brachot 61a says: “Man has two kidneys, one of which prompts him to good, the other to evil.”
But due to a combination of factors — including an incorrect interpretation of halacha, or Jewish law, according to some — Jews make up only a small percentage of organ donors.
A distinction must be drawn between organ donations made by living donors and those who have died.
Recently, laws were passed in France and in Russia allowing medical authorities to harvest organs from cadavers without notice or consent. In response, Russian Chief Rabbi Berel Lazar and the chief rabbi of Paris, Michel Gugenheim, urged Jews to register their refusal to have their organs harvested postmortem without explicit consent from family.
“We understand the need for organs for transplants,” Lazar wrote in a March 11, 2016, statement explaining his unusually strongly worded objection to a ruling by Russia’s constitutional court. “But it is unthinkable to take them from a person against the will of their family and loved ones!
“We have no right to use our bodies improperly, contrary to divine law – either in life or after death. God gave man a body with a set of organs. A man returning to God is obliged to return the body in the same [way] he got it,” Lazar wrote.
Organ transplants in Russia are rare, with just 2,000 such procedures undertaken in 2015, according to the state daily Rossiïskaïa gazeta.
Gugenheim took a different approach, trying for nuance and precision in a piece in the weekly Jewish newspaper Actualité Juive on when donations are allowed if not obligatory.
Gugenheim said that it was a “great mitzvah” for a “living donor to give his organ [without putting his life at risk] to a compatible relative.”
A donation postmortem is considered more delicate. “Taking advantage of a deceased person and not burying him or her right away can be considered a triple prohibition which can be counter-argued by applying the principle of preserving a life above all else.” That is on the condition that the future recipient be identified. According to the chief rabbi of Paris, it is forbidden to harvest an organ and keep it in a bank for future use.
In Israel, organ donation is considered controversial due in part to the belief that it is prohibited by halacha, but since 2008 when the Knesset passed the Brain-Respiratory Death Law, public awareness on the importance of organ donation has risen considerably. By 2015, Adi, Israel’s national transplant and organ donation center, had registered some 860,000 potential donors.
Israel in 2012 also adopted a tiered policy, commended worldwide, that seeks to encourage donations by giving medical priority for transplants to those who are registered donors.
But rabbinical authorities remain split on the matter.
At the heart of the issue is the disagreement over which organ or function determines the moment of death. According to halacha, death occurs when the heart stops beating; medical authorities consider death to be the cessation of brain-respiratory function.
As such, according to some halachic thinking, removing organs from a person whose heart has not stopped beating would constitute taking a life. Organs harvested after the heart stops beating are unsuitable for transplants, according to medical authorities.
In 1985, the Israeli Chief Rabbinate ruled essentially that brain death is death, but the manner in which such death is established became the source of controversy between medical and rabbinic authorities.
As a result, according to Adi, a “limited steering committee was established that set up a list of rules for determining brain death that are accepted by both communities and ensure the largest social consensus possible.”
Those rules were then passed into the Brain-Respiratory Death Law, “which formulates all the requirements for the determination of brain death, accepted both by physicians and by rabbis who recognize in principle that brain death is equivalent to the death of a person.”
Recent examples of organ donations
When 10-year-old Elai Nir died in a hospital last December after sustaining massive head injuries in a fall during a hike during in southern Israel, his family donated his organs, saving five lives.
His father, Omri Nir, died trying to save his son from the fall. More than 1,000 people attended their funeral.
The late former Mossad chief Meir Dagan, who died at 71 last year after a long battle with cancer, gave two people the gift of sight by donating his corneas.
Avraham Gian, 81, and an unnamed 70-year-old woman were the recipients.
“I’m amazed to discover that the corneas of a hero of Israel like him were implanted in me,” Gian told Israeli TV at the time.
“We all owe this man, and now I most of all, because I can see because of him… I hope to have my sight for years to come after many years of not being able to see a thing,” he said.
Gian’s wife, Sarah, said: “Avraham is very pleased; his sight has returned after two very difficult years… It’s a different world for him.”
Deborah Sard, spokeswoman for Ichilov Hospital’s transplant center, said growing numbers of Israelis were signing commitments to donate organs after their deaths.
Matnat Chaim’s efforts have not gone unnoticed.
Earlier this month, donors and some of the recipients through the organization met with President Reuven Rivlin, who called for more organ donations by living donors and congratulated Matnat Chaim for having saved the lives of 406 people.
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By the numbers
In April 2015, more than 101,000 Americans were awaiting a kidney transplant.
In 2014, 17,105 kidney transplants took place in the United States. Of those, 11,570 were from deceased donors and 5,535 from living donors, according to the annual report by the Organ Procurement and Transplantation Network — OPTN and the Scientific Register of Transplant Recipients (SRTR).
Statistically, the waiting period for a kidney transplant in the US is 3.6 years. In that waiting period, the most common form of treatment is dialysis, which carries risks of infection and other complications.
Of 300,000 Americans undergoing dialysis, half will die within five years and 80% within 10 years.
There are close to 6,000 patients undergoing dialysis in Israel and it is estimated that 15% of them die every year. By January 1, 2017, there were 845 Israelis undergoing dialysis while awaiting a kidney transplant, and 350 people on a waiting list to start dialysis.
“We believe that Israel has the highest percentage of altruistic donors in the world,” said Matnat Chaim’s Singer.
Since 2000, the number of organ donors in France has doubled, with an increase in living donors, most notably kidney donors.
In 2015, more than 21,000 people were waiting for a transplant, with a kidney being the most in-demand organ.
There are 3,000 transplants per one million French, for all organs.