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Why Israel has more altruistic kidney donors than any other country in the world

A rabbi made donating a kidney a mitzvah for many Israelis who would never have considered it

JERUSALEM — As a child and then three decades later, Limor Eisner had a lifesaving liver transplant. But several years ago she needed a kidney and feared her luck had run out.

“It was extremely difficult, even for someone who had survived two liver transplants,” said Eisner, now 52. “I had a heart attack and my kidneys were damaged.” By 2018, she needed dialysis three, sometimes four times a week.

Too ill to fly abroad — the Israeli woman’s liver transplants had both taken place in the U.S. —  Eisner had reason to worry. Israel is in the bottom half of countries when it comes to organs harvested after death, the type used in most transplants globally. The chances of her receiving a posthumous kidney donation – especially since younger recipients often take priority – were slim. 

But a growing movement, driven by a campaign in Israel to promote what’s known as “altruistic” donation, gave Eisner hope. For more than a  decade the number of Israelis who have donated kidneys while they are still alive and well has increased to the point that Israel is the worldwide leader in live donations per capita.

That’s in large part thanks to the Jerusalem-based nonprofit Eisner turned to, Matnat Chaim, Hebrew for “gift of life,” which recruits and encourages individuals in good health to donate a kidney for purely altruistic reasons. 

Of the more than 1,450 live kidney donations Matnat Chaim has facilitated, more than 80% percent were altruistic – donated by individuals who had no connection to the recipient. According to the group’s records, it made at least half of the matches between recipients and live donors in Israel from 2015 to 2022. 

Rabbi Yeshayahu Heber, whose life was saved by kidney from a live donor, founded Matnat Chaim in 2009 with his wife Rachel. Rabbi Heber, who died from COVID-19 in April 2020, had said he was moved to recruit volunteer donors after watching other kidney patients die for lack of transplants. 

On Israel Independence Day this spring, Rachel Heber was awarded the prestigious Israel Prize in honor of the couple’s lifesaving work. Before the April ceremony, hundreds of the people touched by Matnat Chaim – donors, recipients, and their families– gathered at Rabbi Heber’s grave in Jerusalem to give thanks.

At his grave in Jerusalem in April, hundreds came to pay tribute to Rabbi Yeshayahu Heber for his work encouraging altruistic donation of organs. Courtesy of YouTube.

He had inspired a sector of Israel society that had mostly eschewed organ donation to embrace it.

The definition of death 

As an ultra-Orthodox rabbi, Heber knew that many religious and even secular Jews mistakenly believe that Judaism requires the body to be buried whole. 

Heber also knew that according to the strictest interpretation of Jewish law practiced by most ultra-Orthodox Jews, the halachic and medical definitions of death aren’t the same.  

Rabbi Yeshayahu Heber and Rachel Heber Photo by Chaim Meiersdorf

Broadly speaking, the medical definition says that death occurs when the brain is no longer functioning, even if the heart is still beating. There are exceptions, but most ultra-Orthodox rabbis say death occurs when the heart stops beating and the person stops breathing. 

“The problem is, if you wait until the heart stops, you can’t harvest the organs,” said Judy Singer, Matnat Chaim’s assistant director. 

For these reasons, Heber made it his mission to recruit live kidney donors. 

With other groups, including the Halachic Organ Donor Society and the Israel Transplant Authority, Matnat Chaim has convinced many religious Jewish communities to encourage members to donate altruistically. “Today, religious Jews, and haredim especially, are at the forefront of live kidney donations,” Singer said. “They say, I can’t donate an organ after death, but take my kidney and help someone now.” About 90% percent of Matnat Chaim’s kidney donors belong to the Modern Orthodox or ultra-Orthodox streams of Judaism. 

“That number used to be 97%, but we’re always looking to increase the number of secular donors and Arab donors,” Singer said. 

The group has arranged for “many” Arab Israelis to receive transplants, she said, but did not share numbers for those recipients. Matnat Chaim is looking to work with an Arab group or individual to increase the number of Arab donors and recipients in the future, she added.

Among Jews, Matnat Chaim tries to connect with both the religious and non-religious “through every means possible,” Singer said. “TV, radio, newspapers, a lot of social media. We do parlor meetings, lectures in workplaces, shuls, schools, army bases, community centers. Anywhere people will listen to us.” 

Most of Matnat Chaim’s speakers have donated a kidney, including Singer, who donated 10 years ago.   

In the Orthodox sector, the organization spreads the word via religious newspapers and especially word of mouth. “It’s people talking to friends and neighbors, to co-workers, in yeshivas. If a person goes away for a couple of weeks, people ask where they were.” The answer can be: donating a kidney or part of a liver.

According to the Ministry of Health, 656 transplants were carried out in Israel in 2022. Of those about half — 326 — came from living donors. By comparison in the U.S. that same year, about 15% of all organ donations came from living donors.

Though transplant rates have been rising in both countries, many are still dying for lack of a donor. In Israel, 77 people died waiting for one in 2022.

A family of donors

Sari Holtz, 40, a modern Orthodox Jew, altruistically donated a kidney through Matnat Chaim when she was 38. Originally from West Hempstead, New York, and now a resident of the Neveh Daniel settlement near Jerusalem, Holtz decided to be a donor after recovering from a freak accident that required surgery. 

“I ended up fine, and a couple months later I saw a message on my community’s email list that someone needed a kidney donor. I thought, hey, I can donate a kidney. I’m fine with anesthesia. I’m in good health. I can do this.” 

After discussing the matter with her husband and five children, Holtz asked her New York-based mother whether she would come and help care for the grandchildren in Israel, should she be accepted as a kidney donor. Holt’s mother said she would help hold down the fort, and then decided to undergo donor testing as well. 

And as sometimes happens within families and groups of friends, according to Singer, one person’s decision to donate inspires others.

Within 18 months, Holtz, her parents and twin sister all donated a kidney to people they didn’t know. The three U.S.-based transplants were facilitated by Renewal, a Brooklyn-based nonprofit. Matnat Chaim facilitated Holtz’s donation in Israel. 

The waiting list

To incentivize live transplants, in 2008 Israel passed a law that provides live organ donors with a month’s paid salary, and lower health insurance premiums. 

“It’s one of the reasons Israel has the highest live donor rates in the world,” Singer said. 

In addition to recruiting donors, the organization helps potential donors schedule medical appointments and explains test results. 

Governing its decisions on who gets the next available organ is an ethics committee that created protocols to prioritize recipients. A kidney patient’s place on the waiting list is a function of age, blood type, how long they have been on the list, how long they’ve been on dialysis, and whether they can be on dialysis, Singer explained.

To reassure potential donors, the organization also offers a mentoring program that pairs them with past donors. These “phone buddies” have been trained how to provide support and information during the pre-donation process, which takes about six months on average.

Eisner’s altruistic donor, Evelyn Hazut, said she donated a kidney “because I have a good life. If I can enable another person to live a better life, how could I not?” She said it means much to her that Eisner, who could barely leave her bed, is now able to volunteer, to travel and eat once-forbidden foods. 

“Evelyn is like a sister now,” said Eisner, whose life has been saved three times by donated organs. “I’m so grateful.”  

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