New Lease of Life for Marsha

"The benefit to the person donating the kidney is even greater than the benefit to the person receiving it" - Andrea Eliwatt

Andrea, a member of ESRA Modiin, donated a kidney to her brother over twenty years ago, an example of a related donor. Donors who are related to recipients were once the usual way of achieving organ donations, but now unrelated donors are not only possible, but are actively encouraged. A match can be successful even where the donor and the recipient are totally unrelated.

All donations are only undertaken after extensive medical tests. But why did Andrea feel that the benefits to the donor were so exceptional when some people might regard it as quite the opposite – that it is the recipient who benefits the most. Her reasoning is that while those who donate a kidney may experience some temporary inconvenience – extensive tests followed by a relatively short stay in hospital – the knowledge of the difference that they have been able to make to the quality of the recipient's life, is more than adequate compensation.

Whereas once donation was a major surgical procedure, now donors can expect to be hospitalized for around three to five days, and then to spend a further couple of weeks resting – though this does vary. Some donors may be back at work and fully recovered after just a few days, others take a bit longer. After this they are able to resume their lives – at least physically – just as before. However, life does not resume in quite the same way for the recipients. Receiving a kidney may be literally a life changing experience. Marsha Goldstein is just one example of someone whose quality of life has been transformed since a suitable kidney donor has been found.

Marsha is a lively wiry 72 year-old. Originally from Brooklyn, New York, she has lived in Israel for more than 40 years. A wonderfully active and empathetic volunteer with ESRA Modiin, she has been a stalwart member of the committee running Modiin's phenomenally successful bookshop, as well as being a volunteer at ESRA's after school care facility for under-privileged children, Neve ESRA. Suddenly, about a year ago, her life changed overnight. Generally feeling unwell and suffering from a high temperature, she was hospitalized while attending the Jacob's Ladder Folk Festival with her husband Avi and some friends. A prolonged period of testing, medical treatment, further hospitalization, and more consultations eventually produced the diagnosis of acute renal failure – and the outcome – a total change to Marsha's active life style.

She required dialysis every night – a procedure lasting around nine hours. Marsha, her husband, and her two married sons and their wives became familiar with the routines – and challenges – of nightly dialysis. The need for careful preparation to ensure that every part of the body in contact with the dialysis machine is thoroughly cleaned and disinfected, the signs of possible infection –

and more seriously, of acute renal failure. The ordinary pattern of everyday life had to be constantly scrutinized to ensure that the best possible conditions for Marsha's health and well-being were being provided – the amount of liquid she consumed and over what period, any changes in her health – and the action that might be needed as a result.

And yet Marsha is one of those people whose empathy, resilience, and generosity of spirit symbolize all that is best in those who volunteer with ESRA. She was, and is, profoundly grateful for the medical treatment and support that she has received and continues to receive, and her warm smile betrays no outward sign of the stress that she has been living under.

About half of all the extraordinarily generous people who offer to donate a kidney will probably be rejected after extensive medical tests and assessments. The challenge of helping Marsha was particularly acute since her blood group is Group O and she could only receive a kidney from another donor with the same blood group. None of her immediate family shares this blood group, and so the most likely way of finding a suitable donor was to appeal to as many people as possible to register as potential donors. On October 1, Marsha became the beneficiary of a cross-transplant. This is a procedure where a donor gives a kidney to one individual in order for that individual's kidney to be the one transplanted, because it is a better match.

Marsha can now expect a good many more years of active life. Think of all the ESRA volunteers that you know who are well into their 80s! But life expectancy, as well as the quality of life, for those receiving dialysis is much more limited. Marsha was well aware that without a transplant in the present state of medical knowledge, she was likely to be able benefit from dialysis for only a further 9 to 10 years. A kidney transplant was the only real alternative and thank G-d she has now received one.

A donation from a living donor is considered to be much more desirable than a post mortem donation as the condition of the donated organ is likely to be better. No one is accepted as a donor without careful guidance and support. Would you be willing to be considered as a possible donor? Marsha got her much-needed kidney but there are another 800 or so other patients awaiting a kidney transplant in Israel alone.

Mosh Levy and his wife Nili, are among the best-known kidney donors in Israel. While they each decided to donate separately, thanks to a television program on Channel 2 which documented their experiences, they have become particularly well known for their involvement. They are both distinguished professionals in their own right – Mosh is one of the two current deputy City Mayors of Modiin and Nili is a highly regarded academic at Bar Ilan University. Although they are both incredibly busy people, Mosh did not hesitate when asked to reflect on his experiences as a donor. He pointed out that if a couple both decide to donate, then any consequences for their children need to be particularly carefully considered. Should they require a kidney at some point in the future, with one kidney each, then neither parent would be eligible as donors. Mosh and Nili are the proud parents of three sons, the youngest of whom are twins and they did not decide to proceed with donation until their children had reached the ages of 21 and 18, respectively, and then they only did so after full discussion with their children. The twins immediately pointed out that should either need a kidney in the future, then the most likely donor would be the other twin.

The Levy experience – while unusual – is no longer unique and Mosh is aware of at least one other couple who has both become kidney donors. Nevertheless, at the time, their decision to each become a kidney donor was unheard of in Israeli experience – and was subsequently recognized by their joint nomination in 2016 to light one of the flames at the Yom HaAtzmut Ceremony on Mount Herzl.

It generally takes around six months between an individual deciding to become a kidney donor and the actual procedure taking place. The choice of the hospital lies with the recipient and the Levy's, as a result, experienced two different hospitals, Sourasky (Ichilov) in Tel Aviv in the case of Mosh, and Beilinson in Petach Tikvah in the case of Nili. Initially Mosh and Nili had thought of donating their kidneys at the same time, but since their sons were due to be away, it was decided that it would be better for them to donate at separate times, so that one could be there to help the other during the recovery period. Mosh donated first and a month later Nili, by which time he was totally and fully recovered. Dr Tamar Ashkenazi, the distinguished Chief Executive of Israel's National Transplant Center and Director of the Halachic Organ Donor Society who had been one of the principal speakers at an information evening on organ donation arranged by ESRA Modiin in October 2017, explained that individuals are initially asked to complete a form indicating their willingness to be considered as donors.

There are stringent requirements to be eligible as a donor, since it is essential to protect the well-being of the donor as well as that of the recipient. For example, anyone regularly taking medication is unlikely to be eligible to be a donor and while age per se is not a bar to becoming a donor, it is unlikely that those over the age of 72 would be considered. There is a full assessment of the prospective donor's physical and psychological history and the approval of an assessment board comprising medical and lay personnel, is required. They check that the donor is agreeing voluntarily to the donation, and that he or she has as much information as possible about the procedure and its consequences.

Another well- known organization. responsible for encouraging kidney donation. is Matnat Haim. Founded in 2009 by Rabbi Yeshayahu Heber of Jerusalem after his own life was saved by a kidney donation, it brings donors and recipients together. While both organizations are keen to increase the number of donors, the Halachic Organ Donor Society arranges donations purely and simply on the basis of the urgency of the medical needs of the recipients. Matnat Haim, however, tries to match any specific preferences of the donors to the characteristics of the recipients—for example, a donor may specify that they would like a recipient to be male or female.

The success rate of living kidney donations is very high. Matnat Haim states that 95% of transplants are successful and that the kidney can survive for many years. The high rate of success is in no small measure due to the medical skill and care taken in matching donors and recipients--and in the change to using living donors rather than organs from the deceased. The procedure for transplanting has also changed radically and the recuperation period is consequently much shorter.

Approximately 80% of the kidneys transplanted survive for at least five years and about half of the kidneys transplanted from living donors survive for more than 25 years, with some lasting even as long as 40 years. There are exceptions, and in fact, both the recipients of Mosh and Nili Levy's kidneys had had previous transplants--and had been waiting a number of years for a new organ. Such was the acute medical need; Mosh was advised that although his kidney was not an ideal match, without it, the recipient would have been unlikely to survive much longer. The procedure was successful. Recipients are asked if they would like to meet donors. In Mosh's case he met the recipient just once. However, Nili is still in touch with her recipient, a 37-year old man who at the time was the father of two children. He and his wife went on to have a third child, and Mosh and Nili were honored guests at the baby's Brit Mila, where Mosh was made the godfather of the little boy.

There can be no greater mitzvah than saving a life. Perhaps fortunately, it is not often that the opportunity to do so presents itself. Mosh seemed to be genuinely taken aback that anyone should regard his and Nili's decision as extraordinary. "Why would someone not help save a life it he/she could?" he asks. "Why were human beings given two kidneys in the first place, if--as experience has shown--people can live totally normal lives with just one?"

But in the absence of even one fully functioning kidney, then the prospects of a normal life are not only very different, but the day to day reality as a kidney patient can be very challenging. It is not just difficult for the patient, but also for their family who experiences new, highly stressful demands. Lives have to be planned around dialysis and access to equipment, the avoidance of infection and so on. The impact of the mitzvah of donating a kidney on the life of a kidney patient can hardly be over-estimated. However – and perhaps more surprisingly – neither can its impact on the life of a donor.

ESRA Modiin's information session on organ donation was held in honor of Marsha Goldstein. Anyone who would like to know more, or who might be willing to register an interest in becoming a kidney donor through Israel's National Transplant Center, can find out more at https://www.adj.gov.il/en.

It is not possible to register in English as the registry is only in Hebrew. However, potential donors can give basic information in Hebrew such as first and surnames, email and phone number and then the center will call back and will help with the rest of the form.

The link for registration with Matnat Chaim and more information in English is available at www.kilya.org.il/en/ , Tel: 02 500 0755