No one looks forward to having surgery, but five and a half years ago, I actually did.
I, a kidney doctor, was about to become a kidney donor.
In the 1970s, shortly after I graduated medical school, kidney transplantation was still in its infancy and the five-year success rate was not that encouraging. My sister was expecting at the time. During the pregnancy, her doctor observed that she had protein in her urine, which could indicate signs of kidney damage. Although she was significantly overweight, the medical community was not yet aware of the relationship between obesity and kidney damage. I mentioned to my sister in passing that if she needed a kidney donor in the future, she should ask me. Neither of us, however, really thought that that would ever be necessary.
Unfortunately, twenty years later, her urinary protein excretion had gradually increased to a level that indicated serious kidney damage. Although she was started on appropriate therapy, over the next few years her kidney function gradually decreased, and the possibility of her needing dialysis or a kidney transplant became very real.
My sister, who lives in Philadelphia, traveled to the Mayo Clinic in Rochester, Minnesota, where she was told that transplantation was a much better option than chronic dialysis. But the two transplant programs in Philadelphia that would consider her wanted her to lose fifty pounds before accepting her for a transplant. By this time the results of transplantation had considerably improved; many studies showed that the patient survival rate was higher with transplantation than with dialysis and that having a transplant before starting dialysis also greatly improved one’s chances for survival.
My sister and I had grown up in a non-observant family in Patchogue, New York. As kids, we attended afternoon Hebrew school and celebrated Rosh Hashanah and Yom Kippur. That was about it for our Jewish education. However, since my wife and I had moved to San Antonio, Texas, after I finished medical school, we had evolved Jewishly. The local rabbi, Rabbi Aryeh Scheinberg and his wonderful family had gradually educated us. We eventually became frum—our three boys attended yeshivah and we were quite active in Rodfei Sholom, Rabbi Scheinberg’s shul. So before getting too involved in the discussion of transplantation with my sister, I sought my rabbi’s advice.
Rabbi Scheinberg indicated that if I wanted to go ahead with it, it was halachically permitted for me to be a donor for my sister. However, he suggested that I discuss the issue with a well-known posek who was a frequent visitor to San Antonio. I met with him, and after reviewing the situation—my sister’s need for a transplant to save her life and the improving statistics for kidney transplant success in recent years—he indicated that it was certainly permissible for me to donate a kidney and might even be a chiyuv, an obligation.
I was committed to donating my kidney to my sister. As a doctor, I am very familiar with the potential risks of surgery—especially for someone in my age group (I was sixty-one at the time of the surgery). But the idea of being able to help my sister was a strong impetus to go forward with the procedure. My sons, all grown and married, agreed that I should have the surgery. My wife, however, was quite worried about the potential risks. It took several serious discussions before she finally relented.
My sister, who has always looked up to her “big brother,” was very ambivalent about asking for or accepting such an enormous “gift.” “How could I possibly repay you for such a gift? It’s impossible,” she kept saying.
The transplant program found no major incompatibilities between my sister and me; this was a tremendous relief since there were few other family members who could be donors.*
Moreover, since my sister was already fifty-seven, it was unlikely that she could receive a kidney from someone who had recently died since there were many younger patients in need of a kidney in Philadelphia.
Shortly before I retired as a nephrologist in 2003, I asked one of my colleagues who regularly did kidney donor evaluations to examine me. My colleague found me to be generally healthy, but pointed out that at my age, after the removal of one kidney, I could not expect my remaining kidney to increase in size and function as a younger kidney would. My colleague’s evaluation was sent to the Philadelphia transplantation program. I was asked to meet with their doctors, which I did shortly before my wife and I made aliyah in June of that year.
My sister had not yet been accepted by a transplant program for the operation—primarily due to her weight. We made aliyah fully aware that I would probably return to the States soon to become a kidney donor. Once in Israel, I spent my mornings studying at Ohr Somayach and my afternoons working at Shaare Zedek Medical Center. I wanted to be in excellent health before undergoing the procedure so I began walking sixty minutes a day. I lost about fifteen pounds, and my blood pressure—which had been somewhat high—came under control.
Over the next two years my sister’s kidney function continued to deteriorate. But by this time, my sister had lost almost fifty pounds through a strict regimen of diet and exercise, and she was accepted into the program.
“How could I possibly repay you for such a gift? It’s impossible,” she kept saying.
As it happened, the only opening for surgery was the week before Pesach. My wife and I flew to Philadelphia in April 2005. I once again sought advice, now from my rav in Israel, Rabbi Chaim Walkin. My son asked if he could be the donor in my place, but both Rabbi Walkin and I insisted that I be the donor. I had explained to Rabbi Walkin that with any operation, there is always a risk of death. Rabbi Walkin stated that since my wife and I had married off all of our children, and our sons all had young children of their own, it was better if I took the risk, small as it was. From a medical standpoint, I would also be a better match than my son since my sister and I shared two parents, while my son was one generation removed.
My sister and her family belong to a Reform shul and do not live within walking distance of an Orthodox minyan. When I asked Rabbi Walkin how my wife and I should spend the Shabbat before the operation, he suggested that rather than leave my sister and her family in order to daven with an Orthodox minyan in Philadelphia, we should spend Shabbat with them. In retrospect, it was wonderful advice. My wife and brother-in-law went shopping for kosher food, and we set up the home for Shabbat (we had to explain a few things, such as no using electricity, et cetera). On Friday night my wife lit candles while I davened Kabbalat Shabbat and Maariv. The five of us—my sister, her husband, their daughter and my wife and I—gathered around the Shabbat table. I sang Shalom Aleichem and Aishet Chayil. I had brought NCSY bentchers along so that my sister and her family would be able to follow along. To be respectful, I asked my brother-in-law if he wanted to recite Kiddush. Somewhat unexpectedly, he said yes. I showed him where to find Kiddush in the bentcher and he proceeded to recite it flawlessly—much to the surprise of his wife and daughter. Apparently, my brother-in-law, who was born in Lodz, Poland, and survived World War II, had learned to read Hebrew as a child and still remembered how to do so. The seudot that Shabbat were wonderful and set the right tone for the events of the week ahead.
On Tuesday, the following week, my left kidney was removed and transplanted into my sister’s pelvis. The Zohar says that the right kidney gives good advice. After our operations, I was left with only a right kidney. My sister had two right kidneys and one left kidney, but only my donated kidney, on her right side, actually functioned. Thus, we both had a preponderance of right kidneys to give us good advice.
My sons were scheduled to daven at the Kotel during the operation. Although I was quite familiar with the details of surgery—I was in the operating room many times as a student and for certain specific patient-related issues subsequently— meeting with an anesthesiologist prior to being put to sleep, and knowing that for the next few hours things would be happening to my body over which I had no control, was disconcerting. Similarly, although I had seen many patients awaken from surgery with many tubes coming out their bodies, it was unsettling to experience it myself.
I awoke from the surgery late in the afternoon with my wife at my side. I was happy to be awake and aware that any dangers from the surgery were over. The next two days were filled with visits and phone calls from family and friends.
My wife and children were relieved that the surgery had gone well, but even more so, they were happy for my sister, since the transplant would allow her to avoid dialysis and continue to live an active, healthy life. My sister’s new kidney worked in the operating room, and within a day, her kidney function was approaching normal. Except for one rejection episode during the first month, she has had stable kidney function since the operation. My sister commented that within days of the transplant she noted that her mind seemed clearer than it had been for many months. While we didn’t realize this at the time, the progressive kidney failure had caused subtle changes in her mental awareness that were only obvious once the successful transplant allowed her mind to become clearer. This is probably because toxic substances accumulate in the body of a patient with progressive kidney failure, and a successful kidney transplant removes these toxins.
In the days following the surgery, I had no pain since I was on painkillers. By Friday I was discharged. My wife and I had arranged to spend the coming Shabbat and first days of Pesach in Passaic, New Jersey, with a close friend. He lives about two blocks from shul, and I was able to walk there and back Friday night and Shabbat day with little difficulty. It felt very good to daven with a minyan after several days of being in hospital and davening on my own. After the first days of Pesach were over, we flew back to Israel.
It took several weeks before my strength returned completely, but after that I went back to my daily routine including my sixty minutes of walking.
My sister is doing well, baruch Hashem, and since this experience, she has greater admiration for those living a Torah lifestyle. She knows that my religious observance played a role in helping me give her the gift of my kidney.
Now, more than five years later, I am completely unaware of my missing kidney, and my scar is almost invisible. My kidney function is slightly reduced from before the surgery, as was expected, but is well within the range for a person my age and in no way alters my regular activities.
As a kidney doctor, I am involved in saving patients’ lives every week if not every day. Yet to have donated my kidney and thus saved my sister’s life was an extraordinary experience and continues to be a source of immense personal satisfaction.
Dr. Lifschitz was a nephrologist in San Antonio, Texas, for thirty years and has been associated with Shaare Zedek Hospital in Jerusalem for the past seven years. His wife of forty years, Elizabeth, and he made aliyah to Bayit Vegan, Jerusalem, seven years ago to join their three sons and their wives. This article is adapted from “Nephrologist as Kidney Donor,” Pharos Alpha Omega Alpha Honor Med Soc. 71(4): 34-5 (2008).