Kidney swap saves mothers, makes history
Pay-it-forward surgeries spring from cyclic exchange
Tamar Ashkenazi was finally airborne. She had been up before dawn but was feeling more excited than exhausted as she glanced down from 40,000 feet at the sprawling desert kingdom of Saudi Arabia.
The private jet had taken off on time from Tel Aviv's airport at 8:30 a.m. and was now winging its way east at 500 mph to a private airport in the United Arab Emirates.
Other than the crew, two things accompanied Ashkenazi, managing director of the Israel National Transplant Center: the powerful thrum of the “What I felt in that moment on the plane was this transplant opportunity was a bridge between hearts, between two countries that had been enemies. We all knew that this was special.”
Tamar Ashkenazi,
Managing director of the Israel National Transplant Center
Hawker 800XP'S engines and a large cooler with an Israeli flag taped to its side.
Inside rested a recently removed kidney that would soon make history.
Most kidneys are transplanted into patients from either a person who died or a close living relative. But this ice-packed organ was donated by a living Jewish daughter to save the life of an ailing Arab mother she did not know.
That surgery would be one of six within a carefully coordinated 18-hour time frame that would save three lives and hinge on the love of two daughters – hailing from countries with decades of built-in antipathy – for their mothers.
“What I felt in that moment on the plane was this transplant opportunity was a bridge between hearts, between two countries that had been enemies,” Ashkenazi said. “We all knew that this was special.”
What happened on July 28 reminds how mutual survival often depends on shared humanity triumphing over historical differences.
In this case, with the assistance of organ transplant experts in the United States, Israel and the United Arab Emirates, three pairs of kidney donors and recipients in Israel and the UAE saved each other in a series of choreographed, pay-it-forward surgeries known as a cyclic exchange.
While organ exchanges and cycles are not uncommon within countries, the procedure is more difficult and rare between nations. Different time zones, national laws, divergent levels of medical expertise and facilities, the time-sensitive nature of transplants, and the vexing issue of black-market organ sales conspire to keep international exchanges complex.
Consider the logistics involved in the Uae-israel exchange. A UAE daughter who was not a match for her mother volunteered to give her kidney to a stranger. An Israeli Arab woman was a match for that kidney, so her husband agreed to donate his kidney to save an Israeli Jewish mother – whose daughter in turn gave her kidney to the sick mother in UAE.
“The reason we are excited about this is simply because the bigger the pool, the more likely you are to find matches,” said Dr. Michael Rees, a surgeon and founder of the Alliance for Paired Kidney Donation, a Toledo, Ohio-based nonprofit instrumental in making this politically groundbreaking kidney transplant chain a reality.
Humans need only one of two kidneys to live, so the organization works with donors who are willing to give a kidney to an unknown recipient to ultimately benefit their own loved one.
Rees was in the operating room in Abu Dhabi, one of seven UAE emirates including the internationally known hub of Dubai, when the kidney flown in from Tel Aviv was placed in the UAE mother. The powerful memory lingers.
“I watched the surgeon release the clamps, and the Israeli Jewish kidney came back to life with the blood of the UAE patient,” Rees said. “I’ve been around, but really I’m still just a kid from Flint, Michigan. And I can tell you this was a real moment for me.”
Rees and his colleagues around the world are driven by altruism and pragmatism.
Chronic kidney disease affects roughly 10% of the world’s population, although about 15% of Americans, or 37 million people, suffer because of the rise in causal conditions such as hypertension and diabetes, according to the Centers for Disease Control and Prevention.
Dialysis is the most common treatment for kidney failure, which for patients is inconvenient and uncomfortable. It is also expensive. On average, a year of dialysis costs about $100,000 – about the same as a kidney transplant, which frees patients from machines and doubles life expectancy, Rees said.
The disease also disproportionately hits people of color, research shows. Compared with whites, Black people are 3.5 times more likely to have kidney failure, and Latinos and Native Americans are 1.5 times more likely.
“Until we are 3D printing human organs, the answer is more living donations,” said Dorry Segev, professor of transplant surgery at Johns Hopkins University in Baltimore.
While the U.S. has a robust transplant program involving deceased donors, there still aren’t enough kidneys available for those in need, Segev said.
That’s partly because while relatives often offer to donate to their loved one, biological factors such as incompatible blood type or antibodies that would result in organ rejection mean intrafamily donations cannot be done in more than 30% of cases.
Women have a particularly tough time with donations from family members. During pregnancy, a woman’s body can detect the foreign proteins from the father and create antibodies – which the baby is protected against. But should the mother need a transplant later in life, those same antibodies often will work to kill a kidney from a child or husband.
Segev said this medical success story has the chance to open new channels of communication. “Here people not on the same side of the aisle politically or historically were brought together by their love of their family members,” he said. “May it happen more.”
Those communications, however, remain politically sensitive. When asked for comment, officials in the UAE focused less on the partnership with Israel and more on a general need for international cooperation.
“We are pleased that our innovative partnership with the Alliance for Paired Kidney Donation has allowed us to help our patients,” said Dr. Ali Al Obaidli, chairman of the UAE National Transplant Committee. He added that a collaborative spirit between countries can be used to “close the gap” for those in need of kidneys.
The UAE donor daughter and recipient mother asked not to be identified by name or religion. Conversations with those involved in the cyclic exchange say kidneys donated outside the UAE generate negative reactions among some Emiratis.
But the donor daughter did answer an emailed question with candor. “The situation we were in is a medical one and is all about saving lives,” she wrote. “It did not matter to me at all from which gender, ethnicity, religion or nationality the parties in this exchange would be.”
More than 1,000 miles to the west, Shani Markowitz Lalkin, 39, whose kidney saved the life of her UAE contemporary’s mother, said she would like to one day meet her counterpart.
“I wonder about the other mother and daughter, maybe as much as they wonder about me,” Lalkin said. “I’m a Jew, they are not. We have different cultures. But maybe one day we can talk. I don’t feel like I did anything historic. I just did something to help my mother, like she did.”
Laklin’s mother, Asiag Yadidi Yafit, 61, was told two years ago that she was in kidney failure and needed to start dialysis. Waiting lists for kidneys stretch years in most countries. Yafit didn’t think she would make it.
“My daughter did a noble deed, saving my life and the life of another mother in the UAE,” she said. “I never thought of my donor being a Muslim or Jew, because I believe all human beings are equal. I just hope people take example from my daughter. If they give while living, it will bring so much hope to those waiting for kidneys.”