One summer morning last year Hadar Koplovich, an Israeli mother of five, finally checked into the hospital for abdominal surgery she had spent months waiting for. But she didn’t need the surgery for her own health. She was there to have one of her kidneys removed so it could be given to save the life of someone she had never met. Then, she would spend a few weeks patiently recovering.

“Lots of people ask me how I could do this,” Koplovich said. “But I don’t feel like it’s such a big deal. For me it was simple. We have two kidneys.”

About a year before she donated a kidney, Koplovich watched her older brother go through the donation process, also giving to someone he had never met.

“This allowed me to think that I could do it, too,” she said. “I also got to see how his donated kidney didn’t just save the life of one sick person, but changed the lives of all of that person’s family members and friends, who had been worried he would die and were also suffering.”

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Koplovich is among the growing number of religiously observant Israelis who are volunteering to donate kidneys to people they have never met, ultimately doubling the number of kidney transplants taking place in the country each year. Officials credit the increase in living donors to improved surgical techniques, increased social welfare benefits, and the work of a nonprofit organization called Matnat Chaim, which raises awareness about and facilitates live kidney donations, especially among Orthodox Israelis.

“Outside the Orthodox community, the number of altruistic donors, who don’t know their recipients, hasn’t really increased,” said Meni Koslowsky, a psychology professor at Bar Ilan and Ariel universities, who has studied the trend of altruistic kidney donation. “But within the religious community, there is a strong desire to do something meaningful, to save a life, so the increased awareness of donating a kidney has an effect of inspiring others to donate.”

Rabbinic authorities, whose often stringent definitions of brain death have led to Israel’s relatively low rate of organ transplants from deceased people, are now actively encouraging live donations of kidneys, the most in-demand organ, especially as the danger to the donor has been reduced, according to recent research by Koslowsky, and nephrologists Walter Wasser and Geoffrey Boner, published in the journal BMC Nephrology.

It is a great mitzvah,” writes Rabbi Chaim Kanlevsky, a noted ultra-Orthodox rabbi from Bnei Brak, in one of Matnat Chaim’s recent advertising supplements distributed free with the religious newspaper HaModia. “It is very advisable because G-d has given every man two kidneys.”

Kanlevsky is one of six rabbis, both living and deceased, pictured in the magazine along with quotes in support of living kidney donation. Two Jewish organizations in the United States, Kidney Mitzvah and Renewal, also raise awareness about and facilitate live kidney donations.

While increasing the number of kidneys available, live kidney donations also usually last longer than those from deceased donors, according to medical research. Advancements in anti-organ rejection drugs have made it easier for people to receive kidneys from nonrelatives, and less invasive laparoscopic surgery techniques have made donation safer and shortened recovery time. But, like any surgery, altruistic kidney donation still carries some risks.

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One day more than a decade ago, Rabbi Yeshayahu Heber, an Israeli school principal and yeshiva teacher, suddenly felt too weak to walk up the stairs. He went to his doctor, who sent him to the hospital, where he soon learned that both of his kidneys had stopped working. He began dialysis, a time-consuming and painful process that was brightened only by his roommate, a teenage yeshiva student named Pinchas Turgeman. After about a year on dialysis, Heber received a kidney from a friend. Then, as he recovered, he helped locate a willing donor and match for Turgeman, who had also lost his brother in Israel’s Second Lebanon War in 2006. But Turgeman passed away a few weeks before the scheduled transplant. The loss hit Heber hard.

“I decided I needed to do something,” he recalled, and he thought up the idea of forming an organization to help encourage and facilitate live kidney donation. “So the day that Turgeman died is also the day Matnat Chaim was born.”

Since then, the organization has facilitated more than 700 kidney transplants, most of them given by religiously observant Jews, but going to religious and secular Jews, as well as a few Arabs. Any Israeli can register with Matnat Chaim to receive a kidney, and there are currently about 1,200 people on the waiting list, most of whom are Jewish. Unlike the government-run kidney waiting list of about 800 people, which only includes people who have already started dialysis and mainly sources organs from deceased donors, people can register for Matnat Chaim’s list prior to starting dialysis, when they still have some kidney function. All kidney donations and transplant pairings made through Matnat Chaim are overseen by the government-appointed National Committee for Kidney Donations, which also makes sure there is no commercial component involved.

But donors coming through Matnat Chaim can choose the characteristics of their recipient, and most Jewish donors choose to donate to a fellow Jew. Although bioethicists are generally divided over directing organs to certain types of people, Israeli health officials allow the practice, saying that it has helped increase the overall number of kidneys available.

Although the government does not track kidney donation by religious affiliation, the number of Jews receiving kidneys from live donors far outweighs that of Arabs, said Tamar Ashkenazi, general director of the Israel Transplant Center, who is involved in granting final approval to all living donations. This stems not only from Matnat Chaim’s kidneys going mainly to Jews, but also from less awareness in the Arab sector about living donation, even among relatives, she explained. For now, most Arabs in need of kidneys are reliant on the government-run waiting list, which does not take religious or any other preferences into account. “But at the end of the day the rise in altruistic Jewish donations is still helping everyone because ultimately, it makes the national waiting list shorter for those left on it,” Ashkenazi said, adding that her office is currently working to raise awareness of live kidney donation in Israel’s Arab sector.

While Miran Epstein, a medical ethicist at Queen Mary University of London, acknowledges that every donated kidney ultimately helps everyone waiting for a kidney, he said an organization that allows donors to stipulate certain characteristics of potential recipients—including religious affiliation—in effect practices conditional organ donation, which Israel and many other countries don’t allow. When accepting matches made through Matnat Chaim, the government-run transplant system is undermining its own ethics guidelines and public trust, he said: “The ethnic-religious condition is effectively concealed behind the fiction of directed donation. There is no doubt that Matnat Chaim has shortened the waiting list, but the question is, at what price?”

Meanwhile, Ashkenazi said that the country’s kidney exchange program—where relatives and friends of those in need of a kidney, but who don’t match, donate to a stranger, whose family or friends in turn donate to their relative—often brings together Jewish and Arab donors and recipients.

“Every kidney helps everyone on the national list, because each time anyone gets a kidney and moves off the list, everyone moves up a place,” explained Judith Abrahams, who was one of the first people to donate a kidney through Matnat Chaim, in 2011, and now is the volunteer coordinator of the group’s English-language activities.

Heber and Abrahams said the organization is currently working to reach more sectors of Israeli society.

“We really need to reach more people and bring everyone into this,” Heber said. “The hardest part of my job is hearing all these terrible stories about people’s suffering, and I can’t help them all.”

Koslowsky and others who have studied voluntary, living organ donation are optimistic the practice could spread to other communities, once they see more people like themselves involved in kidney donation.

“I believe it’s going to catch on,” said Corinne Berzon, who wrote her doctoral dissertation at Bar Ilan University on organ donation in Israel. “This is just another one of those things that Israelis will do because we are used to sacrifice and are very communitarian.”

The government-run Israel Transplant Center, which oversees transplants of all organs, says it plans to increase its public-awareness campaigns about the feasibility and importance of living kidney donation.

“For years we didn’t really advocate this, but with advances in medicine and the government benefits for donors, it seems more fair to approach the public about this,” said Ashkenazi. Those who donate a kidney, along with their family members, are granted priority on waiting lists for all organs, if the need ever arises.

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In addition to raising awareness about the lifesaving effects of donating a kidney through advertising and media campaigns, Matnat Chaim helps potential donors follow through on their desires, guiding them through the bureaucracy and scheduling the dozens of medical tests required prior to donation and transplant—a process that often takes close to a year, and that many have described as among the most difficult aspects of being a donor.

“The testing process gives you so much time to think about your decision,” said Yosef Chaim Cope, 34, who donated a kidney in June. “For me, my conviction just grew and grew, and it was hard to wait.” This was something he had wanted to do for years, and something his mother had talked about doing, until she became sick with blood cancer, passing away last year. Cope first heard of the idea of donating a kidney when he was growing up in Gateshead, England, where his father was a doctor, and he was intrigued by the idea that he could save a life with minimum danger to his life.

The idea remained in the back of his head after he moved to Israel 10 years ago, where in addition to raising four kids with his wife, and working in communications technology, he was a regular volunteer with an ambulance service. But because he is a kohen, who, according to Jewish purity laws is supposed to refrain from being near dead bodies, he constantly dealt with lingering doubts about the amount of time he spent at the hospital, where it is assumed there are often deceased people.

So, after consulting his rabbi, he resigned and decided to find a different way to save lives. He decided it was time to donate a kidney. But he had no idea what to do, so he contacted Matnat Chaim. For 10 months, the organization helped him set up and schedule numerous medical tests, and navigate Israel’s public health care system, which covers the donors’ costs but also requires numerous referrals and other paperwork.

When the day of his surgery finally arrived in June, Matnat Chaim sent volunteers to visit him, and brought Sabbath food for his family. Just before he was wheeled into the operating room, the organization gave him a special prayer to recite, which includes a declaration of what he was about to do, and that it be accepted by God.

“I was just crying when I was reading it,” Cope said. “It made me realize the gravity of what I was doing.” At the same time, a stranger in a hospital gown came over and hugged him. This man, about 10 years older than Cope, would be the one receiving the kidney.

The recovery and post-operation pain lasted a bit longer than Cope had expected. “It was for sure worth it,” he said. “The pain is minimal compared to the suffering the person on dialysis and their family go through.”

Also, shortly after the surgery, Cope accepted an invitation to attend the bar mitzvah of the son of the man whose life he saved. There, Cope found out that the man’s older son had gotten engaged, the night before the surgery, to the granddaughter of a family friend from England. Cope recently served as a halachic witness at the wedding, where his past connected him to the bride, and his donated kidney had made it possible for the groom’s father to be present.

“It was very emotional to stand under the chuppah and be involved in the marriage process,” he said.

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Those who have received kidneys from strangers say there is no way to thank them enough. Shulamith Gertel is still in touch with the woman who donated a kidney to her in 2011. She has become like a relative, someone she sees several times a year and attends family events, like weddings and bar mitzvahs.

“She absolutely saved my life,” said Gertel, who received a kidney at the age of 48 after falling ill and spending more than a year on dialysis, which was not only painful and exhausting but left her little time to care for her six children. “I would do anything for her, but I can’t do enough, compared to what she did for me. I just can’t. I don’t know what to say.”

But some donors and recipients choose to keep more distance. Koplovich, who donated a kidney last year, has only met the recipient of her kidney, a 28-year-old man, a couple of times. They have called each other briefly to send wishes before holidays. But the last time she saw him was at a festive meal he hosted a few months after the procedure, nearly a year ago.

“Part of me for sure is there, with him,” Koplovich said. “But it’s his life, and I want him to feel like he has a normal life now, and that this is in the past.”

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