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Close to the Bone

How Australian Jews became blood marrow donors to the world

Nomi Kaltmann
December 02, 2021
Courtesy Esther Lever
Esther Lever with Einat Zinger on her wedding day, 2016. The two remain friends after Lever donated her bone marrow to Zinger in 2006.Courtesy Esther Lever
Courtesy Esther Lever
Esther Lever with Einat Zinger on her wedding day, 2016. The two remain friends after Lever donated her bone marrow to Zinger in 2006.Courtesy Esther Lever

In the early 1990s, Yehuda Kaplan was gravely ill with lymphoma and was urgently seeking a bone marrow transplant—a lifesaving procedure that removes blood-forming stem cells from a healthy donor’s bones and transplants them into a person who does not have enough healthy blood cells, due to a serious illness. While the transplants are highly effective, they are quite rare, as they require both the donor and recipient to be a perfect genetic match.

Kaplan said that in Melbourne, Australia, where he was living, there was “not a lot of awareness” about the procedure. “So, we went to the leadership of the Australian Jewish community, rabbis as well as doctors and specialists, and asked them to promote the idea of joining the bone marrow registry in the community.”

In response to Kaplan’s public campaign, hundreds of Australian Jews responded to the call from community leaders, donating small vials of blood and joining the Australian Bone Marrow Registry. While Kaplan didn’t end up getting a bone marrow transplant because no match was found—he ended up surviving lymphoma using an experimental treatment—the call for potential donors helped spearhead awareness of bone marrow transplants in Australia, particularly among Australian Jews.

Now decades after this event, within Australia, Jewish people continue to join the bone marrow registry in numbers disproportionate to the size of the community. From these donors, matches for gravely ill persons have been found all over the world, including in America, Europe, and Israel.

Soon after the positive response to Kaplan’s call for donors, and in response to growing global awareness that Jewish people were more likely to match with each other, Gift of Life Australia was created by Sydney-based Jewish geneticist Shula Endrey Walder. In response to multiple international requests for assistance in finding bone marrow matches for Jewish people around the world who were sick, in the early 1990s, she decided to encourage more Australian Jews to join the bone marrow registry. Prior to Gift of Life Australia, smaller organizations had been active in recruiting bone marrow donors in Australia, like Keren HaYeled in Melbourne.

The original American organization, called Gift of Life, was created by Boca Raton, Florida, resident Jay Feinberg; in 1991, when he was ill with leukemia, he launched a global search to find himself a match.

“The collaboration [between Australia and America] started in the early days when Shula Endry Walder, of blessed memory, contacted Arlene Feinberg, my mother, and offered to run drives to help find a match for me,” said Feinberg. “Donors recruited are included in the Australian Bone Marrow Registry, which is a longtime international colleague and partner of the Gift of Life Marrow Registry,” in the United States.

The global campaigns that many people engage in to secure a transplant is not surprising.

“Bone marrow is the largest medical collaboration on the planet, if you are on the registry [somewhere], you are on the registry everywhere,” said Dovid Slavin, a rabbi who also holds a doctorate in philosophy, and who has been a board member of Gift of Life Australia since its inception. “In Australia, the bone marrow registry is run by the government, which subcontracts the collection of blood samples to the Australian Red Cross. Any sample collected by Gift of Life Australia is then given to the Red Cross and added to the Australian Bone Marrow Registry, which then hooks in with the global bone marrow registry.”

At the time Gift of Life Australia was founded, the Jewish community was considered one of the “hard to match communities” in Australia. “There were not many people from our community on the registry,” said Debbie Redelman, another longtime Gift of Life Australia board member. “So, the Australian Bone Marrow Registry contracted Gift of Life Australia to collect samples [from the Jewish community] to increase the chance of finding matches.” Jewish donors are much more likely to be matched with other Jewish recipients because tissue type is inherited, so the best chance of finding a transplant is from someone with the same genetics (often family members) or from people of a similar ethnic background.

In Australia, Slavin estimates that 10,000 Jewish Australians have been signed up to the registry by Gift of Life Australia, and more than 30 have provided transplants to recipients around the world. For a community of approximately 100,000, this is quite a high number, considering that the Australian Bone Marrow Registry only performs a handful of transplants each year for the whole country.

My stem cells and plasma were removed over four hours. They called it liquid gold.

In America, Gift of Life operates a little differently: It is privately run and operates its own registry, which then shares its data with other bone marrow registries across the world. To date, it has recruited over 300,000 Jewish Americans to join the registry and has facilitated 20,974 matches and 4,012 transplants.

Collecting DNA samples to the registry is also done differently, with the Australian register operated by the Red Cross, therefore requiring all Australians to provide a small blood sample to join the registry, rather than a cheek swab scraping, as is standard protocol in America.

However, this is about to change.

In Australia, the COVID-19 pandemic put a stop to almost all in-person collection drives, and many prospective donors found it difficult to join the registry as many Australian cities locked down for months. As pandemic restrictions begin to ease in Australia, there are plans in the works for mail-order kits that will allow people to self-swab their cheeks and join the registry without the need for a blood sample.

“In the post-COVID age we are looking to pilot a cheek swab option, where people can order a mail-out kit and receive a scrape kit where they will be able to provide a small sample of saliva and then post it back to us which will then be added to the Australian Bone Marrow Registry,” said Slavin.

“Over the years we ran a lot of drives within both the Jewish and wider Australia community; Gift of Life Australia has tested thousands of people, at every single event, every school fair, at every Yom Ha’Atzmaut party, we popped up and encouraged people to join the registry,” remarked Slavin. “So, hopefully cheek swabs will continue to grow the number of people on the registry.”

As this transition takes place, and more people sign up to join the Australian Bone Marrow Registry, there is a greater chance of matches being created, which widens the chances that desperately ill people can find a perfect match from the Australian Jewish community.

Esther Lever remembers lining up with her parents in Melbourne to donate a small vial of her blood in the early 1990s, in response to the community call for donations to help Yehuda Kaplan. She wasn’t a match, though, and didn’t think much about it after that. However, in 2006, more than a decade after donating her blood, she received a phone call out of the blue.

“The Alfred Hospital [in Melbourne] received a phone call from the world bone marrow registry advising that I may be a potential match for someone,” she said. “The only three things they told me about my prospective match was that she lived in Israel, she was female, and she was 48 kilograms [105 pounds].”

Before undergoing further testing to confirm her eligibility to donate, Lever knew she would not hesitate to assist if she could: “When I heard she was [105 pounds] I knew she must be quite sick and I wanted to help,” she said.

Esther Lever meeting Einat Zinger, 2007
Esther Lever meeting Einat Zinger, 2007Courtesy Esther Lever

After undergoing further testing Lever was stunned to find out that her DNA was a genetic match, with one hematologist telling Lever that the odds of two nonfamily members having this kind of match were about “one in a million.”

“The hematologist told me that it didn’t mean we were necessarily related, but maybe back in the day, our ancestors came from the same village,” she said.

The process to organize Lever’s donation moved quickly. She had injections to boost her own stem cell production and then, on the day of the procedure, she was admitted to the hospital.

“I was hooked up to a dialysis machine, with a needle in each arm, and my body’s blood was passed through the machine twice. My stem cells and plasma were removed over four hours,” she said. “They called it liquid gold.”

After Lever’s procedure, later that day, the stem cells were already on a plane bound for Israel.

On Feb. 22, 2006, they arrived at Schneider Children’s Hospital in Petah Tikva, where Lever’s beneficiary had undergone chemotherapy in expectation of the transfer. The transplant was a success.

Eleven months later, Lever received a phone call from Schneider’s Children Hospital asking if she would be interested in meeting up with her beneficiary, who was now in remission.

With a ticket coincidentally already booked for a Jewish education conference in Jerusalem in January 2007, the timing was perfect.

“When I arrived in Jerusalem, the hospital sent a car to pick me up, there was a Channel 2 news crew filming me, asking me questions and interviewing medical staff at the hospital, ready to film our meeting,” Lever said.

The meeting was emotional for both donor and recipient. Lever’s stem cells were transplanted into 15-year-old Einat Zinger, an Israeli who’d been battling cancer since she was 12.

“When we met, we stood there and hugged, and everybody was crying,” said Lever.

That night, the story of the miraculous match was the top news story in Israel. For the rest of her trip, people recognized Lever, as store vendors offered her free gifts and ice cream and random people stopped her on the street to hug her for saving Zinger’s life through her donation.

“In fact, five years later I went back to Israel for a conference, and someone still recognized me and asked to hug me!” she said.

To this day Lever and Zinger remain friends, with Lever making the trek to Israel for Zinger’s wedding day in 2016.

“It was so emotional, matching with her was the result of so many miracles coming together,” said Lever. “We are just waiting for Australia to not have such strict travel and quarantine restrictions and hopefully she and her husband will come to visit my family in Australia.”

Lever hopes that stories like hers will continue to encourage other Jews in Australia to join the registry.

“I was blessed with good health and the ability to save someone’s life with modern technology,” she said. “So who wouldn’t want to be on the [bone marrow] registry and help save someone’s life if they could?”

Nomi Kaltmann is Tablet magazine’s Australian correspondent. Follow her on Twitter @NomiKal.