Over the last two weeks I have been trying to collect my thoughts on the most recent journey I undertook – the donation of my kidney. To be sure, I am certainly not the first to choose this route. In fact, I am donor number 1230 through Renewal. That means that one thousand two hundred and twenty nine incredible people did this before me just with Renewal. It is because of their courage that I was able to make this leap myself. However, every person views their experience slightly differently, I want to organize some of the thoughts that I have been processing over this special journey.
Who's Body is it?
One of the main issues I struggled with before going forward with kidney donation was the moral question of whether to undergo a procedure with minimal risk but significant pain to help save someone else's life. How much did this make a difference to the recipient? How much risk was it on my end? Was this fair to my family? I was obviously a biased party and wanted to do this from the start. However, I felt it important to investigate fully.
During my research I learned a whole lot. I discovered that someone on the New York State kidney list has a 5 year wait list, during which less than 50% of recipients make it. I also learned about the limitations and dangers of dialysis. I studied the risk factors for kidney donors.
As I was digesting all this information, I kept coming back to a particular passage I learned 20 years ago in the words of R. David ben Zimra (1479–1573). He commented on a passage in the Rambam's Mishna Torah in the laws of Sanhedrin 18:6. The Rambam notes that the court of Jewish law will not accept the defendant's admission of guilt in capital cases. He surmises this might be because the court has to be concerned that the defendant may be mentally unstable and would be too fearful to commit suicide so he uses court as the means to end his life. But the Rambam concludes that this law is such not for a particular reason but as a rule from God that such an admission is not accepted. The Radvaz comments on the Rambam and suggests a reason for this rule from God. He observes that our life on earth is not a gift. It is a lease. We do not have the right to take our lives or harm ourselves because we do not own ourselves. A person has no right to inflict harm on themselves by force or even by admission in court.
I thought about this comment extensively. The process of surgery is somewhat humiliating. One has to leave one's clothes, submit to anesthesia, allow others to cut, examine, poke and measure themself. It took me many days afterward the surgery just to be rid of all the IVs, the bandages and markers all over my body. My body did not feel like my own for many days after the surgery. It looked different and it behaved differently. All these experiences drilled in this lesson – the body was not mine in the first place.
Which takes me back to pre-surgery. The body was not mine even in the decision making. This was not about me 'nobly' giving away an organ, rather it was handing over part of the lease I was given. God gave me this body and if I had the opportunity of helping give a part of it away to help another child of God. Within this framework, everything I underwent was most natural.
Who is family?
As I worked through my own hesitations surrounding kidney donation, I asked the same question to each doctor I spoke to - 'if you were told you were a match today, would you donate your kidney?' I felt it was important to see if the various surgeons, nephrologists and providers believed in what they were doing enough to feel it was safe.
One nephrologist I spoke to extensively at New York Presbyterian gave me a particularly thoughtful response. He explained that there are certain risk factors for kidney donors such as hypertension, late onset diabetes and so on. While the donor team at the hospital try to screen for all such indicators as much as possible now, one can never be sure till later what might develop. He therefore explained that if a family member needed a kidney right now, he would donate without hesitation. But if it were someone he did not know, he would hold off donating until he was in his sixties and any potential latent conditions could have surfaced so he could be even more sure about his own risk factors.
He had obviously given this serious thought and I was gracious for his logic. At that same moment I realized the missing piece. You see, when I was told that I was a match, it wasn't for a complete stranger. It was for a fellow Jew. It was really family, and it felt as such to me. To an average non-Jew, I can understand why deciding to donate a kidney to someone I do not know seems very foreign. But for a Jew helping a brother, it is all one family. It was an astonishing revelation.
The Power of Altruism
One thing I was struck by was the incredible outpouring of support and encouragement for my undergoing this surgery. I did not expect the degree and intensity of the outpouring of appreciation and adoration for this act. People were viscerally moved by this decision. This helped me understand something quite Godly – the value we place on altruism.
As I was dragging myself down the hospital halls, dutifully trying to walk after the surgery, I was struck by the fact that very few patients chose to be in a hospital. A vast majority of patients suffered some sort of ailment, illness or trauma which forced them to come to hospital. Only mothers in labor and living donors make a choice to want to come to a hospital. They do so because they want to give to others. That will to sacrifice of self for another is one of the purest forms of altruism.
Which leads us to a fascinating conundrum about the human condition. Why should there be altruistic people at all? Why should we value altruism so deeply? After all, evolution argues that we are simply the most evolved life form on the planet. Darwin argued that the mechanism of the selection of gene mutations is called survival of the fittest. But what about altruism? The propensity to sacrifice of self should long ago been pushed out of the gene pool by the fitter, faster and bigger brutes.
Dr. Francis Collins, renowned scientist and head of the human genome project, noted that the existence of altruism points to the fact that God programmed this world. In his book, The Language of God, he argues that human development is not just a haphazard war among species and life forms. God coded the algorithm which values giving to the other.
The Wonder of God's Organs
Another thought I have been processing is the power of the organs God has given us. The nurse who was preparing me for the operation found out what I was about to do, and she burst out crying. She explained that her husband had had renal failure and was able to receive a kidney from a 10 month old baby who had tragically passed away. Ten years later, that kidney had grown in him and given him a new lease on life.
The kidney he received was little bigger than a thumbnail and yet that tiny organ had given him a whole new life. We are blessed to have come so far in medical advances today in the 21st century. And yet, there is nothing we can create which can be nearly as miraculous as an organ, even a thumbnail sized one. I was told that the creatinine levels in the blood of my recipient went from 21 (dangerously high) to around 1, which is normal, after just one week with a new kidney. The kidneys filter around 50 gallons or 180 liters of blood a day. In addition, they control the pH of the blood, produce supplemental glucose, create protein to increase blood pressure and produce hormones which allow for the absorption of calcium. This is the power of just one small organ.
The Interdependence of Human Beings
The most important lesson this process has taught me is that human beings are not independent. It has been a humbling experience to lose the control of doing the simplest of things like bending down or just putting on socks. Over the course of the last weeks, I have come to understand just how dependent human beings are. We do not live in a vacuum. We need help from each other. We need physical, emotional and spiritual support on an hour to hour, day to day basis.
My decision to go forward with kidney donation was not just a personal sacrifice. It demanded much support from my wonderful family, my dedicated friends and my wonderful Shul and community. I am eternally grateful to my wife, my family, Rabbi and Rebbetzin Schreier, Alan Domb and our shul office, David Saffra and the shul leadership, and every member of the community for their support, space and encouragement.
Not everyone can easily donate a kidney. Even after matching, there are many medical and surrounding issues which can disqualify a person from donation. But people save the lives of others all the time. Those who care for the elderly, those who are in the medical field, and those who provide the social support for others in difficult times, are all engaged in life saving without even giving organs. We all have the responsibility of being someone else's support. And we all have the responsibility of articulating our appreciation to those who support us.