There aren't enough days in the year to remember all of important history by naming a day, but some days stand out. The oldest one I know is the 9th day of the month of Av in the Jewish calendar, Tisha b'Av.
But October 7 is likely to be remembered for a long time, an unimaginable day whose dire consequences are still unfolding.
The Genesis Prize Foundation remembers the first anniversary with these videos:
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Israel Hayom has the story. (Itai Ashalgi's software gets a shout-out):
Unprecedented Israel-Cyprus kidney exchange saves 8 lives. Cross-border medical collaboration showcases the power of organ donation and transplant innovation. By Eleanor Favriker/Makor Rishon
"In a remarkable display of international medical cooperation, eight kidney transplants have been performed across Israel and Cyprus as part of a pioneering cross-border organ exchange program. The intricate operation, involving multiple hospitals and a meticulously coordinated logistics effort, was made possible by two altruistic donors who approached the National Transplant Center, initiating a "transplant chain."
"The joint operation, conducted on Monday, saw five procedures taking place in Israel and three in Cyprus. The National Transplant Center matched the pairs using specialized computer software, drawing from an international database containing incompatible family member pairs.
"Starting at 5:00 a.m., kidneys harvested at Hadassah and Soroka hospitals were transported by ambulance to the airport and flown to Cyprus. Concurrently, another kidney from Hadassah was transferred to Soroka, while one from Beilinson was sent to Hadassah. At 2:00 p.m., two kidneys arrived from Cyprus, destined for Beilinson and Hadassah. By 6:00 p.m., all transplants were completed in both countries, with recipients in good condition and new kidneys functioning.
"In Israel, three transplants occurred at Hadassah, one at Beilinson, and one at Soroka, with an additional Hadassah transplant performed a day earlier. In total, Israel saw 10 surgeries: five kidney removals and five transplants.
"Professor Shlomo Mor Yosef, chairman of the Steering Committee, said, "I commend the cooperation between Israel and Cyprus. These exchanges provide solutions for patients with antibodies. I urge every family with a patient needing a kidney transplant to join the exchange database if no match is found among them."
"Dr. Tamar Ashkenazi commented, "This marks our first two-way kidney exchange with Cyprus. Their single transplant center in Nicosia performed six surgeries in one day, supported by a surgeon from England. I'd like to thank Ms. Rona Simon, who manages our exchange database, facilitating over 60 successful cross-transplants annually. Israel maintains similar programs with the Czech Republic, Austria, and the United Arab Emirates."
Here's an article that includes description of the joint Austria, Czech Republic and Israel kidney exchanges.
Böhmig, Georg A., Thomas Müller‐Sacherer, and Ondrej Viklicky. "Kidney Paired Donation—European Transnational Experience in Adults and Opportunities for Pediatric Kidney Transplantation." Pediatric Transplantation 28, no. 6 (2024): e14840.
"One approach to expanding the pool, akin to deceased donor kidney transplantation through the transnational Eurotransplant Organization, involves the establishment of cross-border KPD joint programs. In Europe, several joint programs have successfully conducted such transplants, one of which is the Scandiatransplant Exchange Program, inaugurated in 2019. As of February 2023, this program has facilitated 49 transplantations [29]. Another transnational initiative, the focus of this article, is the joint program involving Austria, the Czech Republic, and Israel. This collaboration resulted in the first transnational live donor kidney exchange in Europe, a two-way exchange between Vienna and Prague in 2017 [30].
"The Vienna and Prague Kidney Paired Donation (KPD) programs were merged in 2015 following a consensus on medical, psychological, and immunological requirements [23]. ... Both programs agreed on a binational algorithm, utilizing a computer algorithm developed in Prague. This algorithm not only facilitates the calculation of ABO-incompatible combinations but also includes the option of Non-Directed Altruistic Donor (NEAD) chains initiated by altruistic donors [23].
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"Recent developments in the transnational program include its expansion to additional centers. Prague initiated a transnational cooperation with the national KPD program in Israel, successfully conducting the first ring exchange in 2019. In this context, transplantations cannot be realized simultaneously due to the financial burden associated with the need for two private flights. Later, this cooperation extended to the Vienna center, leading to the first exchange between Vienna and Israel in 2022, involving a simultaneous three-way chain with one Vienna and two Israel pairs. Innsbruck has also joined the international KPD program as a second Austrian center, participating in local exchanges and one 2-way exchange with Prague (2020). A good example of different approaches in timing of surgeries among Prague and Israel centers (non-simultaneous) in one hand and Vienna (simultaneous surgeries) in the other hand is Czech-Austrian-Israel international NEAD chain initiated in Prague which has lasted for several years, prioritized smaller exchanges and has not been terminated so far. Such a NEAD chain used both altruistic and bridge donors in Prague. Terminated NEAD chain may allow to prioritize patient at special need. For example, our short 3-country NEAD chain was terminated to offer transplantation to a previous kidney donor who donated 20 years ago but unfortunately developed end stage kidney disease. Such approach may have implications also in pediatrics."
In Israel, where commercial surrogacy is legal, surrogates are more and more coming from educated and religious communities.
Haaretz has the story:
Married, Educated, Not in It for the Money: The New Profile of Israeli Surrogate Mothers. Who are the Israeli women who wish to be pregnant and give birth for others? The answer to that question has changed dramatically over the past decade by Ronny Linder
""I'm a little tired of women telling me how disadvantaged all surrogates are, so I thought of starting a thread just for surrogates, with: name + our occupation + town. I'll go first." This is what one moderator of an open Facebook surrogacy group wrote, about a year ago – and the responses came pouring in: a computer programmer from Tekoa, a sociolinguistics Ph.D. from Kfar Sava, a school principal from Jerusalem, a postgraduate student of gender studies from Hatzeva, a lawyer from Gush Etzion, an oncology nurse from Mevasseret Zion and so on and on.
"The post and the responses to it, written in reaction to the prevalent perception that views surrogacy as bearing the potential for exploitation of disadvantaged women who must "hire out" their uteruses for money, largely reflects the great transformation, over a few short years, in the profile of surrogate mothers and of the entire field in Israel.
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"Since the surrogacy law was legislated in 1996, almost 1,300 children have been born in Israel through surrogacy procedures. In recent years, the number has averaged around 80 children per year. Data collected by the Health Ministry about surrogate mothers between 2022 and 2023, reveals the changes in the profiles of women who choose to take on the task, as compared with the last study, in 2010. That study, which reviewed surrogate mothers during the years 1996-2010, was conducted by Etti Samama as part of the work for her doctoral thesis in health-system management at Ben-Gurion University. To compile recent data, Adam Ringel and Eti Dekel, for many years the national supervisor of the surrogacy law, collected information from 246 cases – 90 percent of the cases filed with committee in the last couple of years.
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"The data indicate a fundamental change in the socio-economic status of women who choose to become surrogates. In terms of education, while in 2010 the majority of surrogate mothers had a high school education (70 percent), nearly one fifth (18 percent) had less than 12 years of schooling, and only 7 percent had academic degrees. Less than a decade and a half later, however, the picture has been transformed: 65 percent of surrogate mothers have an academic degree, and only about one fifth have only a high school education (14 percent) or less than 12 years of schooling (8 percent). The proportion of those with academic degrees among surrogates is significantly higher than that group's share of the population, which is 38 percent.
"A similarly changed picture emerges in terms of employment: In 2023, only 2.5 percent of surrogates were unemployed, compared with 25 percent in 2010. No less interesting is the finding regarding geographical dispersal of surrogates, as compared with the general public: In recent years, almost half (45 percent) of them come from kibbutzim, moshavim and organized communities – compared with just 12 percent in 2010.
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"An absolute majority of surrogates come from [the world of] religious Zionism, on the one hand, or are secular women from kibbutzim and other organized communities, on the other," Ringel elucidates. "These two groups are seemingly worlds apart, but in the world of surrogacy, you see the resemblance between them. These are independent, strong women, with a fully developed values-based worldview, who are looking to do something big for others, who see surrogacy as a calling, as female empowerment and as the ultimate giving."
"What happened between 2010 and 2024 that led to such dramatic change in the profile of surrogate mothers? Experts in the field ascribe the change mainly to the opening up of the option for married women to become surrogates, beginning in 2010 – a move that significantly increased the pool of potential surrogates and also changed their socio-economic backgrounds.
"This is indeed a transformation: in 2010, all surrogates were unmarried women, 75 percent of them divorced, the rest single (and a few widows). In contrast, in 2022-2023, 80 percent of surrogates were married or in relationships, and only 20 percent were divorced or single.
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"There was always an altruistic element with surrogates, but ever since married and more affluent women entered the picture – the economic part became more of a bonus, rather than the main motive," Dekel points out."
The Jerusalem Post reports another kidney exchange between Israel and the Czech Republic:
Miraculous kidney donation between friends spans continents and save lives. The complex and sensitive cross-continental operation required coordination between senior officials in both countries. https://www.jpost.com/international/article-804396 By JERUSALEM POST STAFF MAY 30, 2024 18:39
"it was soon discovered that Glaor was not a direct match for a transplant, and their medical details were entered into the National Transplant Center's cross-matching database. The entry resulted in an international kidney transplant exchange in which Glaor donated his kidney to a patient in the Czech Republic, and the wife of the Czech patient donated her kidney to Shitrit.
"The complex and sensitive cross-continental operation required coordination between senior officials in both countries, with an emphasis on the precise timing of operating rooms, flights, and quick security and customs arrangements.
"The operation began in the middle of the night at the Hadassah University Medical Center in Jerusalem’s Ein Kerem. It was managed and coordinated by the National Transplant Center.
"Dr. Tamar Ashkenazi, director of the National Transplant Center, was in charge of coordinating the transplant. Alongside her on the flight to Prague were coolers containing two kidneys that were removed overnight from two Israeli donors at Hadassah Ein Kerem, which were intended for transplantation in two Czech patients.
"In the evening, at around 10 p.m., the transplants in Israel were completed, and the Czech kidneys successfully functioned in the bodies of the Israeli recipients, as reported similarly from Prague regarding the Israeli kidneys that were transplanted in the Czech Republic.
""We planned the process precisely, and were in constant contact with our counterparts in the Czech Republic regarding the surgical issues. Every action that takes place is critical and impacts the continuation of the operation," said Dr. Ashraf Imam, a senior surgeon in the transplant unit at Hadassah, who participated in the transplant operation."
Here's the announcement for this summer's summer school in Economics in Jerusalem (with the program and list of speakers updated on April 8).
The 34th Advanced School in Economic Theory and Computer Science Sun, 23/06/2024 to Thu, 27/06/2024
General Director: Eric Maskin, Harvard University
Organizers: Elchanan Ben-Porath, The Hebrew University of Jerusalem, Michal Feldman, Tel Aviv University, Noam Nisan, The Hebrew University of Jerusalem
Contemporary economic theorists and computer scientists have a large research agenda in common. Topics of mutual interest include the design of contracts, auctions, and information structures, as well as the use of algorithms to achieve fair allocations. This summer school will explore all these topics and more
Speakers:
Fair division of indivisible items: Uriel Feige, Weizmann Institute of Science
Algorithmic contract design: Michal Feldman, Tel Aviv University
Multidimensional mechanism design: Sergiu Hart, The Hebrew University of Jerusalem
Revenue maximization from samples: Yannai Gonczarowski, Harvard University
Fairness in learning and prediction: Katrina Ligett, The Hebrew University of Jerusalem
Matching markets: From theory to practice: Assaf Romm, The Hebrew University of Jerusalem
Economic aspects of Blockchains: Aviv Zohar, Assaf Romm The Hebrew University of Jerusalem
Saturday, on the last night of my just-ended visit to Israel, I attended two adjacent mass public events.
One was a political demonstration against the leadership of Prime Minister Bibi Netanyahu and his governing coalition. The other was a vigil for the kidnapped hostages, living and dead.
In each of these two events, the one Hebrew word you heard more than any other was NOW (עכשיו). As in "Elections NOW!" or "Bring them home NOW!"
In the political demonstration, the primary mood expressed by the speakers was anger. In the vigil, it was sadness.
Below some pictures and a video of a speech with added subtitles in English translation.
From the demonstration:
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| The signs say "Elections Now!" |
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| The sign (addressed to Bibi) says: "You are the boss. You are guilty" |
From the vigil for the hostages:
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| Prepared to welcome the hostages home to Shabbat dinner |
I'm expecting to be back in California later today. I gave three talks while in Israel, and met with many people, but the proximate cause of my trip was the economics conference organized by Effi Benmelech on behalf of Northwestern's Crown Family Israel Center for Innovation. It was organized as an expression of support for Israeli academics.
Wednesday, March 20 | Mishkenot Sha’ananim, Jerusalem
9:00-9:15 Welcome Effi Benmelech, Northwestern University
9:15-10:00 Amir Yaron, Governor of the Bank of Israel
10:00-10:15 Break
Macro Session
10:15-11:00 Moving to Fluidity: Regional Growth and Labor Market Churn Eran Hoffman, Hebrew University
11:00-11:45 Policy Design and Rates of Convergence in Learning Models Martin Eichenbaum, Northwestern University
11:45-12:45 Lunch
Applied Micro Session
12:45-13:30 Fostering Soft Skills in Active Labor Market Programs: Evidence from a Large-Scale RCT Analia Schlosser, Tel Aviv University
13:30-14:15 Decomposing the Rise of the Populist Radical Right Roee Levy Tel Aviv University
14:15-14:30 Break
14:30-15:15 Why Has Construction Productivity Stagnated? The Role of Land-Use Regulation Edward Glaeser, Harvard University
15:15-15:30 Break
Matching Markets Session
15:30-16:15 Organ Allocation for Transplants, Around the World and in Israel: Part I Al Roth, Stanford University
16:15-17:00 Organ Allocation for Transplants, Around the World and in Israel: Part II Itai Ashlagi, Stanford University
Thursday, March 21 Mishkenot Sha’ananim, Jerusalem
Industrial Organization Session
9:15-10:00 Selling Subscriptions Liran Einav, Stanford University
10:00-10:15 Break
10:15-11:00 An Empirical Analysis of Merger Efficiencies Alon Eizenberg, Hebrew University
11:00-11:15 Break
11:15-12:00 Pharmaceutical Advertising in Dynamic Equilibrium Ariel Pakes, Harvard University
12:00-13:00 Lunch
Economic History Session
13:00-13:45 Land Privatization and Business Credit: The Response of Bankruptcies to Land Enclosures in England 1750-1830 Karine van der Beek, Ben-Gurion University
13:45-14:00 Break
14:00-14:45 Diversity, Pluralism and Tolerance: The Roots of Economic Progress Joel Mokyr, Northwestern University
14:45-15:00 Break
Experimental Economics
15:00-15:45 Describing Deferred Acceptance to Participants: Experimental Analysis Yannai Gonczarowski, Harvard University
15:45 Adjourn
I spoke in Jerusalem yesterday about kidney exchange, and one of the things I talked about is the kidney exchange between Israel and the UAE. At the time (summer 2021) I was careful not to blog about anything beforehand, because there were delicate political issues, and so I didn't start to tell the story until I returned from the UAE, and I waited until the story appeared in a U.S. newspaper.
I never got around to linking to the stories in the Israeli press, so here are two. via Google translate.
From ynet:
Historical transplant: Shani's kidney will be transplanted into an Abu Dhabi resident, her mother will receive a kidney in Israel Shani Markowitz of Nesher is expected to go down in history this week as the first Israeli to have her kidney transplanted into the body of a resident of Abu Dhabi. The transplant will be carried out as part of an international crossover program in which an Israeli citizen will also receive a kidney from a resident of the United Arab Emirates. Markowitz: "My goal is for my mother to receive a kidney in exchange." Prof. Eitan Mor, Director of the Sheba Transplantation Center: "It is possible that after the Corona we will meet face to face" by Adir Yanko, 24.07.21
and from Mednews Israel
Israel Kidney Crossing Abu Dhabi
"Medical fruits of the peace agreement with the United Arab Emirates: a kidney, donated at the Sheba Hospital, was flown and transplanted in Abu Dhabi, in exchange for a kidney donated in Abu Dhabi and transplanted at the Rambam Hospital
"July 28, 2021 was a historic day for the State of Israel, the Ministry of Health, the National Center for Transplantation and the kidney patients and their families: thanks to the transfer of a kidney in a crossover, from Israel to Abu Dhabi and from Abu Dhabi to Israel, three transplants were performed on this day, two of them in Israel
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"Dr. Tamar Ashkenazi, director of the National Center for Transplantation and the initiative [said]of the cooperation: "The program was theoretically born from the moment the Abraham Agreement was signed in September 2020, and from the day the agreement between the Ministries of Health was signed on April 21, 2021, we began to move rapidly towards the agreement on the crossbreeding program. An American company assisted in the agreement which accompanies the program in the Emirates, APKD, along with laboratory data provided to us by the company. The matches were found by Prof. Itai Ashlagi, an Israeli researcher at Stanford, with the help of software he developed and even donated to us. Prof. Ashlagi accompaDr. Tamar Ashkenazi, director of the National Center for Transplantation and the initiativenies us in all the international crosses together with Rona Simon from the transplant center. A great feeling of satisfaction accompanies us. We turned to the next crossovers and to find more matches"
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Here are all my posts on that and related kidney exchanges
I'm in Israel this week, where there are constant reminders of the hostages
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| at Ben Gurion airport |
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| at Symphony hall |
Israel's Organ Transplantation Law grants some priority on waiting lists for transplants to candidates who are first-degree relatives of deceased organ donors (i.e. whose family has given permission for someone's deceased organ donation) or who previously registered as organ donors themselves. (There's also a tiny priority for relatives of people who signed organ donor cards...) Here are two papers that looks at the effect of those priorities on kidney and liver transplants, and how they interact with other priorities on waiting lists for Israeli organs.
The first paper, on kidneys, concludes that the priorities are effective in reducing waiting time to transplant, and suggests that perhaps these priorities should not be so large compared to other existing priorities (e.g. for time on dialysis), or for priorities that could be established, e.g. for highly sensitized patients (who get high priority in the U.S., for example.)
Mor, Eytan, Meitar Bloom, Ronen Ghinea, Roi Anteby, Ronit Pasvolsky-Gutman, Ron Loewenthal, Ido Nachmani, and Tammy Hod. "The Impact of the Donor Card Holder Prioritization Program on Kidney Allocation in Israel." Transplantation (2024): 10-1097.
Abstract
Background: Since 2014, as part of a priority program within the Israeli Transplant Law, additional points were given to waitlisted candidates with donor cards. We assessed the impact on deceased donor kidney allocation.
Methods: This study enrolled all patients older than 18 y who underwent deceased donor kidney transplantation (January 2016–December 2019). Data were obtained from the National HLA Tissue Laboratory registry at the Sheba Medical Center. Patients were grouped by donor card status (ADI group) (not signed, 0 points; relative signed, 0.1 points; patient signed, 2 points; and relative donated, 9 points). The primary outcome was waiting time until kidney transplantation with and without the additional score.
Results: Four hundred forty-four patients underwent kidney transplantation during the study period: 281 (63%) were donor card holders (DCH) and 163 (37%) were not DCH. DCH with extra points waited 68.0 (±47.0) mo on average, compared with 94.6 (±47.3) mo for not DCH (P < 0.001). Donor card signers had a shorter time until transplant in a multivariable model. Without extra points, 145 recipients (32.6%) would have missed organs allocated to higher-scored candidates. Allocation changes occurred in 1 patient because of an additional 0.1 points, in 103 candidates because of an additional 2 points, and in 41 candidates because of an additional 9 points.
Conclusions: Additional DCH scores improved allocation and reduced waiting time for donor card signers and those with donating relatives. To enhance fairness, consideration should be given to reducing the score weight of this social criterion and raising scores for other factors, especially dialysis duration.
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There are many fewer liver transplants than kidney transplants, and the effect of priority is less clear:
Ashkenazi, Tamar, Avraham Stoler, and Eytan Mor. "The effect of priority given to donor card holders on the allocation of livers for transplant—evidence from 7 years of the Israeli priority program." Transplantation 106, no. 2 (2022): 299-307.
Abstract
Background. The Israeli Transplant Law grants priority in organ allocation to patients signing a donor card. Liver transplant candidates get additional 2 points on their Model for End Stage Liver Disease score for signing a donor card, 0.1 points for a relative holding a card, and 5 points if a relative donated an organ. We studied the effect of the priority program on waiting list mortality and allocation changes due to priority.
Methods. Using Israeli Transplant data of 531 adult liver transplant candidates with chronic liver disease listed between 2012 and 2018 we compared waitlist mortality and transplant rate of candidates with and without priority. Then we analyzed liver allocations resulting from additional priority points and followed outcome of patients who were skipped in line.
Results. Of the 519 candidates, 294 did not sign a donor card, 82 signed, 140 had a relative sign, and for 3, a relative donated an organ. The rates of waitlist mortality in these 4 groups were 22.4%, 0%, 21.4%, and 0%, respectively, and the transplant rates were 50%, 59.8%, 49.3%, and 100%, respectively. Of the 30 patients who were skipped because of priority, 24 subsequently underwent transplant, 2 are on the waiting list, and 4 died within 0.75, 1.75, 7, and 17 mo.
Conclusions. The 2 points added to the Model for End Stage Liver Disease score were associated with lower waitlist mortality and higher transplant rate for candidates signing a donor card without significantly affecting access to transplant during allocation. Further research and consideration of optimal policy when granting priority for candidates signing a donor card should continue.
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Earlier:
Stoler, Avraham, Judd B. Kessler, Tamar Ashkenazi, Alvin E. Roth, Jacob Lavee, “Incentivizing Authorization for Deceased Organ Donation with Organ Allocation Priority: the First Five Years,” American Journal of Transplantation, Volume 16, Issue 9, September 2016, 2639–2645.
Stoler, Avraham, Judd B. Kessler, Tamar Ashkenazi, Alvin E. Roth, Jacob Lavee, “Incentivizing Organ Donor Registrations with Organ Allocation Priority,”, Health Economics, April 2016 Volume: 26 Issue: 4 Pages: 500-510 APR 2017
Eyal Winter, the eminent Israeli economist (who was a postdoc of mine a lifetime ago, in Pittsburgh), has published a novel called Anna's Children, about his aunt, who tried to rescue 22 orphans after Kristallnacht. It's discussed in this interview in Haaretz (and there is another link to the article here if the one below doesn't work).
'The Idea That Who You Are Is Only Genetics Is the Essence of Evil' A new book by Prof. Eyal Winter, an economist and games theory researcher, tells the story of his aunt, a woman of high society in pre-Nazi Germany, who tried to rescue 22 orphans from the Holocaust. by Gili Izikovich
"Winter, 64, is no stranger to writing, but "Anna's Children" is his first novel. He was born and raised in Jerusalem and now lives in a bright, beautiful stone house in the suburb of Mevasseret Zion.
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"Is this a good time to publish a book about the Holocaust?
"I pondered a lot about the link between the Holocaust and what happened in October," says Winter. "I considered delaying the book. It's a difficult story with a bad ending, but it also has elements of comfort given what is happening with us. It's possible to understand our reactions to the contemporary situation and maybe make it easier somehow."
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Here's his related post on Linkedin: Eyal Winter’s Post
Markets change over time, including the marriage market. American marriages have become more assortative in recent years, and it appears that, in the 21st Century, women no longer pay a 'marriage penalty' (measured in spousal income) for graduate education.
The Human Capital–Reproductive Capital Trade-Off in Marriage Market Matching, by Corinne Low, Journal of Political Economy Volume 132, Number 2, February 2024
"Abstract: Throughout the twentieth century, the relationship between women’s human capital and men’s income was nonmonotonic: while college-educated women married richer spouses than high school–educated women, graduate-educated women married poorer spouses than college-educated women. This can be rationalized by a bidimensional matching framework where women’s human capital is negatively correlated with another valuable trait: fertility, or reproductive capital. Such a model predicts nonmonotonicity in income matching with a sufficiently high income distribution of men. A simulation of the model using US Census fertility and income data shows that it can also predict the recent transition to more assortative matching as desired family sizes have fallen."
Notable sentence about the ancien regime: "I provide a simple condition such that there always exists a man rich enough that he prefers a higher fertility but poorer woman to a richer and less fertile woman."
And here's an earlier paper on fertility (through IVF) and age of marriage in Israel:
Gershoni, Naomi, and Corinne Low. 2021. "Older Yet Fairer: How Extended Reproductive Time Horizons Reshaped Marriage Patterns in Israel." American Economic Journal: Applied Economics, 13 (1): 198-234.
Israel leads the world in per capita living kidney donation. A good part of that comes from the work of Matnat Chaim (gift of life), an organization of religious Jews, who donate kidneys to people they don't know. They are "semi-directed" rather than non-directed donors, in that the organization allows them to indicate some criteria they would like their recipients to have. Sometimes they want their recipients to be fellow Jews, and this has generated some controversy in Israel.
Below is a study of this phenomenon, and in an accompanying editorial, a criticism of it.
Nesher, Eviatar, Rachel Michowiz, and Hagai Boas. "Semidirected Living Donors in Israel: Sociodemographic Profile, Religiosity, and Social Tolerance." American Journal of Transplantation (in press).
Danovitch, Gabriel. "Living organ donation in polarized societies." American Journal of Transplantation, (Editorial, in press).
"Nesher et al are to be congratulated for reporting on a unique, effective, yet ethically problematic manifestation of living kidney donation in Israel. To summarize, living kidney donation has become “de riguer,” a “mitzvah” (a religiously motivated good deed) among a population of mainly orthodox Jewish men living in religiously homogenous settlements. According to the authors, the donors view themselves as donating altruistically within a larger family. The donations, over 1300 of them, 60% of all living donations in the country, have changed the face of Israeli transplantation, reduced the waiting time for all transplant candidates on the deceased donor waiting list,2 and minimized the temptation of Israeli transplant candidates to engage in “transplant tourism,” a phenomenon that was an unfortunate feature of Israeli transplantation before the passage of the Israeli Transplant Act of 2008 that criminalized organ trading.3
So, what’s the problem? Matnat Chaim (“life-giving”), the organization that facilitates the donations, permits the donors to pick and choose among a list of potential recipients using criteria that according to its own website,4 and as Nesher et al note,1 are not transparent. ... frequently the donors elect to donate to other Jews. ... " Israel is a country with an 80% Jewish majority; a decision to only donate to other Jews, thereby excluding non-Jews, is a practice that, were it reversed in a Jewish minority country, would likely be labeled antisemitic. Concern that the process encourages racist and nationalistic ideation has been raised in the past6 and only emphasized by the public pronouncement of some media-savvy kidney donors.7
"What lessons does the Israeli experience hold for the US and other countries, faced as all are, with a shortage of organs for transplant? Conditional living donation exists to a limited extent in the US: DOVE is an organization that works to direct living kidney donation to US army veterans9; Renewal is an organization that encourages and facilitates living donation from Jews to other Jews but also to non-Jews10; in the 1990s an organization called “Jesus Christians” made organ donation one of its precepts.11 But in each of these cases, it is a minority group whose interests are being promoted.
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"What now for Matnat Chaim? Given its prominent impact on Israeli transplantation, its allocation policies must be transparent and subject to public comment. Criteria must be medical in nature and religious or political considerations excluded. Fears that as a result living kidney donation rates will plummet are likely exaggerated. "
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I can't help reading this discussion while being very aware that Dr. Danovitch is an ardent opponent of compensating kidney donors, for fear that inappropriate transplants would take place if that were allowed. In much of that discussion, inappropriateness of transplants focuses on possible harm to the (paid) donors, but the donors in the Israeli case are unpaid. Here his concern is that donor autonomy about to whom to give a kidney comes at the expense of physician autonomy in choosing who should receive a transplant, by "medical" criteria. But frequently those criteria have a big component based on waiting time, rather than any special medical considerations. So maybe in general he thinks that privileging the physician's role in this way is worth having fewer organs and consequently more deaths.
Still, I think he has a point about how we perceive what is repugnant. Having minority donors donate to fellow minority recipients seems much less repugnant than having majority donors specify that they aren't interested in donating to minority recipients.
But, speaking of donor autonomy, I'm not sure that there are practical ways around it, since semi-directed donors could always present as fully directed donors to a particular person that some organization had helped them find. So, we may just have to live with the increase in donations and lives saved that donor autonomy can support.
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Earlier posts:
" A new organization, Kidneys for Communities, plans to advocate for living kidney donation by seeking donors who identify with a particular community. Their come-on is "Put your kidney where your heart is. Share your spare with someone in your community"
Al Jazeera provides some interesting statistics and graphics in a story about UNRWA, the United Nations Relief and Works Agency for Palestine Refugees in the Near East, which was founded in 1949 to provide aid to Palestinian refugees from the war that followed Israel's independence. While Palestinians who left the middle east are of course no longer refugees (just as Jews who were refugees from Arab countries at that time are now citizens of the countries in which they settled) that's not the case for the Palestinians who fled to neighboring Arab countries, nor for their children or grandchildren. See the map below.
Here's the Al Jazeera story:
Which countries have cut funding to UNRWA, and why?. The UN urges continued funding to UNRWA’s ‘lifesaving’ aid in Gaza, after several Western countries cut aid to the agency. 28 Jan 2024
"The United Nations agency for Palestinian refugees (UNRWA), considered a lifeline for two million people in the besieged enclave, has suffered funding cuts after several of its staff were accused by Israel of involvement in the October 7 Hamas attack."
During World War II, many anti-Nazi people of good will might have been disturbed by the firebombing of Dresden (sometimes said to be in retaliation for the firebombing of Coventry). But I imagine that it would have been clear that their opposition to bombing the city of Dresden was not in any way support for the Nazi regime and its aims in the war and in the Holocaust.
One of the disturbing things about current campus protests in support of the dire situation in which civilians find themselves in Gaza is that they often seem to be expressed as support for Hamas, and the goals that Hamas has so clearly expressed in words and in actions, to kill all the Jews living in Israel and perhaps elsewhere. Indeed the celebrations of Hamas began before Israel began to counterattack, while Hamas was still killing civilians in Israel.
Another disturbing thing is that American university leaders, who have often made clear moral statements about other matters, seem to subscribe to the view that regarding Hamas, 'there are fine people on both sides.'
I don't doubt that some demonstrators are supporting Hamas out of ignorance or indifference to its goals and its atrocities, not to mention of its mis-governance of Gaza. But others are clearly anti-Semitic, and support genocide against Jews.
Harvard Business School's dean, Srikant Datar, has (in contrast to Harvard's top leadership), issued a statement that seems to me to include both recognition of the tangled politics of the Middle East, and a distinction between political opinions and hate speech. (Universities, which aren't government bodies, have some flexibility about regulating speech on campus, and don't universally protect hate speech, e.g. in general swastikas and nooses are condemned, even though the First Amendment to the Constitution limits what government bodies in the U.S. can do to curtail even hate speech.)
Here is Dean Datar's nuanced letter (that still manages to have relevant content):
Our Values 24 Oct 2023
"Dear members of the HBS community,
Two weeks have passed since the horrific attack by Hamas on Israeli citizens. As I noted in my letter on October 10th, terrorist actions against civilians are not only unconscionable, they are inconsistent with our most fundamental values; as humans, we must condemn them. The atrocities carried out were heinous and they have left the Israeli and Jewish members of our community, and all of us, reeling.
The ensuing days also have been deeply unsettling as the conflict has escalated in the Middle East. Shock has given way to deep pain and grief, sadness, and anger. Many in our community are afraid: uncertain whether they are welcome at Harvard Business School, unsure how to engage in class discussions, and even feeling physically unsafe for themselves and their loved ones. In the U.S. and around the world, examples of antisemitic hate speech, graffiti, vandalism, riots, and fire bombings, as well as violence such as the stabbing of a young Palestinian boy and his mother in Chicago, have only heightened this fear. Other individuals are afraid in a different way: that what they say might offend or make people angry, that they don’t understand the history behind the current events, and that if they try to offer support or speak up, they will get it wrong and be seen as insensitive or even complicit.
Moreover, the pro-Palestinian demonstration that crossed from Cambridge onto our campus last Wednesday, which included a troubling confrontation between one of our MBA students and a subset of the protestors, has left many of our students shaken. Reports have been filed with HUPD and the FBI, the facts are being evaluated, and it will be some time before we learn the results of an investigation. But the protest has raised questions about how we address freedom of speech, hateful speech that goes against our community values, and security and safety for everyone at the School.
In this context, I am reaching out to all members of the Harvard Business School community to discuss these and other issues that are affecting our School and campus. This is my purview as Dean and this is my responsibility to each of you.
Our Values
“And Thinking” is the idea that we can go beyond traditional either/or dichotomies and think expansively about the challenges we face. Hearing the pain and anguish so many of you have shared, I have debated whether to apply And Thinking to the moment we are facing now—it may be perceived as being too equivocal, or the wrong moment. But, not saying And has perhaps kept me from saying things that are important to say.
Let me start, then, by acknowledging that antisemitism exists on our campus, and stating unequivocally there is no place for it here. We have a strong and deeply valued Jewish and Israeli community at Harvard Business School. In recent days, many have shared with me their anger at Harvard’s history of antisemitism and their dismay that it continues today. We can and must start by making a difference at HBS. Antisemitism is insidious and we simply cannot allow it to persist in any form. We must ensure that our Jewish and Israeli faculty, staff, students, and alumni feel not only safe and supported by our community, but also a deep sense of belonging and understanding.
And, let me say emphatically that Islamophobia exists at HBS, and has no place on our campus either. We have a strong and deeply valued Muslim and Arab community. We must ensure that these faculty, staff, students, and alumni feel safe, supported, and at home at our School; Islamophobia, too, is insidious and cannot be allowed. We must be a place that embraces diversity—of culture, of religion, of ethnicity, and of every other aspect of identity and experience. This is what enriches our classroom discussions and the learning environment, and this principle is codified in our community value of respect for the rights, differences, and dignity of others. We must ensure we live up to that value.
Let me also state that I condemn violence and hateful speech, words, and actions like doxing that damage the fabric of our community, detract from learning, and can incite violence. Some protestors at Wednesday’s demonstration held banners and chanted words widely understood to call for the end of Israel—inciting the eradication of a nation and its people. There is no place for hateful speech on our campus. It violates our community values—values that hold all of us to a higher standard than simply protecting free speech.
And, we must enable robust dialogue and the expression of divergent points of view. At a University whose motto is Veritas, we should strive to ensure that our arguments and claims are true and rooted in fact. But we must be okay with being uncomfortable, even offended, at times. We must allow peaceful protests, demonstrations, and gatherings, and I will defend the right to voice dissent without hate. This is a fundamental principle of a strong democratic society that respects civil liberties.
I believe that we can do more than one thing at the same time—and that we must do so now, when there are many values we must uphold. I also believe that, by doing so, we can come together as a community and deliver on the promise we make to the students who come to our School: an engaging learning experience, and an education in business, management, and leadership. Yet we must also create the space necessary to grieve, to console, to express, to understand, to challenge, to debate, and to inspire.
Action
It also is a time for action. Let me outline efforts either underway or planned to launch this week.
First, we will undertake an effort to understand the experience of antisemitism at Harvard Business School—investigating more deeply the concern I have heard that noxious elements of antisemitism persist on our campus and in our classrooms. After this assessment—which will engage faculty, staff, students, and alumni—is complete, we then will develop an action plan outlining specific steps we might take to address antisemitism at the School. The lessons we learn from this effort will help us examine other hidden forms of discrimination that persist at HBS, including Islamophobia. Throughout my time as Dean, I have expressed my aspiration that Harvard Business School be a place where every individual is able to be the best they can be. It pains me to acknowledge this is not our current reality, and so we must take on this work with energy and urgency. Toward that end, we will announce the leadership and composition of this group before the end of the month.
Second, I am mobilizing small groups of faculty, staff, and students to revisit and clarify aspects of our campus culture. One group will look at our classroom norms and how we continue to deliver our planned curriculum while providing opportunities to discuss and deepen understanding of the conflict. A second group will examine demonstration guidelines, ensuring we protect and balance our community values, rights of expression, restrictions on hateful speech, and the safety and well-being of every member of our community. This will necessitate developing a deeper and shared understanding of hate speech: what constitutes it, how we define it, and the repercussions for members of our community who use it. Both groups will be asked to develop recommendations we can implement quickly and modify as circumstances change.
Finally, we are taking additional steps to ensure the safety and well-being of our community. We have a sophisticated security plan as our baseline, including a state-of-the-art Security Operations Center that is staffed 24/7 and the ability, for example, to lock down a classroom, an office, or a building almost instantly. Campus security can be reached, night and day, by calling 617.495.5577, and HUPD is available at 617.495.1212 if any individual senses a threat to their personal safety. Both HUPD and HBS have increased patrols by officers and other security personnel. And our Operations team works daily with HUPD, local, state, and federal agencies to evaluate threat levels and to support events and campus activities in a coordinated way. While no credible threat has yet been identified, we are considering additional steps such as requiring ID-card access to more buildings on campus.
Additionally, two Harvard-wide Community Spaces—one to support Jewish, and one to support Arab, Muslim, and Palestinian community members—have been launched which aim to foster a sense of belonging through dialogue with peers. Gatherings have been scheduled through the end of the month and additional details can be found here in the Quick Links. The University also has published a Guide for Protecting Against Online Abuse and Harassment, which can be found here. We will work closely and individually with any student, faculty member, or staff member who comes to us with concern, and are open to other suggestions and ideas. We want our campus to be safe, secure, and vibrant.
Closing Thoughts
We must find a way forward. Why? Because if we can’t do it here—drawing on the strength of our community, the knowledge and experience among us, and the resources of Harvard University—then where else can this work be done? I recognize the grief and pain of so many at the School. I feel it myself. I also firmly believe that by educating leaders who make a difference in the world, and by learning and working together across our differences, we can contribute to peace and prosperity around the globe. Now is the time to recommit to our mission with a sense of urgency and purpose."
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