Directed and semi-directed living donation of kidneys: a current debate in Israel and elsewhere

 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).

Abstract: Living kidney donations in Israel come from 2 sources: family members and individuals who volunteer to donate their kidney to patients with whom they do not have personal acquaintance. We refer to the first group as directed living donors (DLDs) and the second as semidirected living donors (SDLDs). The incidence of SDLD in Israel is ∼60%, the highest in the world. We introduce results of a survey among 749 living donors (349 SDLDs and 400 DLDs). Our data illustrate the sociodemographic profile of the 2 groups and their answers to a series of questions regarding spirituality and social tolerance. We find SDLDs to be sectorial: they are mainly married middle-class religious men who reside in small communities. However, we found no significant difference between SDLDs and DLDs in their social tolerance. Both groups ranked high and expressed tolerance toward different social groups. Semidirected living donation enables donors to express general preferences as to the sociodemographic features of their respected recipients. This stirs a heated debate on the ethics of semidirected living donation. Our study discloses a comprehensive picture of the profile and attitudes of SDLDs in Israel, which adds valuable data to the ongoing debate on the legitimacy of semidirected living donation.

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.

...

"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:

Thursday, July 27, 2023

Kidney brouhaha in Israel: is a good deed still good when performed by a shmuck?

I ended that post with this:

"I'll give the last word to a Haaretz op-ed, also in English:

 Is It Kosher to Donate Kidneys Only to Other Jews?  A well-known religious journalist in Israel declared the " -only" donation of his kidney. His act is imperfect, but not immoral by Robby Berman"

Monday, July 31, 2023

Altruistic kidney donors in Israel

...

and, here in the U.S.:

Friday, March 12, 2021

Kidneys for Communities

" 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"

Altruistic kidney donors in Israel

 The Forward has the story

Why Israel has more altruistic kidney donors than any other country in the world By Michele Chabin

"Israel is in the bottom half of countries when it comes to organs harvested after death, the type used in most transplants globally. ...

"But ...for more than a decade the number of Israelis who have donated kidneys while they are still alive and well has increased to the point that Israel is the worldwide leader in live donations per capita.

"That’s in large part thanks to the Jerusalem-based nonprofit ... Matnat Chaim, Hebrew for “gift of life,” which recruits and encourages individuals in good health to donate a kidney for purely altruistic reasons. 

"Of the more than 1,450 live kidney donations Matnat Chaim has facilitated, more than 80% percent were altruistic – donated by individuals who had no connection to the recipient. According to the group’s records, it made at least half of the matches between recipients and live donors in Israel from 2015 to 2022.

"Rabbi Yeshayahu Heber, whose life was saved by kidney from a live donor, founded Matnat Chaim in 2009 with his wife Rachel. Rabbi Heber, who died from COVID-19 in April 2020, had said he was moved to recruit volunteer donors after watching other kidney patients die for lack of transplants. 

"On Israel Independence Day this spring, Rachel Heber was awarded the prestigious Israel Prize in honor of the couple’s lifesaving work. 

...

Broadly speaking, the medical definition says that death occurs when the brain is no longer functioning, even if the heart is still beating. There are exceptions, but most ultra-Orthodox rabbis say death occurs when the heart stops beating and the person stops breathing.

“The problem is, if you wait until the heart stops, you can’t harvest the organs,” said Judy Singer, Matnat Chaim’s assistant director.

"For these reasons, Heber made it his mission to recruit live kidney donors.

"With other groups, including the Halachic Organ Donor Society and the Israel Transplant Authority, Matnat Chaim has convinced many religious Jewish communities to encourage members to donate altruistically. “Today, religious Jews, and haredim especially, are at the forefront of live kidney donations,” Singer said. “They say, I can’t donate an organ after death, but take my kidney and help someone now.”About 90% percent of Matnat Chaim’s kidney donors belong to the Modern Orthodox or ultra-Orthodox streams of Judaism.

“That number used to be 97%, but we’re always looking to increase the number of secular donors and Arab donors,” Singer said.

"The group has arranged for “many” Arab Israelis to receive transplants, she said, but did not share numbers for those recipients. Matnat Chaim is looking to work with an Arab group or individual to increase the number of Arab donors and recipients in the future, she added.

...

"According to the Ministry of Health, 656 transplants were carried out in Israel in 2022. Of those about half — 326 — came from living donors. By comparison in the U.S. that same year, about 15% of all organ donations came from living donors.

"Though transplant rates have been rising in both countries, many are still dying for lack of a donor. In Israel, 77 people died waiting for one in 2022."

 

Kidneys for Communities

 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"

They say "Kidneys for Communities was founded on the idea that communities inherently take care of each other. If we can save a life, we can save the world.

"When we tap in to the compassion and connection of communities, we can radically increase the number of living kidney donors around the world and save tens of thousands of lives every year. By enlisting one community after another to join our mission, more donors will choose to give, more lives will be saved and more communities will be strengthened."

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Here's their press release, which includes the idea of a community member starting a kidney exchange chain that would end with a donation to a community member:

Kidneys for Communities' new program aims to increase living kidney donations impacted by COVID. New national community-directed donation program takes center stage for National Kidney Month

"Tackling the living kidney-donor shortage, Kidneys for Communities, a nonprofit, has launched the first-ever national community-directed donation program to increase the pool of living kidney donors in the United States.

"The pandemic has impacted living kidney donations across the U.S. According to the U.S. Organ Procurement and Transplantation Network (OPTN), living kidney donations in 2020 dropped to just 5,237, the lowest number in just over two decades. 

...

"The Kidneys for Communities model addresses the significant shortage of living kidney donations in the U.S., where more than 100,000 people are in immediate need of a kidney transplant, according to the OPTN. Based on OPTN data, of those who receive kidneys from living donors, approximately 95 percent know or are associated with the donor through their community network.

"The community-directed donation model increases living kidney donations by allowing potential donors who belong to membership-based associations to direct their lifesaving donation to someone—even a potential stranger—based on a community they want to support.

...

"To further increase living donor and recipient matches, Kidneys for Communities partners with leaders in the renal transplantation field, including Alliance for Paired Kidney Donation, which matches willing but incompatible kidney donor and recipient pairs through paired donations.

"Through Kidneys for Communities and Alliance for Paired Kidney Donation, a person can donate their kidney on a community member's behalf, similar to a voucher concept; the member in need is then entered into a pool, where they're matched with a viable donor. This creates a chain that allows for at least two people in need to receive a kidney: the member of the respective community and another recipient in need.

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The program is loosely motivated by some of the faith-based organiztions that have been so successful in recruiting living donors in the U.S. and Israel.

Related posts

Friday, February 9, 2018

Altruistic kidney donation in Israel: Matnat Chaim (gift of life)

hursday, September 5, 2013

Project Renewal: Kidney donation in faith-based communities

Tuesday, April 21, 2015

Expanding non-directed kidney donation: the Renewal model

Rabbi Yeshayahu Haber (1965-2020), who founded "Gift of Life" kidney donor organization

Rabbi Yeshayahu Haber, who founded the Matnat Chaim ("Gift of Life") organization of kidney donors in Israel, has died of coronavirus. He was 55 years old.

YNet has the story:
הרב שהציל חיים נפטר מקורונה (Google Tranlate: The rabbi who saved lives died of corona)

Here's a story in English from Vos Iz Neias? (Yiddish: "What's New?")
Rabbi Yeshayahu Haber, Who Founded “Gift Of Life” For Kidney Donations, Passes Away From Coronavirus

and this from the Jerusalem Post:
'Gift of Life' founder Rabbi Haber passes away at age 55 due to COVID-19

"Haber's funeral will take place at 2 a.m. in Jerusalem. The public is asked not to come to the funeral procession."

GIFT OF Life: Matnat Chaim donors, 2016-2017.

Here are all my posts on Matnat Chaim, which recently recorded its 800th kidney donation.

Kidney donation in Israel

In Israel, as in the U.S., a lot of living kidney donations to strangers come from people associated with faith based organizations.  Tablet Magazine has the story:

TO SAVE A STRANGER’S LIFE
Kidney donations are on the rise among Orthodox Israelis
By Sara Toth Stub October 28, 2019

"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.
...
"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.
...
"Two Jewish organizations in the United States, Kidney Mitzvah and Renewal, also raise awareness about and facilitate live kidney donation/
...
"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.
...
"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."

Kidney exchange in Israel using Itai Ashlagi's software

My colleague Itai Ashlagi has been inventing, building, distributing and updating state of the art kidney exchange software ever since he came to Harvard, some years ago. Since then he's been at MIT, and now Stanford, but this recent article from the Jewish Telegraphic Agency about how his software is propagating in Israel still thinks he's at Harvard:

New program finds donors for complicated kidney transplant patients

"JERUSALEM (JTA) — Kidney transplant patients who have had a hard time finding a match will have another opportunity through a new unit at an Israeli hospital.

"Kidney transplant patients who suffer from high levels of antibodies due to previous transplants or blood donations can go for many years without finding a suitable donor. A new and advanced software program can be used to cross-check through advanced information systems from hospitals in Israel and around the world.

"The program, developed by Professor Itai Ashlagi of Harvard University, was donated to the Matnat Chaim organization and will be operated out of Beilinson Hospital’s Department of Transplantation in Petach Tikvah, in central Israel."

Gift-giving cycles: kidney exchange stories from Britain and Israel

The Guardian has a podcast about a British kidney exchange involving three patient-donor pairs. They call it a "chain" but they mean a cycle--it's a cycle of gift giving. You can listen at the link.

Would you give your kidney to a stranger?
The UK’s living donor scheme allows six people to enter a chain, and three of them will get a new kidney from a stranger. Rachel Williams speaks to six participants. 

"The UK’s living donor scheme allows six people to enter a chain, and three of them will get a new kidney from a stranger. Such chains are anonymous but, for the first time, the Guardian’s Rachel Williams has brought together six participants.

In today’s episode, we hear from those giving and receiving a kidney, and Williams explains how the matches are made possible. "

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And from YNet, a story of a non-directed donor who became a directed donor and part of a cycle with four patient-donor pairs:

The kidney club: Doctors at Beilinson Hospital performed an extraordinary 8-way kidney surgery involving 4 donors and 4 recipients brought together by Matnat Chaim, dedicated to encouraging altruistic kidney donations.

the 4 recipients

"The transplant chain was facilitated by Matnat Chaim, an Israeli non-profit dedicated to encouraging healthy volunteers to donate kidneys to patients requiring a transplant. The organization, which has already facilitated 626 transplants to date, was founded in 2007 by Rabbi Yeshayahu Heber after he found himself needing a kidney, finding a donor and then setting out to help others who were in the same predicament.

"This kidney donor chain began with altruistic donor Benjamin, who donated to a man named Lee. Yardena, Lee’s partner, in turn donated a kidney to a woman named Leah, whose son, Yonatan, donated a kidney to a man named Suheib. Suheib’s mother, Maison, then donated her kidney to a woman named Gil—who was meant to be the original recipient of the kidney donated by Benjamin.

""I approached Matnat Chaim Chairman Rabbi Heber and asked him to help me find a kidney donor," said Gil, 36, adding, "to my delight, Benjamin, a person I don’t even know, agreed to donate his kidney … unfortunately though he wasn’t a match.”

"After tests conducted by doctors at Beilinson ahead of the planned cross-transplant, a possibility arose for Gil to be at the receiving end of a new kidney.

"We have all become like family," Gil continued, “All of us are from a different background—religious, secular, right and left-wing, Jews and Arabs—there is now a special connection between us."
*********

See my previous posts on Matnat Chaim
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Gift giving rings have for some reason reminded me today of the anthropological literature on gift giving in cycles through Kula rings in New Guinea, studied by the early anthropologist/ethnographer Bronisław Malinowski.

Merry Xmas to all of you for whom today (or yesterday) is a day of gift giving.

Religiosity of non-directed kidney donors

Here's an online early view of a paper from the Journal of Clinical Nursing (and see some related blog posts at the end of this post):

Spirituality and religiosity of non‐directed (altruistic) living kidney donors
Ariella Maghen BA  Grecia B Vargas MSPH  Sarah E Connor MPH, CHES Sima Nassiri BS  Elisabeth M Hicks MA  Lorna Kwan MPH  ... See all authors
First published: 5 March 2018 https://doi.org/10.1111/jocn.14223

Abstract
Aims and objectives
To describe the spirituality and religiosity of 30 non‐directed (altruistic) living kidney donors in the USA and explore how they may have affected their motivations to donate and donation process experiences.

Background
The rise in non‐directed donors and their ability to initiate kidney chains offer a novel approach to help alleviate the overextended kidney transplant wait list in the USA. However, little is known about the non‐directed donors’ motivations, characteristics and experiences.

Design
We conducted a qualitative‐dominant study and used a grounded theory approach to analyse data.

Methods
Thirty participants completed in‐depth interviews between April 2013–April 2015. Three analysts independently read and coded interview transcripts. Grounded theory techniques were used to develop descriptive categories and identify topics related to the non‐directed donors donation experience.

Results
Sixteen of the 30 non‐directed donorss discussed the topic of spirituality and religiosity when describing their donation experiences, regardless of whether they were actively practising a religion at the time of donation. Specifically, three themes were identified within spirituality and religiosity: motivation to donate, support in the process, and justification of their donation decisions postdonation.

Conclusions
Findings from this study are the first to describe how spirituality and religiosity influenced the experiences of U.S. non‐directed donorss and may help improve non‐directed donors educational resources for future spiritual or religious non‐directed donors, and the overall non‐directed donors donation experience in efforts to increase the living donor pool.

Relevance to clinical practice
Spirituality and religiosity are often overlooked yet potentially influential factors in Western medicine, as demonstrated through the experiences of Jehovah's Witnesses and their religious restrictions while undergoing surgery and the beliefs of Christian Scientists against taking medications and receiving medical procedures. Understanding needs of non‐directed donors specifically with spirituality and religiosity can better position kidney transplant centres and teams to improve predonation screening of non‐directed donor candidates and provide support services during the donation process.
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Here are some earlier posts about religion and living kidney donation:

Thursday, September 5, 2013

Project Renewal: Kidney donation in faith-based communities

Tuesday, April 21, 2015

Expanding non-directed kidney donation: the Renewal model

Friday, February 9, 2018

Altruistic kidney donation in Israel: Matnat Chaim (gift of life)

Altruistic kidney donation in Israel: Matnat Chaim (gift of life)

Matnat Chaim (gift of life) is an Israeli organization, led by a rabbi, that promotes living kidney donation.  It's been quite successful, but has also been the source of some controversy and suspicion.

Here's an academic article about them:

Altruism and Religion: A New Paradigm for Organ Donation
by Aviad RabinowichEmail authorAlan Jotkowitz, Journal of Religion and Health, February 2018, Volume 57, Issue 1, pp 360–365

Abstract: "Activity of NGO’s supporting living donor kidney donations can affect the shortage of kidneys. Matnat Chaim is a Jewish orthodox organization active in Israel since 2009. This is a voluntary organization with aims to shorten and eliminate the waiting list for kidneys. Since the beginning of its activity, it has said to play a key role in 379 kidney transplantations. In 2015, out of 174 live donor kidney transplantations that took place in Israel, Matnat Chaim had a key role in 88 of them (50.6%). We found some ethical issues concerning the organization's activity. The donor can restrict his or her donation to specific characteristics of recipient which can result in organs transplanted in a homogeneous group of the population. Another issue is the question of whether nudging people to kidney donation takes place and whether it is valid to do so. We found that Matnat Chaim does a great deal for promotion and intermediation of kidney donations in Israel. This form of promotion can be implemented by other organizations and countries."

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They earlier were the subject of some investigations, but I haven't heard that anything further has come of this. Here's an article from The Times of Israel in September 2017
Head of transplant organization arrested over ‘organs for donations’ scheme
Charity suspected of bumping potential recipients to top of waiting list in exchange for funding, paying illegal compensation to donors

"Police on Monday arrested the head of a charity that facilitates voluntary organ donations in Israel, and three of its employees, on suspicion that it illegally traded organs for donations.
"The suspicions include managing the waiting list so as to bump potential recipients to the top in exchange for donations to the organization, and paying compensation to potential organ donors, police said.
...
"A police spokesperson explained that the investigation was “particularly complex and sensitive” and officers have made an effort not to interrupt the continuing work of the organization “in order to allow its life saving services to continue regardless of the ongoing probe.”"

Living kidney donation in Israel: Matnat Chaim in trouble with the law

The Israeli organization Matnat Chaim (gift of life) encourages and facilitates non-directed kidney donation, i.e. living donor kidney donation by donors who don't have a particular recipient in mind. It's generally agreed that they have saved hundreds of lives. In an earlier post I linked to stories reporting that they were under investigation for potential violations of some of Israel's laws involving the financial donations they received. (Israel, like almost everywhere, has laws against paying for a kidney...)

Now the plot has thickened, and some leaders of the organization have been arrested. They have also received strong expressions of support.  Here are two stories in English.

From The Times of Israel:
Head of transplant organization arrested over ‘organs for donations’ scheme
Charity suspected of bumping potential recipients to top of waiting list in exchange for funding, paying illegal compensation to donors 

"The organization is said to have encouraged relatives of those in need of transplants to make donations to the organization in order to shorten the waiting time to receive organs.

"Police noted that they are not treating individual donors or organ recipients as suspects. “If anything, they are victims who themselves have been working to save lives,” the statement said.

"Police said the investigation begun a number of months ago after a complaint was received against the organization from the Health Ministry. Evidence has since been collected from organ recipients, their families and other sources.

"A police spokesperson explained that the investigation was “particularly complex and sensitive” and officers have made an effort not to interrupt the continuing work of the organization “in order to allow its life saving services to continue regardless of the ongoing probe.”
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and from Arutz Sheva (channel 7, Israel National News):
Rabbi Kanievsky supports head of NGO investigated by police
Rabbi Chaim Kanievsky publicly visits head of the 'Matanat Chaim' NGO, under investigation for trading organ donations for money.

"Prominent haredi Torah sage and leading halakhic authority Rabbi Chaim Kanievsky visited the house of Rabbi Yeshayahu Haber, who heads the Matnat Chaim NGO, in a public show of support for the embattled organization. Police are currently investigating Matanat Chaim over suspicion that the NGO bumped patients to the top of its recipient list in exchange for donations.

"The visit is seen in the haredi world as signaling Rabbi Kanievsky's support for Haber and Matnat Chaim, which works to assist kidney donations in Israel. Earlier this month, hundreds of people who had received kidney transplants joined in a social media campaign defending Matnat Chaim, which one of them called "a sanctification of Gods name, people who do God's holy work on this earth".

"In early September, police had arrested Haber and other heads of Matnat Chaim over suspicions that members of the association advanced names on the organ transplant wait list in exchange for money that was transferred, in most cases, in the form of donations to the association.

"Police had opened the investigation several months ago following a series of complaints to the Ministry of Health. As part of the probe, police interviewed former donors to the NGO, and their suspicions were strengthened due to the fact that the majority of those donating money were unable to work and their financial situation was poor, leading authorities to conclude that these were not really donations, but in fact payment for being advanced on the waiting list for an organ transplant.

"Matnat Chaim is revered in the haredi world, and many public figures have slammed the investigation, including famed haredi author Chaim Walder, who called it a "witch hunt". Yisrael Hayom's haredi affairs writer Yehuda Shlesinger wrote last week that "the State of Israel should ask forgiveness from Rabbi Yeshayahu Haber, who saved the lives of 466 Israelis and who has been under house arrest for four days in one of the most delusional investigations ever."

Israel transplant investigation

The Israeli organization Matnat Chaim (Gift of Life), founded by Rabbi Yeshayahu Heber, is under investigation about whether it encouraged families to contribute to the organization in order to receive a shorter waiting time for a kidney transplant.

Organ donor organization suspected of moving donors to head of line for money
Police currently investigating an organization specializing in organ donor mediation, on suspicion of receiving money to provide donors with organs before others in line for transplants.
Omri Efraim & Rotem Elizera|Published:  31.03.17 , 15:06

"Israel Police is carrying on an investigation into Matnat Chaim, an organization that helps find organ donations for those in need of a transplant. The investigation is centered on claims that the organization charged for a "donation" intended to push forward those who paid it, despite there being other people in front of them in line waiting for the same organ donation.
...
"The police stressed that the investigation is a very delicate one, involving people who are suspected of paying the extra fee out of a wish to facilitate a vital transplant that for a member of their family.

Matnat Chaim stated that "We know nothing about the investigation carried against (the organization—ed), and so we do not find it necessary to respond." The organization has so far aided in some 400 transplants in Israel. It only works with organ donors wishing to donate organs for zero pay."
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Here's another story with a bit more detail:

Police launch inquiry into kidney transplant organizationCops investigating claims that Matnat Chaim bumped patients to top of recipient list in exchange for donations

"The probe follows a complaint from the Health Ministry that recipients were bumped to the top of the list in exchange for donations to the organization.

Police have taken evidence from organ recipients, their families and other sources in the ongoing investigation.

A police spokesperson explained that the investigation was complex and sensitive. The organization is suspected of encouraging relatives of those in need of transplants to make donations to the organization in order to shorten the waiting time to receive a kidney.
...
"Over 400 healthy people have donated a kidney through the organization.
...
"In the past, the organization has said that it had never agreed to accept donations in exchange for promoting a patient in the waiting list. It said that “it completely rejects any suggestion of any hint of wrong-doing.”