Terror victim Eytam Magini leaves the gift of sight after death

How does organ donation in Israel work, and how does one become an organ donor?

 Israelis light candles at the scene of a terror attack on Dizengoff street, central Tel Aviv. 2 people were killed and several more injured in last night terror attack, April 8, 2022.  (photo credit: NOAM REVKIN FENTON/FLASH90)
Israelis light candles at the scene of a terror attack on Dizengoff street, central Tel Aviv. 2 people were killed and several more injured in last night terror attack, April 8, 2022.
(photo credit: NOAM REVKIN FENTON/FLASH90)

As a holder of an Israeli organ donor card, 27-year-old Eytam Magini was able to restore health to patients awaiting transplants, despite his own life being cut short in Thursday night’s terrorist attack on Tel Aviv’s Dizengoff Street.

On Sunday morning, the National Transplant Center of Israel reported that Magini held an Adi Card – Israel’s organ donation card – and with his family’s agreement, the corneas of his eyes will be donated for future cornea transplant surgery.

What is an Adi card?

Israel’s organ donor card is named after Ehud “Adi” Ben Dror, who died at the age of 26 from acute kidney disease after waiting for a transplant for over two years.

Throughout the course of his illness, Adi spoke with his parents and friends about his dream of creating some sort of database through which people could sign a statement agreeing to donate organs after their deaths.

ADI card for donors (credit: Courtesy)ADI card for donors (credit: Courtesy)

In October 1978, following his passing, his parents made his dream a reality and created the Adi Association in his memory. This signified a turning point for organ donation in Israel. Since 1989, the National Transplant Center has administered the database of Adi Cardholders.

Organ donation in Israel

Israel’s National Transplant Center was established by the Health Ministry in 1994 with the aim of creating an official and independent body for the management and coordination of organ donation and transplantation in Israel. The center manages organ donations from all donors – both living and deceased – and is the sole organization in Israel responsible for both the registration of donors and the distribution of organs.

While the center runs several transplant programs in which organs are donated by living donors, a large portion of their work goes to expanding the database of Adi Card holders. The card signifies that in the event of death, the cardholder wishes for their organs to be donated.

On average, around 250 transplants are performed in Israel every year, on both adults and children. The waiting list is still long, however, with more than 1,000 people waiting for a transplant.

Of that number, about 700 are awaiting a kidney, 150 are waiting for a liver, some 70 await a lung, and 120 are waiting for a heart transplant.

An article included in Israel’s 2008 Organ Transplant Law states that holders of an Adi Card and their close relatives will be given priority on the transplant waiting list, should the need arise.

How can one sign up for an Adi card?

Any Israeli citizen over the age of 17 can apply to sign a donor card, regardless of their health status. In the event of the cardholder’s death, the signature on the card testifies their willingness to donate their organs. Despite this, the family is always consulted and can refuse to donate the deceased’s organs if they so choose – although this is a rare occurrence and the family usually tends to follow the wishes of the deceased, the center said.

How does organ donation in Israel work?

The list of organs that can be donated in Israel includes the heart, lungs, liver, pancreas and kidney. However, corneas, skin, bones and heart valves can also be donated. A total of seven transplants can be performed from a single donor.

Each organ has its own separate list of allocation criteria, created according to the characteristics required for a match between donor and recipient. These criteria include items such as blood type, height and weight, as well as the degree of necessity for a tissue and the probability of the transplant increasing the quality of life for the recipient.

Organs can be donated only after brain-respiratory death has been declared. This means that there is a confirmed total and irreversible cessation of activity in the brain stem, which is responsible for the body’s vital systems including breathing capacity, blood pressure and pulse. The reason that organ donation is approved only after this point is that brain stem death will always lead to system collapse, and nobody has ever regained consciousness afterward.

Once brain-respiratory death has been declared in a person who holds an Adi Card, a transplant coordinator, along with members of the deceased’s medical team, will contact the family and discuss the process of organ donation with them, allowing them to decide whether or not to proceed with the wishes of the deceased

A health assessment will then be done on each organ, deciding which ones are suitable for transplantation. Organ donation has progressed considerably over the years. Organs can now be taken from people up to the age of 80, which was not possible several years ago.

For many religious people in Israel, the question of whether post-death organ donation is allowed in Jewish law might dissuade them from signing an Adi Card. However, many religious authorities have come out in favor of authorizing organ donation, so long as the death of the person is established in accordance with Jewish law.

Jewish law defines death by three necessary conditions: The person does not move their limbs, the person is unconscious, and the organ which defines the moment of death (the brain stem) has ceased to function completely and irreversibly.

In 1985, the Chief Rabbinate of Israel appointed a committee made up of rabbis and medical-rabbinic advisers to establish the meaning of the last condition as there was disagreement over which organ would need to cease working in order to define the moment of death.

The committee’s conclusion established that “a person in which all the objective scientific conditions for determining total brain death are present – including, in particular, brain stem death, and total and irreversible absence of respiration – is dead for all intents and purposes.”

However, over the following years, disagreements continued between medical professionals and rabbinic leaders over the practical manner of pronouncing brain death. Therefore, the rules and definitions were finally established legally with the passing of the Brain-Respiratory Death Law in 2008, meaning that both physicians and rabbis had a set of legal regulations to follow when determining brain death.

The transplant center said that Magini’s corneas were successfully harvested and will now be used to restore sight to a patient or patients awaiting a full cornea transplant. They did not mention if they had succeeded in saving any other organs from the young man.

His donation was approved by his parents, who emotionally called it “Eytam’s last contribution to Israeli society.”