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Monday, July 27, 2020

It's Time To Bake!

As in years past, this week, in preparation for Shabbat Nachamu, you can once again sign up to participate in the Challah Bake International.


To sign up, click here.

Happy Baking!

Posted by David Bogner on July 27, 2020 | Permalink | Comments (0)

Wednesday, July 22, 2020

The Ultimate Downer of a Wedding Speech

A few years ago I was asked to speak at a wedding-weekend dinner hosted by the groom's family.

In my life, I'd suffered (and slept), through countless rose-colored wedding speeches that if used in an advertisement, would be defined as 'bait-and-switch'.  We married folks have a bad habit of gilding the lily, and IMHO, we do our single friends and children a disservice with our deceptions.

The reason it came to mind now is that the groom (who is still married and now has a beautiful son), reached out to me asking for a copy of the speech.  It turns out his younger brother is getting married soon, and he wants to give his little bro a copy.  He said it was the best advice he received regarding married life.

You can decide for yourselves if I did right or wrong:


Most people in my position, if asked to share a few words over a wedding weekend Shabbat meal, would probably offer the kind of speech that is long on blessings for a long, happy life of married bliss… and short on specifics on how to achieve that, or what to do when the real world intervenes and things don’t turn out exactly the way you envisioned them.

I think we can all agree that I’m not like ‘most people’.

So, when I sat down to write these remarks, I had a choice of going in one of two directions.  Happy and fluffy… or honest and a little dark.   I decided on the practical, honest one… even if it may not be as up-beat as one would expect at an aufruf.

To start with, who am I to offer any advice.?  After all, I’m not the groom's father and I’m too old to really be called a friend.  So what right do I have to offer advice?

There’s a term in English for someone who offers frank, harsh, or severe advice in order to educate, encourage, or admonish someone.  Such a person is called a ‘Dutch Uncle’.

I’ve never been able to pin down exactly what my relationship to the groom is.  But I’ve known him since he was born, and he lived in my home for nearly 4 years while he served in the IDF, so I think that ‘Dutch Uncle’ probably best describes not only my relationship to him… but also my responsibility to him. 

[looking at the groom] I can never approach the closeness of your relationship with your parents and family.  And I’m a whole generation removed from being one of your buddies.  So yeah… ‘Dutch Uncle’ feels about right.  I feel like that title gives me the right, and even the responsibility, to tell you some of the important truths I’ve learned over the past 25+ years of marriage. These truths may sound strange to you today.  But some day, if you are doing things right, they’ll start to make sense.

The one thing that seems to cause the most trouble for newly married couples can be summed up in one word:


The best illustration of this is an old joke about the difference between men and women that goes like this:

Men Marry Women with the Hope They Will Never Change. Women Marry Men with the Hope They Will Change.  Both end up disappointed.”

As with most jokes, at its core is a tiny kernel of truth… or at least a half-truth.

The full truth is that both men and women change throughout their lives, and neither really expects it.  And while I don’t have any scientific studies to support me on this, it seems to me that many of the marriages that don’t last contain at least one person who wasn’t able to accept or adapt to changes in their partner or themselves.

I recently read a compelling article in the New York Times by a middle-aged married person like myself, named Ada Calhoun.  It was entitled “To Stay Married, Embrace Change” (for those who are interested in a good read, it was in the ‘Style’ section on April 21st 2017)

The article starts out with the following statement that caught my attention right away:

A couple of years ago, it seemed as if everyone I knew was on the verge of divorce”.

That statement really resonated with me for the simple reason that Zahava and I have said the exact same thing to each other more than once over the years.

The author goes on to quote some of her friends whose marriages were in deep trouble:

He’s not the man I married,” one friend told me.

“She didn’t change, and I did,” said another.

And then there was the no-fault version: “We grew apart.”

The common denominator that shook the foundations of each of these marriages was ‘change’.  Or more correctly, the inability or unwillingness of one or both partners in the marriage to accept or adapt to change.

But if you look at all of the married people you know in your life, not one of them is the same person they were when they stood under the chuppah.  That means that, not only did they change… but they both adapted to and accepted the changes.

If you’ll indulge me one more quote from the article, I think it reinforces this point:

“Sometimes people feel betrayed by…change. They fell in love with one person, and when that person doesn’t seem familiar anymore, they decide he or she violated the marriage contract. I have begun to wonder if perhaps the problem isn’t change itself but our susceptibility to what has been called the “end of history” illusion:  “Human beings are works in progress that mistakenly think they’re finished…”

The reason I’ve shared all this with you (and your soon-to-be wife if you decide to show it to her), is that if you don’t remember anything else I say to you for the rest of your life… please remember this one thing:  that as long as you are alive, neither of you are finished, or fully formed.  You are both works in progress and you are both going to continuously change; mentally, physically and emotionally.

Another thing that bears mentioning is that it may be ambitious, and even noble, to try to model your marriage after some of the happier marriages you see around you.  But the truth is you can never know everything that goes on behind the closed doors of those you know and admire.

We put on our best faces for the rest of the world.  But nobody outside your immediate family really knows what your life is truly like.

I’m not telling you all this to scare you.  I just don’t want you to be too hard on yourselves if your married life doesn’t seem to measure up to the marriages of others.

I don’t want you to go into this thing thinking your parents or my wife and and I... or any married couple you may know, have some magical gift or secret recipe for our marriages' longevity.  We don’t. It takes constant work.  Hard work!  And the easier someone’s married life looks, the harder they are probably working at it.

Don’t get me wrong… marriage is great; perhaps the greatest thing of all!  But what makes it great isn’t that it is always good, or always easy or even always happy.  On any given day of being married it can also be hard, challenging or even frightening.

And one of the most frightening things that you will discover is that you are going to fight; …at first, a lot.  And I promise you that your fights are all going to be about one of the following three things: 

~ Money, Family or Sex ~ 

Seriously, if you are married 90 years, nearly every argument you’ll have will be connected - at least tangentially - to at least one of those things.

And like I said, arguing can be scary, for the simple reason that we all tend to think that by fighting, it means our marriage is failing.  After all, nobody else we know who is happily married seems to be fighting!  Guess what?  They are.  

It took me a long time to figure out that our arguments were simply an indication that something or someone in the relationship had changed… and that it caught one or both of us by surprise. 

As humans, we’re hard-wired to notice change… and to be alarmed by it.  From a survival and evolutionary standpoint, change has always been the doorway to the unknown, and the unknown is scary… and often dangerous. So it’s no wonder that change often triggers our primal fight or flight reflex!

Just remember what I said at the start of this upbeat little pep-talk:  Everyone, and everything changes over time, even though nobody expects it.  We’re never finished changing, and as much as we may try to be perfect and find perfection in others.  Perfection doesn’t exist… at least outside of Hashem.

To quote Robin Williams from the film, ‘Good Will Hunting’:

“You're not perfect, sport, and let me save you the suspense: this girl…, she's not perfect either. But the question is whether or not you're perfect for each other.”

And I’ll take that movie quote one step further by telling you that this myth of ‘bashert’ - some perfect soul mate that you are destined to marry and spend your life with - is just that; a myth. 

I’m not saying that you and your bride aren’t soul mates.  Right this minute, you may be.  But tomorrow… and the day after that, you’ll both be a little different.  And you will have to work to recognize the soul mate in each other… just as you’ll continuously have to work to be that soul mate for each other.  And while I can tell you from experience that it is totally worth the effort…it’s also really, really hard. 

And what makes it even harder is that some people are really good at making it look easy.  But don’t be fooled by appearances.  I don’t care who you are; being a grown up is hard.  Being someone’s life partner is hard.  Being a good husband or a wife is really, really hard.

Remember what I told you about never knowing what is going on behind other people’s closed doors.  What you are seeing outside your house is what people want you to see.  You are watching everyone else’s highlight film, while late at night your own blooper reel seems to be playing in an endless loop in your head. 

Keep that in mind any time you are tempted to feel like you, your spouse or your marriage isn’t measuring up.  Chances are you’re doing just fine.  You are just making unfair comparisons.

You may not be aware of this, since you’ve been busy getting ready for your wedding, but May 21st 2017 is a fairly significant date.  While you two are standing under the Chuppah on Sunday, something momentous, and a little bit sad, will be taking place not too far away.

After more than 100 years, on May 21st 2017 The Ringling Bros. and Barnum & Bailey Circus will be giving their last performance before folding up the big top for the very last time.  It would be a shame not to find some deeper meaning in the timing.  All that excitement. .. all that magic… all those illusions… coming to an end, at the very moment in time that you two are starting out your new lives together.

What I would suggest you take from this is what I’ve been saying all along:  That what you see outside your new home together isn’t real; at least not completely real.  From where you are sitting, there is magic at work… and illusions… and excitement.  That’s what you’re meant to see.  It’s what you two will also show the world.

Don’t get me wrong; some of it will actually be real.  If you work at it, and conscientiously practice at it, maybe even a lot of it will be real.   But the love, happiness, satisfaction and respect you’ll have later on in your marriage will be completely different from the feverish, confused versions of those feelings you experienced when you first met and started dating.  And I promise you that it can be so much better.

A hint of this washed up in my email inbox a few weeks ago when a friend sent me a screen grab of a tweet someone had written about an event they had witnessed:

“My parents are wine drunk watching jeopardy and my dad just looked at my mom and said "you're my best friend" and that's all I want in life.”

That may not sound like much to you now, but as you travel down the bumpy, lonely, challenging road of life together, sharing that kind of intimate, trusting lifetime bond with another human being will make you feel like you’ve won the lottery.  It will feel like sitting in front of a roaring fire on a cold winter’s night.

Since you are a musician, and the son of a musician, I feel like I should end on a musical note, so I I’d like to close with the wisdom found in the well-loved standard ‘Paper Moon’ as it eloquently explains how everything outside the two of you isn’t really real, and you shouldn’t build your expectations for yourselves based on the illusions created by others;

“Say, it’s only a paper moon
Sailing over a cardboard sea
But it wouldn't be make-believe
If you believed in me
Yes, it's only a canvas sky
Hanging over a muslin tree
But it wouldn't be make-believe
If you believed in me
Without your love
It's a honky-tonk parade
Without your love
It's a melody played in a penny arcade
It's a Barnum and Bailey world
Just as phony as it can be
But it wouldn't be make-believe
If you believed in me”


[Postscript: At the wedding a couple of days later, I was called up as a witness as 'the Dutch uncle' of the groom.]

Posted by David Bogner on July 22, 2020 | Permalink | Comments (0)

Monday, July 20, 2020

So, about that whole kidney donation thing... (Part 4)

[Read Part 1,  Part 2 and Part 3 first for context]

Now that I've shared a little bit about how I got the idea to donate a kidney, and the hoops I had to jump through to get to the point of being allowed to donate, I guess it's time to look outwards and talk a little about the reason for the entire exercise: the person who will (hopefully), wind up walking around with one of your healthy kidneys.

I'd like you to re-read the previous sentence. 

If the word 'hopefully' seems a bit out of place, I assure you it is not.  In fact, it's arguably the most important word in that sentence.  You see, there are several reasons why the person you want to get your kidney might not end up walking around with it:  The two most common reasons are blood/tissue incompatibility and unsuccessful transplant.

Mismatch:  Part of the medical screening process is a blood test to check the donor and recipient comparability.  It's actually a series of blood tests; the first being to check basic blood type compatibility, and subsequent ones (closer to the surgery) to check - and ensure - specific match between your blood and tissue and that of the intended recipient. There's an excellent discussion of the basics of blood and tissue matching for kidney donation here

If you want to donate to a relative or friend but aren't a suitable match, you can opt for what's called a Paired Donation; basically you end up donating to a stranger, while a better matched stranger donates to your intended recipient.  More about that here.  

Unsuccessful Transplant: When you make a charitable donation to an in individual or organization, you hope that your money will be used well by the intended recipient(s).  But there's no guarantee.  The organization may misuse or redirect the money, or the individual may squander the money meant to provide food or shelter, on drugs and alcohol.  

If you're considering donating a kidney, you need to make peace with the idea that the transplant may not 'take'.  Here are just a few scenarios: 

  • The surgeon may botch the procedure (not likely... but he/she is human). 
  • The recipient's body may attack the transplanted organ (despite blood and tissue compatibility). 
  • The organ itself may not function properly after transplantation. 
  • The recipient may neglect his/her anti-rejection meds, causing the organ to be damaged by the body it was intended to save.

The point is, kidney transplantation - while extremely safe, reliable and overwhelmingly successful - is not a sure thing.   

Think about this for a second:  We tell ourselves that we give our hard-earned charitable donations freely, and with no strings attached, and trust that they will be used as we intend.  But a dirty little secret that we rarely talk about is that we are secretly troubled by the possibility that our monetary gifts might be diverted, misused, or squandered. 

How much more so when giving away something you only have one of?!

I encountered an additional hurdle due to my imperfect Hebrew comprehension.

I didn't have a specific recipient in mind.  Maybe I was naive, but I honestly assumed that I had no say in who received my kidney if I didn't have a specific recipient in mind.  I've been walking around with an organ donor card in my wallet for most of my adult life, and figured that whoever was at the top of the list of people waiting for a transplant was the person who would get my organ when I was rolled into the operating room.

So, you can imagine it came as a bit of a shock when I was in the midst of my full day of medical and psychological screening and the social worker who was interviewing me started out her interview with, "It says here you don't have a specific recipient in mind.  So, tell me the criteria for who will get your kidney?"

I just sat there and stared at her across the table.  It was as though she'd been speaking Chinese.  She'd actually been speaking Hebrew, so there was a real possibility I'd misunderstood her.  I played it back in my head a few times to make sure I understood the individual words... but the sentence still made no sense. 

When I asked her to elaborate, she explained that some people gave general instructions, such as 'The recipient must be Jewish'.  Or 'the recipient must be religious'. 

When I just sat there staring at her, she went on; "Others get very specific", and tossed off a hypothetical,  'I want my recipient to be between the ages of 25 - 35, have blonde hair, blue eyes and be a non-smoker'.

She then restated her question: "Tell me the criteria for who will get your kidney?", and began tapping her pen impatiently on the notepad in front of her.

I was stunned.  I felt like I'd shown up unprepared for an important exam.  Clearly this was something a serious potential kidney donor was supposed to know... and I had no answer. 

Add to that the fact that she'd used the Hebrew grammatical imperative (a command rather than a request), so it seemed that I was required to provide an answer.  

I hedged.  I asked if I could think about my answer and follow up with her.  She scribbled furiously for a few minutes, nodded, and then moved on to the next question in the interview.  But I couldn't help feeling I'd flunked the test right there and then.

I went home and had a really troubled week.  Keep in mind,I hadn't told anyone but my wife I was considering kidney donation, at this point.  And I really didn't want to admit to her that I hadn't given any thought to a critical aspect of the process.

Night after night I lay awake troubled by the weight of the decision.  I couldn't escape the fact that no matter how I phrased my criteria, I was playing God.  The moment I gave any indication of who could receive my kidney, I was also giving clear instructions that others could not receive it.  

I was horrified by the responsibility of having the power of life and death over another human being.

When I went back to the hospital the following week to do a medical test that I hadn't had time for the previous week, and to drop off some follow-up paperwork from my family doctor, I asked to speak with the social worker again. 

When we were seated in her office, I blurted out that I wasn't sure I could go through with it.  I must have looked a wreck after a week of insomnia and a good cry on the drive to the hospital, but she pretended not to notice and simply sat with her pen poised over the legal pad, ready to write.

I told here that if I was required to provide criteria for who would receive my kidney that I couldn't go through with it.  I said that I really, really wanted to donate a kidney, but not if it meant sentencing anyone outside my donation criteria to a slow death on dialysis.  When I finished, I started to gather my things to leave.

I must have looked ridiculous with my red eyes and dramatic pronouncement.  But it was like a huge weight had been lifted off my chest.  For the first time in a week I felt like I could draw a proper breath.  I was disappointed to not be able to go forward with the donation, but I really didn't want to be the one to decide who lives and who dies.

Her reaction was a bit unexpected:  She started to laugh.

For the record, it's hard to feel a sense of closure when the social worker isn't taking you seriously after you've one of the most difficult divisions of your adult life.

She explained that I wasn't required to provide criteria... it was just a standard question since many potential donors preferred to have some control over where their organ went.  But many people opted not to provide any criteria; in fact some preferred not to know who was getting the organ!

She gently explained that I wasn't obligated to provide any guidance on who the recipient would be. She went on, that many people don't want to know who the recipient is until after the surgery is a success.  And others didn't want to know even then.

Hebrew is a simple language in many ways, but to a non-native speaker, it can be tricky sometimes.  Note to self:  The use of the imperative does not preclude options.

So, I told her to write down that I preferred not to have any say over who got my kidney (assuming I would pass all the medical and psychological testing, and be approved as a donor).  The transplant team, I felt, would be in a much better position to weigh the two most important factors I could think of: who would be the best match for my kidney... and who needed it most.

I slept like a baby that night.

Stay tuned for the next installment which will provide a short overview of the transplant surgery and the recovery period... and meeting my recipient. 

As always, if you want to be informed of new posts here, follow me on twitter @treppenwitz



Posted by David Bogner on July 20, 2020 | Permalink | Comments (3)

Sunday, July 12, 2020

A Cautionary Tale In Three Pictures




Quod Erat Demonstrandum

Posted by David Bogner on July 12, 2020 | Permalink | Comments (0)

Friday, July 10, 2020

Photo Friday

Okay, boys and girls (not that I'm suggesting gender is a fixed binary structure...), it's that time again.

Just click on the thumbnail to view the full size image:

As always, if you'd like to be notified when new posts are up, please follow me on twitter @treppenwitz

Posted by David Bogner on July 10, 2020 | Permalink | Comments (0)

Wednesday, July 08, 2020

The Sound of a Bee in a Bottle

I grew up in the '60s and '70s when the advertising prowess of the '50s still held sway over people's habits and preferences.  And as a result, pretty much every waking moment of every day was filled with the sight, smell and sound of cigarettes.

Seeing people smoking and smelling the stink of cigarettes are both fairly obvious.  But do cigarettes have a sound?

Well, maybe not... but the smokers sure do. 

When I was a kid, I knew which of my parent's friends were smokers; not from seeing them smoking, but from the sound of their voices.  Especially women.   If a teacher, telephone operator or waitress had a voice that sounded like a bee in a bottle, it was a pretty sure thing that she was a smoker. 

For that matter there were many actors and singers whose voices gave away their heavy smoking habit even if they were rarely (if ever), seen in public with a cigarette.

As smoking declined in popularity in the late '70s and '80s, so did the ubiquitousness of that 'smoker's voice'. 

But for all the good those health awareness and anti-smoking campaigns did, something happened in the '90s and early '00s.  Young people started taking up the habit in staggering numbers.  And despite legislation that prohibits smoking just about anywhere in shared public spaces, I'm again hearing 'smoker's voices' just about everywhere I go.   

And the truly head-shaking part is that these voices don't belong just to middle-aged people anymore.  I'm hearing twenty-somethings who sound like they belong in a 1940s film noir.



Posted by David Bogner on July 8, 2020 | Permalink | Comments (0)

Monday, July 06, 2020

So, about that whole kidney donation thing... (Part 3)

[Read Part 1 and Part 2 first for context]

If you've finished reading the two previous installments, you now have a vague understanding of what put the idea into my head.  But everyone who donates a kidney comes to the decision by a different road.  Always keep that in mind.

Today's installment is about that critical stage where thoughts are translated into actions.  And here, pretty much everyone travels the same road.  

To be clear, one doesn't go from idly thinking that kidney donation might be a neat idea, to checking into the hospital and letting the surgeons remove the organ. 

Oh my, no... that's how altruistic financial donations work.   In fact, most charities count on hooking you with a compelling pitch at an impulsive moment, so that you'll whip out your credit card before you have a chance to think about all the other things you could do with the money you're about to hand over.  After all, you can always make more money.

That is the very antithesis of the process of considering living organ donation!  You have only two kidneys, and even under ideal conditions you can only give one away.

Obviously the the organizations that manage the stream of potential kidney donors (not to mention the potential recipients), are very anxious for as many people as possible to sign up for altruistic donation.  But there are two main hurdles that must be cleared in order for the donation to go ahead: 

1. Medical

2. Psychological / ethical 

Today I'll be discussing both. 

As an aside, for many people, there is a step before this which deals with the question of who you actually want to receive your kidney.  But I'll leave that for the next chapter. 

The Medical Hurdle:

In order to be able to donate a kidney, a person must be healthy enough that the surgery to remove the organ, and the future lived (to 120!), with only one kidney, do not present unreasonable medical risks.  After all, aside from the whole 'do no harm' thing that the transplant surgeons are bound by, the math falls apart if by removing one person from the list of sick people waiting for kidneys, they end up adding someone new to the list by allowing an unsuitable candidate to go under the knife.

Not only that, but there are a bunch of medical conditions ranging from weight to cardio fitness that can influence your chances of tolerating/surviving the surgery and loss of a kidney  

The kidneys are responsible for a whole range of essential functions in the human body.  The most obvious is removing waste and excess fluid from the body.  That's why people in kidney failure are dependent on ongoing dialysis to stay alive. 

But the kidneys are also responsible for regulating blood pressure, making red blood cells, keeping bones healthy, and controlling the body's PH levels.  If your body is struggling with any of these things with two kidneys, chances are you aren't a good candidate to give one away.

[More about what kidneys do here

That means that the first thing you are going to be asked to do when you make contact with a kidney donation organization or hospital transplant center, is to go to your family doc and get a complete physical exam (including a bunch of basic blood tests).  If you're a grown-up, you should be getting an annual physical anyway, so this might be just the kick-in-the-pants you needed to get into the habit.  

Bottom line, in order to be considered seriously - from a medical standpoint - as a potential donor, you need to make sure your body can survive the surgery and carry on comfortably with only one kidney.

Once you pass that hurdle, buckle up for a long journey of self-discovery.  You are going to find out more about your physical health than most people care to know.  I personally found this process reassuring.  But others take an 'ignorance is bliss' approach to knowing what is going on under the hood. 

I would also add that it is really important to have access to one or more people who have already donated a kidney.  Hearing the perspective of a layman is incredibly helpful to sort the wheat from the chaff.  I was blessed to have several friends who had previously donated, offer insight, advice and guidance during my journey.  If you don't know someone, the hospital and/or donation organization will certainly have a list of people who have offered to have potential donors contact them.

The actual time-frame for this screening process is not set in stone.  If, G-d forbid, you have a critically ill family member waiting for your organ, that might fast-track the screening process to a couple of months or even weeks.  But for most people, you're looking at a minimum of 6-8 months of testing before you get the 'Good Housekeeping Seal of Approval' to don the backless gown and surf into an OR on a gurney.

The Psychological / Ethical Hurdles:

Once you've gotten acceptable results from your basic blood work and physical exam, you will begin a long, two-pronged, path of testing designed to establish your suitability for living organ donation.  I've already talked a bit about the medical side.  Now for the psychological and ethical side.  Even though these two criteria are mostly unrelated, I've decided to address them together since neither can be determined using blood tests or other 'hard' medical exams.

From an ethical standpoint, they are going to want to make sure you aren't being pressured, or paid, to donate a kidney.  As hard as it is to imagine, there are deals being made with the devil every day where the imbalance of wealth is leveraged to essentially extort a kidney from someone in financial need.

I'm not talking about someone waking up in a bathtub full of ice in Tijuana after being rolled in some back-alley cantina. That kind of thing may happen occasionally in the third world... but is mostly the stuff of fiction.

But if someone has a pressing financial need (say, a wedding, college tuition or an expensive medical procedure in the family), 'selling' a kidney might seem like a quick and viable solution.  Sadly, there are doctors and middle-men around the world who profit from this imbalance of organs and resources... and it is as unethical as it is dangerous.  The screening process you are about to undergo is designed to prevent even the appearance of anything of the kind.

You will also be screened several times by a psychologist and/or social worker to determine if you are mentally fit to undergo the organ donation process, as well as to make sure you aren't volunteering to give away a healthy organ for unhealthy reasons (feelings of guilt, inadequacy, desire for accolades, extreme risk-taking behavior, surgery-fetish, etc.).   They will also ask a question that caught me off-guard:  How will you feel if the transplant is unsuccessful (meaning you gave away a kidney for nothing)?  It gets kinda real when you think about such things.

Many potential donors are focused solely on the act of donating.  But they aren't prepared for the day after, and the return to normalcy (and relative obscurity), that invariably occurs weeks, months and years after they've recovered.  That's a topic for another day, but it is worth mentioning that the psychological screening is meant to force a potential donor to take a brutally hard look at what is driving the decision process, and how it might all play out before, during and especially after the kidney donation is completed.

I'll be happy to answer any specific questions about MY screening process (your mileage may vary), in the comments or private email.  But assuming you successfully pass all the screening hurdles, you will find yourself with an appointment to sit before a multi-disciplinary committee tasked with giving final approval to you as a potential donor.  At least this is how it is done in Israel... I assume most developed countries have similar approval committees in place.

The committee is made up of medical doctors, mental health workers, attorneys and a civilian advocate.  They will be given your entire file of screening tests / reports to review in advance.  Their job is to determine - objectively - if you are a suitable candidate for living kidney donation.

What does 'objectivity' have to do with anything'?  Isn't the hospital that did all the tests objective?  Aren't they staffed by physicians bound by the Hippocratic oath to 'do no harm'? 

Yes.  But they are also an interested party.  In fact they are one of many interested parties involved in the process!

Your motivations may be ethically and psychologically correct/healthy, but the fact that you want to donate a kidney makes you an interested party.

The recipient needs a new kidney.  They would never want to do anyone else harm, but the fact that they have a need colors their objectivity.  So they too, are an interested party.

Even the hospital doing the transplant is an interested party, albeit their interests are confusing and often conflicting: 

On the one hand, they genuinely want to 'do no harm'.  Add to that, they are like a baseball player whose future prospects depend heavily on maintaining good 'stats'.  A ball player needs to keep their batting average or ERA at optimal levels.  A hospital has its own set of stats by which it is ranked locally and internationally; particularly in the realm of transplant surgeries.  A hospital with a strong transplant program wants to have a statistically 'all-star' success rate (for both surgical outcomes and long-term donor and recipient health).  Accepting bad candidates means increased risks... which translate into bad 'stats'. 

On the other hand, there are far fewer potential kidney donors than there are people waiting (desperately), for viable transplant organs.  Even if everyone signed their donor cards, and every fatal accident and illness ended with two viable kidneys entering the transplant pool, cadaver kidneys don't last nearly as long as organs taken from a living donor.  The difference can be the difference between a donor kidney lasting 5-8 years in the recipient's body... and lasting 15-20 years! 

So hospitals have an interest/stake in qualifying as many living donors as possible.  I don't believe they would deliberately qualify an unsuitable candidate for kidney donation.  But I could certainly see how they might qualify a borderline candidate with rationalizations and statistics to back up their decision.

So, standing in the way of all these interested parties is this final committee whose job it is to objectively determine if the person in front of them is medically, ethically, and psychologically suited to take the fairly drastic step of allowing the removal of a healthy organ from their body.

This committee is not a rubber stamp.  They will ask hard questions, And as adversarial as they may seem during what may feel like an interrogation... they are actually the only party in the entire process that is completely uninterested.  Their interest is protecting the health and welfare of the donor, and ensuring that the entire process is transparent and adheres to international medical and ethical standards.

If / when you receive the formal approval of this committee, you are free to commit to donate your kidney and schedule the transplantation surgery with your hospital team.

But (and this is a huuuuge but), at any point up to the point when you are rolled into the OR and put under general anesthesia, you can change your mind and decide not to go through with it.  The recipient will only be told that it turned out you weren't a suitable donor, and nobody will hold it against you.  At every stage of the process it is important to keep this in mind.  At no point while you are still conscious are you committed to the point where you can't change your mind.  This harks back to the previous installment when I explained why its best not to tell too many people in advance.  Leaving yourself the ability to back out gracefully is important to decision-making process and your long-term mental health.

Stay tuned for the next installment which will deal with the issue of who actually winds up with your kidney, should you decide to give one away.

As always, if you want to be informed of new posts, follow me in twitter @treppenwitz

Posted by David Bogner on July 6, 2020 | Permalink | Comments (2)

Friday, July 03, 2020

Photo Friday

It's that time again...

Just click on the thumbnail to view the full size image:


As always, if you want to be informed of new posts, follow me in twitter @treppenwitz

Posted by David Bogner on July 3, 2020 | Permalink | Comments (3)