The United Arab Emirates (UAE) and Israel have carried out a historic, lifesaving exchange of kidneys for the first time that has saved the lives of three women. 

The arrangement involved three families — two in Israel and one in Abu Dhabi. An Israeli woman donated a kidney to a recipient in Abu Dhabi, in exchange for a kidney from the UAE to a different Israeli woman.

The exchange involves relatives of would-be kidney recipients who are not histologically compatible with that of their kin. 

At 5:30 a.m. on Wednesday, doctors at Sheba Medical Center removed a kidney from Shani Markowitz, 39. The surgery went smoothly, and the organ speeded to Ben-Gurion Airport in a special cool box that was flown to Abu Dhabi.

Involved in the complicated arrangement were six operating rooms (four of them in Israel), two ambulances, an airplane, coordination, and management to speed up procedures involving air staff, customs and security personnel, and, of course, dozens of doctors and nurses and lab and imaging personnel.

Meanwhile, a woman in Abu Dhabi underwent surgery to remove her kidney that was flown to Israel for a woman hospitalized at Rambam Medical Center in Haifa who needs a kidney. The Rambam patient’s husband donated one of his kidneys to Markowitz’s mother, undergoing the operation at Rabin Medical Center in Petah Tikva, near Tel Aviv, and Markowitz’s kidney has gone to the mother of the Abu Dhabi donor.

The Israel National Transplant Center (INTC) has signed such organ exchange agreements so far with the Czech Republic, Austria and Cyprus, but so far, it has been implemented only with the Czechs. The US government, which was closely involved in the Abraham Accords that last August established normalization between Israel and the UAE, was also involved in the details of the organ exchange, said Dr. Tamar Ashkenazi, a veteran nurse and grief counselor who heads the INTC.

“From the moment the Abraham Accords were signed,” she said, “we started to learn online about the health system and hospitals in the UAE, with the aim of promoting a joint kidney pair donation program for kidney replacement. Since this was during a period of lockdown, no transplants from live donors were performed.”

In early April, a woman who spoke English with an Arabic accent called the INTC office and said she was asking on behalf of someone in Abu Dhabi whether an international exchange program existed in Israel as she wanted to donate a kidney to her mother and no match had been found. We supplied her with the phone number of a transplant nephrologist from Abu Dhabi with whom we had contact. The woman who called us is a pharmacist in Tira [an Arab town near Kfar Saba] and did not know the donor from Abu Dhabi. We continued the contact with the daughter from Abu Dhabi who insisted on donating a kidney to her mother, and she underwent had advanced testing including all that is required for donation and transplantation.”

After an agreement was signed between the health ministries of the two countries, the exchange project was approved by the INTC’s steering committee headed by Prof. Rafael Beyar, the former director-general of Rambam Medical Center. “This is very exciting. It’s the first time we have conducted such a process between Israel and an Arab state, and it really shows that medicine has no borders,” said Beyar, a long-time interventional cardiologist. 

An American company, Alliance for Paired Kidney Donation assisted the team in Abu Dhabi, which had never carried out any kidney exchanges with other countries before. 

Logistics for this procedure included medical aspects such as transferring fresh blood samples between countries to ensure final and accurate matching, coordinating communication between surgical teams, surgical methods, and management aspects such as coordinating times to commence surgeries, coordinating flights, customs and security clearance. All of these were conducted in parallel with the preparation of the mutual agreement between the two countries. 

Kidneys exchanges are considered by Israel if there is no local patient needing an organ that has compatibility. It is not simple for Israel to obtain suitable kidneys from live donors from other countries, like Spain, for example, exchanges organs with adjacent Portugal, and organs are more easily removed from brain-dead potential donors in European countries.  “I believe other countries will join such agreements with us,” Ashkenazi predicted. “Maybe Egypt and Jordan, with which we have peace agreements, will also join in the future.” 

If a would-be recipient has developed a large number of antibodies while waiting for a kidney, finding a suitable donation is more difficult. Organs from live donors, said Ashkenazi, can be attached to a kidney-preservation machine that keeps them viable even for 24 hours.