Giving up an organ to help save a life is not an easy decision. Yet, when possible, living donors provide organs that are more likely to result in what doctors call positive outcomes.

Previous coverage

Holiday hearts: Area residents give extraordinary gifts, published 12/25/11

Among the most common living donor transplants are kidneys since a healthy donor needs only one to live. But just 20 percent of all kidney transplants involve a living donor, according to the U.S. Department of Health and Human Services.

Transplant statistics

MUSC statistics on transplant operations:29 Median kidney wait time in months3,900 Number of kidney transplants since 196893% Graft survival (adult)99% Patient survival (adult)96% Graft survival(pediatric)100% Patient survival (pediatric)

A few years ago, Rabbi Ari Sytner of Brith Sholom Beth Israel, Charleston's Orthodox synagogue, first contemplated donating a kidney to someone in need. Last month, it happened. The decision was the result of much discussion, research and faith. The Post and Courier asked Sytner to describe the experience.

The numbers

In South Carolina, only the Medical University performs organ transplants. In 2011, the hospital did 220 kidney transplants, 28 of which involved living donors. Currently, there are 870 people registered with the MUSC Transplant Center who are waiting for a kidney, and more than 100,000 nationally, according to MUSC and the Organ Procurement and Transplantation Network.Though the state has one of the shortest wait times for kidney transplants, it is among the worst regarding kidney health.One in eight South Carolinians has chronic kidney disease, according to the National Kidney Foundation. The state is third in the nation for the number of people on dialysis.Blacks suffer disproportionately. About 30 percent of the population is black, but blacks make up 75 percent of the state's kidney patients. Many more go untreated.Diabetes is the leading cause of kidney failure, according to the foundation.

Q: It's less than a month since you donated a kidney. How are you feeling? How goes the recovery?

A: Thank God, I feel terrific. I was told to expect to feel 20 percent better with each passing day, and it has been incredible to watch the progress and the miracle of the human body and modern-day medicine. It is amazing how the body can adapt and run just as perfectly with one kidney as it did with two.

Q: Tell me about the recipient. Who is she? You met for the first time in New York City shortly before the procedure. What was that meeting like?

A: Ronit Havivi is one of the most special people I have ever met. She is a 44-year-old single mother of three children and lives in Israel. During the last few years of her kidney illness, she had been connected to a dialysis machine for much of the day and unable to work. During that time she had become certified as a life coach and volunteered to help people in need. More recently, she has enrolled in law school and is excitedly preparing to begin her second year. What I have been most struck by about Ronit is her constant positive attitude, no matter what life throws at her.

When I first met her at the hospital, the week prior to surgery, we were both grinning from ear to ear. She immediately began crying as she kept repeating "thank ... thank ... thank ..." She covered her mouth as she collected herself and explained that she wanted so badly to say "thank you," but she couldn't bring herself to say the words. She felt that the words themselves seemed too empty compared to the deed, and she almost felt embarrassed to say two simple words for an act that was so incredible.

At the same time, I felt that the words "you're welcome" seemed silly. This surgery would connect us for life and runs so much deeper than words can express. Our connection was instantaneous and I could not have imagined a more perfect person to receive my kidney. My family and I now speak to Ronit nearly every day, and we feel as if we have known her our entire lives.

In the hospital, her oldest daughter shyly asked me if I would consider coming to Israel to officiate her wedding when it is time for her to get married! I responded that it would be my greatest pleasure. In fact, I am thrilled to think about the fact that, while I cannot presently live in the Holy Land, at least a part of me will always be there.

Q: What first prompted the idea of donating a kidney? And in your thinking, how did you get from that initial idea to implementation?

A: Several years ago, I began teaching a series of classes to my synagogue on the topic of Jewish medical ethics. I spent a great deal of time researching, studying and teaching about the Jewish and ethical perspectives of organ donation. The conclusion of my classes was always the same: Not only is living kidney donation permitted by Jewish law, but if a person is inclined to donate, it is a tremendous mitzvah (good deed). After hearing myself say those words over and over, I began to look in the mirror and wonder if my teachings were simply lip service, or if I truly meant what I was preaching. Thus began my personal journey.

I continued to research the topic and eventually contacted a nonprofit organization in New York which helps people in Israel find compatible kidney matches from around the world. At that point, I put the brakes on. I nervously sat down with my wife to have the first conversation with her on the subject. I was fairly convinced that she would think I was crazy, and that would be the end of the conversation.

I took Chana out for coffee and told her that I was thinking about altruistically donating a kidney and wondered what she thought. I was stunned when she responded with such incredible wisdom and support. She said, "We don't need to make that decision today, but why don't you begin with the long list of medical testing, and we can just take it one step at a time." She went on to explain that if it was the will of God, I would pass all of the medical tests and things would fall right into place. However, if it were not meant to be, then I would be excluded for one of a thousand possible medical reasons, and I can sleep comfortably at night knowing that at least I tried. Her words resonated with me and motivated me to begin the process of testing and see where it led.

If nothing else, I would receive what the medical community refers to as "the million-dollar workup" -- a very extensive set of scans and tests, which would all be covered by the recipient's insurance. After 10 more months of research and batteries of medical tests, some done here at MUSC and some done in Montefiore Hospital in New York, they confirmed that I would be an ideal candidate to donate a kidney to Ronit.

There is simply no way that I could have gone through this experience without the loving support of my close and extended family, as well as the support of my synagogue and community. Although the surgery was laparoscopic, and I was walking around the very next day, it was nevertheless major surgery which required me to have extra care and attention. During my recovery, our family moved in with my in-laws where I spent two weeks convalescing. The sacrifice my wife made in putting her law practice on hold while helping me recover is a testament to her incredible support and commitment. Having this network of friends and family that could be there with me in the hospital as well as during my recovery really made a huge difference. Whenever somebody comments about the "wonderful act" that I did, I remind them that it was not just me, but my entire family that shares this deed.

Q: Jewish ethics provide lots of food for thought. Summarize the ethical considerations and describe how you reached your conclusions.

A: As I always teach my congregation, the Torah is the book which guides us through every one of life's decisions. This was no exception. On the one hand the Torah explains that there is nothing more sacred than life itself, and we are forbidden to stand idly by the blood of our brother. Thus, any actions to preserve, save or extend life are seen as extremely positive. On the other hand, if the actions being taken present a risk to one's own well-being, it creates an ethical dilemma. Whose life is more valuable? Do I have the right to jeopardize the sanctity and longevity of my own life just to save someone else's life?

The dilemma is resolved, as it is with many medical ethics questions, through patient autonomy. In other words, a person is not obligated to donate a kidney. However, if they wish to assess the risk and determine it to be minimal, they may voluntarily subject themselves to the unnecessary surgery in order to save the life of another human being.

In this case, I had spoken to dozens of doctors and past kidney donors to fully understand the short- and long-term risks. It was clear to me that risks were, in fact, minimal, and I was comfortable undergoing the surgery -- knowing that I would be saving a life. In fact, thousands of people take risks every day by undergoing unnecessary cosmetic surgeries, for reasons far less valuable than this.

Kidney donation may not be for everyone. If a person is inclined to consider it, I would strongly encourage them to do so. In fact, I would be happy to speak to anyone about my own experiences.

Q: How has this experience affected you intellectually and emotionally? Has it altered the way you see the world or think about issues such as identity, personhood, life, death?

A: During the 12 months that I researched kidney donation, I used that time to challenge myself to get into prime health. With my wife's support, I began dieting and exercising and lost about 30 extra pounds and felt better than ever. For me, this journey became one of physical, intellectual, spiritual and emotional growth. Honestly, I feel stronger and happier than ever before. Sure, I may tire quickly right now, but even with one less kidney, I feel more complete than ever. Knowing the impact that I have made in the lives of Ronit and her children is a feeling that is indescribable.

Life is full of tough decisions and sacrifices. Yet, every day women allow their bodies to go through all forms of physical trauma solely for the purpose of giving life. For me, while I will never experience pregnancy, this is as close as I will ever feel to the joy of giving life. It was a sacrifice I was glad to make. In the spirit of Nathan Hale, I would say that, "I only regret that I have but one kidney to give."

As a person of faith, I believe that life is ultimately in God's hands. That does not mean we should be reckless with our lives, but calculated risks are always acceptable. As a rabbi, I have officiated many funerals and am very in touch with the balance of life and death. I view my temporary existence on Earth as being for the purpose of doing good, serving God and helping his children. Therefore, for me, the idea of donating a kidney was not a scary one, but just another way that I can help the world, serve God and positively impact someone's life.

When people tell me how amazing they think my donation was, I respond, "We all have to give in ways that speak to us." For me and my family, this was a way for us to give, and I can only hope that each person will take their own look in the mirror and find meaningful ways for them to give back to the world.