Shortly before laying themselves down on an operating table in New York’s Mt Sinai hospital on Tuesday, two strangers embraced in an emotional, unforgettable meeting. Sobbing, the young men exchanged prayers and blessings before their simultaneous surgeries.

For young Israeli Yossi Azran, the surgery literally marked a new lease on life: After 15 years of debilitating kidney disease and 2.5 years of dialysis, Azran’s slow death was averted through the altruism of an idealistic American Orthodox rabbi.

However, for Rav Shmuly Yanklowitz, while immensely meaningful, the donation was but another of his signature thoughtful efforts to live his ideals out loud.

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“I have been teaching about social justice and the value of human dignity and saving human life for many years,” Yanklowitz told The Times of Israel from his hospital bed.

As of April 2015, some 101,662 Americans are awaiting kidney transplants. The need far exceeds supply

Speaking somewhat slowly, still in pain, Yanklowitz said Wednesday that he felt divinely inspired in making his decision to donate. “I felt an imperative to give all I could give,” he said.

Yanklowitz is one of very few who donate their kidneys to complete strangers. As of April 2015, some 101,662 Americans are awaiting kidney transplants. The need far exceeds supply. In 2014, 17,105 kidney transplants took place in the US. Of these, 11,570 came from deceased donors and 5,535 from living, according to the US Department of Health & Human Services Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR) Annual Report.

Statistically, the wait for a kidney transplant is 3.6 years. In the meantime, the most common therapy is dialysis, in which patients are attached to a machine three to four days a week for three or four hours each time to clean their blood. There are grave problems with infection and other complications, however. Of the 300,000 Americans on dialysis, 50% will die within five years; 80% die within 10 years.

Through a combination of factors — including, some claim, halachic misinterpretation — Jewish communities throughout the Diaspora are among the lowest percentages of donors, all the more so altruistic donations such as Yanklowitz’s. Therefore, American Jews have largely been getting a proverbial free ride when it comes to organ donations.

This is slowly changing, primarily in ultra-Orthodox communities, which, according to a recent in-depth report in the Forward, “accounted for up to 17% of the people who donated a kidney to strangers” in the general US population. And with two Jewish organizations dedicated to facilitating transplants — The Halachic Organ Donor Society for mainstream Modern Orthodox and Renewal, which has until recently focused on the ultra-Orthodox sector — this number is slowly rising.

But Yanklowitz is still an anomaly. So is Azran, who despite his chronic kidney disease volunteered for the IDF. The fledgling playwright told the Hebrew-language Yediot America this week, “I can’t believe there are people like this… The truth is, I’d started losing hope.”

‘I want to do this, but am a little afraid’

Based in Arizona, Yanklowitz, 33, is the executive director at the pluralistic Valley Beit Midrash. He’s also the founder and CEO of the Jewish animal welfare institute Shamayim V’aretz, and founder and president of the Orthodox social justice organization Uri L’Tzedek.

And as if that wasn’t enough, he’s written seven books on ethics, blogs for The Times of Israel, has a masters in moral development and psychology from Harvard University, a second masters in Jewish philosophy from Yeshiva University, and a doctorate in epistemology, moral development and developmental psychology from Columbia University.

Evidently extremely thorough in his education, Yanklowitz also holds three rabbinic ordinations: from New York’s Yeshivat Chovevei Torah Rabbinical School, from Efrat Chief Rabbi Shlomo Riskin and a third private smicha from Jerusalem-based Rabbi Nathan Lopez Cardozo.

Normally exuding health, the always smiling, energetic husband and father of two is just that type of guy who would decide to donate his “spare” kidney. He’s a passionate vegan, a civil rights activist, spiritual scholar, teacher and most of all, a real mensch.

But the decision came with real fear, said Yanklowitz, who has never even broken a bone, let alone undergone medical procedures or a hospital stay.

“I felt like it wasn’t a fear about it being the right decision, more a fear of the unknown, the pain, the risks,” said Yanklowitz a day after the surgery. He said, however, that once he realized his fear was of the physical, he knew he could go through with it.

‘To be honest, I had to really spiritually work on myself to overcome some fears… Placing myself on the operation table was very counterintuitive’

“Once I knew that God wanted me to do this, I knew that two kidneys were put into my body for him [Azran], not for me,” he said. He admitted, however, “To be honest, I had to really spiritually work on myself to overcome some fears,” citing some of the testing he underwent to ascertain if he could be an acceptable donor.

“The first time I had an MRI, I was really terrified,” he said. But as the machine whirred and hummed while he lay in its close quarters, “I could feel God’s presence very close in a unique way.”

On Tuesday morning, the day of the surgery, Yanklowitz went to the mikveh (Jewish ritual bath) and read Genesis 22, the Binding of Isaac, three times. The story describes God’s call to Abraham to sacrifice his son Isaac, a counterintuitive sacrifice that has been analyzed throughout theology and philosophy, and which Danish philosopher Søren Kierkegaard (1813–1855) famously called the “Teleological Suspension of the Ethical.”

Yanklowitz said that morning, in contemplating his own personal sacrifice, it was the first time he truly connected with the story.

In part, he said, he felt he too “was being asked to do something more than I was capable of… Placing myself on the operation table was very counterintuitive.”

Yanklowitz credits his wife Shoshana as a source of strength. In a moving — and apparently rare — Facebook post which Shoshana wrote while her husband was in surgery, she clearly feels the same way.

“Four years ago I married the most magical and amazing man I’d ever met. Everyday and with every action he shows me what it means to live life according to your ideals. Everyday he shows me how to be kind and gentle. Everyday he shows me how to be thoughtful and intentional. Everyday he shows me how to be loving and sincere. Everyday he shows me how to be strong and determined. Everyday, with every word and every action, he amazes me. Today is no different.”

Giving life is a Jewish thing

One of God’s epithets, as found in the Book of Jeremiah, is the “Examiner of Kidneys and Heart.” Also in Jewish tradition and still used in everyday Modern Hebrew, the kidneys are the seat of emotion, thought and conscience. For example, the expression “musar kliyot” in Modern Hebrew (derived from Psalm 16:7), connotes remorse or regret.

Kidneys can also be used as describing a vessel of happiness, according to Proverbs 23:16-17. And in the Talmud Bavli Brachot 61A it is written, “Man has two kidneys, one advises him for good, and one advises him for bad.”

The head of the Orthodox Kehilah of Riverdale, Dina Najman, studied at a joint New York University and Yeshiva University’s Albert Einstein School of Medicine bioethics and medical humanities program before receiving smicha from progressive Orthodox Rabbi Daniel Sperber.

In an early morning phone call this week, Najman, wearing her scholar of Jewish law hat, took The Times of Israel through the medical history and resulting halachic process relating to organ donation. As a board member of the Halachic Organ Donor Society, her remarks were prefaced with support and admiration for Yanklowitz’s public promotion of altruistic donation.

The “tachlis” or straightforward halachic answer to whether organ donation is permitted is clearly that it is. Najman took The Times of Israel on a journey answering a qualified question: whether donation is an obligation.

Through the centuries, rabbis including the great physician-philosopher Rambam (who was pro compensation for donors) have debated the issue with conflicting opinions. But as the technology of the surgeries has decreased their risks, rabbis have increasingly ruled it to be a great mitzva or the fulfillment of a positive commandment.

A minority opinion, however, said it should be an obligation — the recently deceased founder of the Shas political party and renowned halachic judge, Rabbi Ovadia Yosef.

In a forthcoming article for the Open Orthodox International Rabbinic Fellowship on the subject, Najman wrote, “R. Ovadiah Yosef claims that a person is obligated to donate his or her kidney based on the verse: ‘Do not stand idly by the blood of your fellow’ (Lev. 19:16). While R. Yosef’s is the minority opinion, it nevertheless illustrates the importance of organ donation.”

Yosef’s promotion of organ donation has not, unfortunately, raised Israel’s levels to those of other western nations.

The halachic issues are broad, including whether one can harm oneself for another, whether one could — or should — be compensated for it. But much of the discussion surrounds the idea of pikuach nefesh, or saving a life.

Essentially, the rabbis state that performance of pikuach nefesh supersedes every commandment, including Shabbat observance, for example, except for three: the worship of false idols, incest or inappropriate sexual relationships, and the spilling of blood, which said Najman, includes your own.

Additionally, misinterpretation of Jewish law, including the idea that one must be buried with all their organs to be resurrected at the end of days, leads Jews — religious and secular — to avoid the discussion of even post-mortum organ donation.

This paucity of Jewish donation is most felt in Israel, where there are 31 donations for every million Israelis. In comparison, in the US there are 90 per million citizens. There are currently some 720 citizens who require a kidney transplant, 100 of which are expected to annually die while waiting for a donor.

“In Israel, the need exceeds the country’s readiness to donate,” said Najman. Many who can afford to go abroad, resulting in a situation of only those who can afford a kidney, receive one.

“In America, we [Jews] can benefit from the kindness of others,” said Najman.

This is why the efforts of Jewish organizations like Renewal, which facilitated Yanklowitz’s donation, are so important. Currently a very small non-profit with only eight staff members, since its founding in 2006 it has succeeded in matching and seeing through some 50-60 transplants a year.

In a brief conversation this week with Renewal founder Mendy Reiner, he emphasized the organization’s steady, but slow work pace, in which there are two coordinators for each donor and recipient during the process leading towards a successful transplant.

Overwhelmed with potential recipients following the Forward article highlighting his organization’s work, he said diplomatically that with the organization’s current manpower, “We cannot do more than what we’re doing.”

In the meantime, he asks communities to educate themselves about donation.

“Get involved. There are people in every single community who need kidneys and it could make a difference if people are educated about it,” Reiner said, adding that

“Renewal is here to help them, and we will try to help in every way. Hopefully we can save lives.”

And at the core, that is what donation is about — saving lives.

In closing our conversation, Najman again praised Yanklowitz for his public discussions promoting donation in a genuine and experiential way on his social media platforms. “The halacha stresses the importance of saving a life,” said Najman. Organ donation is “a noble act in saving a life.”

“Shmuly lives this idea of pikuach nefesh,” she said.