How a Canadian Donor Cleared Israel's Central Transplant Committee

Result: Israel's central evaluation committee approved a Canadian resident's kidney donation to her Israeli brother and the hospital's NIS 186,000 medical tourist invoice was withdrawn · Timeline: 9 months · Challenge: Foreign donor, cross-border family money, Hebrew committee hearing · Authority: Central Evaluation Committee and the National Transplant Center, Ministry of Health · Financial Impact: NIS 186,000 billing cancelled plus NIS 61,000 in statutory donor payments

Background

A secondary school teacher in Ottawa, in her early fifties, has one brother. He moved to Israel in 1998, lives in Rishon LeZion, and by early 2025 had spent three years on dialysis with kidney failure caused by IgA nephropathy. He was on the national waiting list and had been told the realistic wait for a deceased donor kidney was measured in years, not months.

She was tested in Canada and matched. She had never lived in Israel, holds no Israeli citizenship, speaks kitchen Hebrew at best, and had assumed the process would be roughly what it would have been in Ontario: a transplant unit, a workup, a surgery date.

That assumption cost the family four months. The Israeli transplant unit was happy to have her. The Israeli statute was a separate matter, and it treats a donor who lives abroad differently from a donor who lives in Netanya.

The Challenge

The Organ Transplantation Law 5768-2008 was written to do two things at once: to make living donation possible and to make organ trading impossible. Section 3 prohibits any person from receiving consideration for an organ removed from their body, and it prohibits paying it. Every other procedural requirement in the Law exists to test that prohibition against the facts of a particular family.

The testing is done by an evaluation committee. Section 13 routes the application to a local committee sitting at the transplanting hospital where donor and recipient are relatives, and to the central evaluation committee where they are not, or where the donor is not an Israeli resident. Our client is a sister, which would ordinarily have sent the file to the local committee at the hospital in a matter of weeks. Because she lives in Ottawa, the file went to the central committee instead.

The composition is the same either way. Section 14 requires five members: a senior physician as chair, a psychiatrist or clinical psychologist, a social worker, a public representative and an attorney. What differs is the volume of files the central committee handles, the fact that it sits in Israel and expects the donor to appear before it, and the depth at which it examines money.

That last point is where this file nearly failed. In 2021 the brother had wired his sister CAD 38,000 towards their late mother's care home costs in Ottawa. It was an ordinary family transfer between two siblings sharing a parent's expenses, made four years before anyone raised the word donation. On a bank statement produced to a committee whose statutory job is to detect payment for organs, it is a transfer of money from a recipient to a donor.

In Practice: Section 13 of the Organ Transplantation Law 5768-2008 sends an application from a donor who is not an Israeli resident to the central evaluation committee rather than the local committee at the transplanting hospital, and Section 16 gives that committee up to sixty days from a complete application to decide. Section 15 requires it to be satisfied that consent is genuinely voluntary, that no consideration prohibited by Section 3 has passed, that the donor understands the right to withdraw at any point, and that there is no other impediment, including within the family. On this file the committee spent most of its attention on a single CAD 38,000 bank transfer made four years before the donation was contemplated, and clearing it took eleven weeks of documentary work.

There was a second problem, and it was purely commercial. When the family first contacted the hospital, the enquiry landed with the international patients department, which opened her as a medical tourist and quoted NIS 186,000 for the donor evaluation and the nephrectomy. Nobody at the hospital was acting in bad faith. A Canadian resident telephoning an Israeli hospital about surgery is, on the face of it, exactly what the Medical Tourism Law 5778-2018 was written to regulate.

It was still the wrong file. A living donor is not a patient buying a procedure. She is the source of an organ for somebody else's treatment, and that treatment belongs to an Israeli resident insured under the National Health Insurance Law 5754-1994.

What We Did

We closed the medical tourist file before anything else. Section 17 of the Medical Tourism Law 5778-2018 requires a medical institution to issue a written invitation to a medical tourist setting out the diagnosis, the proposed treatment, its risks and a detailed price quotation, with the tourist's written approval before arrival. Once such a document is signed, unwinding it is an argument. We wrote to the recipient's health fund and asked it to confirm in writing that the donor pathway, meaning the tissue typing, the imaging, the psychological assessment, the surgery and the inpatient stay, was funded as part of his transplant. The confirmation came back in nineteen days, the international department cancelled the quotation, and the donor's file was reopened under the recipient's authorisation number. Nothing was ever paid on the NIS 186,000.

We documented the 2021 transfer to a standard a committee could accept. This was the bulk of the work. We obtained the Ottawa care home's invoices and receipts for the relevant months, the mother's Canadian bank statements showing the money leaving the sister's account for the care home, the brother's Israeli statements showing it leaving his, and a short affidavit from each of them explaining the arrangement. Every Canadian document was notarised, apostilled under the Hague Convention by the competent authority in Ontario rather than the federal one, and translated by a notarial translator in Israel. Two of the care home receipts had been issued to the mother rather than to our client, which meant a further letter from the facility confirming who had actually paid. Producing this before the hearing rather than in answer to a question at it changed the tone of the entire file.

We arranged the hearing so she could be understood. The committee works in Hebrew. Section 13 of the Patient Rights Law 5756-1996 requires that consent to medical treatment be given after an explanation delivered in a language the patient understands, and a donor's consent is the whole subject of the hearing. We instructed a court-grade interpreter, had the consent documentation translated into English in advance, and asked for the donor and the recipient to be heard separately, which Section 16 permits and which committees generally prefer in any event. She flew in for the hearing and flew home the same week.

We dealt with entry and length of stay in advance. Canadians do not need a visa in advance for a short visit, but the surgical stay was a different proposition: admission, the operation, and roughly five weeks of recovery before she was cleared to fly. We prepared a letter from the transplant unit setting out the dates and the medical purpose, so that the length of the intended stay was explained at the border rather than improvised, and so that an extension application to the Population and Immigration Authority would have had a foundation if the recovery had run long. It did not.

In Practice: Section 22 of the Organ Transplantation Law 5768-2008 and the Organ Transplantation (Payment of Compensation and Reimbursement of Expenses to a Donor) Regulations 5770-2010 give a living donor a state payment for loss of earning capacity over the forty days following the donation, plus reimbursement of life insurance premiums capped at NIS 145 a month for up to sixty months, up to five psychological sessions capped at NIS 483 each, and recovery leave taken within ninety days of the donation. The payment is administered by the National Transplant Center at the Ministry of Health and is available where the recipient is an Israeli resident, which is the position here even though the donor is not. Claims go to the transplant center within twelve months of the expense and are paid into a bank account within sixty days of a complete submission. Our client had no Israeli bank account, and opening one as a non-resident took five weeks, which is why we started it before the surgery rather than after.

The Outcome

The central evaluation committee approved the donation forty-one days after the file was accepted as complete. The Director General's decision under Section 17 followed within a week, and the transplant centre received its authorisation the next day. Surgery took place at a transplant unit in the Tel Aviv district six weeks later.

Nine months elapsed between the family's first instruction and the operation. Roughly four of those months were spent unpicking the two false starts, the medical tourist quotation and an incomplete first application that had been submitted without any explanation of the 2021 transfer. The genuinely irreducible part of the timetable, meaning the committee's own assessment and the Director General's decision, was under two months.

The NIS 186,000 quotation was cancelled in full and nothing was invoiced to the donor. Her statutory donor package came to just over NIS 61,000, of which NIS 47,200 was the loss of earning capacity payment assessed on the income documents she filed, with the balance made up of the insurance and recovery elements. Israeli legal fees, apostilles, notarial translation and interpretation came to NIS 34,000.

Two things did not go smoothly and are worth recording. Her Ontario coverage paid nothing towards a procedure performed outside the province, and the out of country prior approval route was never realistically open, because living donor nephrectomy is available in Ontario. And her Canadian transplant physician, entirely reasonably, questioned whether accepting money from an Israeli state body in connection with a donation was appropriate at all. The answer is in the statute: Section 3 prohibits consideration for an organ and then expressly carves out the Section 22 payments, which are compensation for loss and expense rather than a price. We provided that analysis in writing for her Canadian file, and it settled the question.

Key Takeaways

What this case illustrates for non-residents in similar situations:

1. Where the donor lives changes which committee decides. Section 13 of the Organ Transplantation Law 5768-2008 sends an application from a donor who is not an Israeli resident to the central evaluation committee, not the local committee at the hospital. Build the timetable around that from the first week, because the transplant unit's own scheduling has nothing to do with it.
2. Any money that has ever moved between donor and recipient will be examined. Innocent family transfers are common and are not disqualifying, but they must be evidenced with invoices, statements and affidavits, apostilled and translated, and filed with the application rather than produced in answer to a question. Our guide to medical treatment in Israel as a non-resident sets out the document standards Israeli institutions expect from abroad.
3. Do not let a hospital's international department open you as a medical tourist if you are a donor. The Medical Tourism Law 5778-2018 governs the sale of treatment to a tourist. A donor's evaluation and surgery attach to the recipient's entitlement under the National Health Insurance Law 5754-1994, and a written confirmation from the recipient's health fund is the document that resolves it.
4. A non-resident cannot join the Israeli deceased donor waiting list. The national list run by the National Transplant Center is for residents insured under the National Health Insurance Law 5754-1994. If the patient rather than the donor is the one living abroad, a living related donation is the route that exists, and the committee stage becomes correspondingly more important.
5. Open the Israeli bank account early. The Section 22 donor payments are made by transfer, and a non-resident account application in Israel takes weeks rather than days. Starting it after the surgery adds a month to money the donor is entitled to.

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Facing a Similar Situation?

If you live outside Israel and are considering donating to a relative there, or you are the Israeli patient waiting on a donor abroad, the committee route and the funding route are two separate problems and both are easier to solve before the first appointment than after it.

Contact us for a confidential consultation about your Israeli legal matter.