Israel, Canada Collaboration Breathes New Life Into Transplant Patients

Nov. 4, 2020

By SHARON GELBACH

Sheba Medical Center in Israel and Toronto General Hospital are collaborating to advance lung transplantation in Israel and to enhance medical education in both countries.

Dr. Liran Levy

In the last year, Sheba’s Institute of Pulmonary Medicine has established a new lung transplant program, headed jointly by Dr. Liran Levy, who, in 2019, completed four years of clinical, research and surgical training at Toronto General, together with surgeon Dr. Milton Saute who brought lung transplantation to Israel.

Dr. Milton Saute

According to Sheba’s head of Pulmonary Medicine, Dr. Amir Onn, collaboration with Toronto General “will put Sheba on the map of lung transplantation” due, in large part, to revolutionary technology that can increase the number of donor lungs by almost 50 percent.

Dr. Amir Onn

Toronto General is renowned for having performed the world’s first successful lung transplant in 1983. The hospital has since expanded its lung transplantation program, both clinically and in terms of research.

Dr. Marcelo Cypel

One of the most groundbreaking discoveries was made in 2013 by Dr. Marcelo Cypel, a staff thoracic surgeon at Toronto General and director of their ECLS (extracorporeal life support) program. This technique “effected a change in paradigm for how we do lung transplants,” Cypel said in a recent webinar moderated by Canadian Friends of Sheba.

The innovation, called “ex vivo lung prefusion” (EVLP), doubles the amount of time that donor lungs can remain outside the body.

“Previously, donor lungs could be kept for only six to eight hours,” explained Cypel. “Patients had to uproot their lives to live near a transplant center, and staff had to race against the clock to transfer the organ from the donor to the recipient, often forced to perform the complex surgery in the middle of the night.”

The valuable hours gained don’t just optimize the logistics of the transplant operation, they actually allow for recovery of the organ itself.

“As a rule, over 80 percent of donor lungs are unsuitable for lung transplantation due to poor functioning, infection, blood clots or injury,” Cypel said.

By pumping a solution of oxygen, proteins and nutrients into the injured donor lungs, the EVLP system enables injured cells to heal themselves or to be prepared for more sophisticated repair techniques. The method doubled the number of lung transplants performed in Toronto in the last seven years, according to Cypel.

With the help of Toronto General, Saute estimates that the EVLP program will become operational at Sheba by the middle of 2021.

“We anticipate that [EVLP] will make a huge impact and significantly increase the pool of donors for lung transplantation in Israel, especially now, during COVID, with donors reduced by more than 50 percent,” he said in the webinar.

According to Cypel, some of the reasons for the reduction in donor lungs during the pandemic and lockdowns include deaths that occur at home due to the reluctance of patients to seek hospital care, and fewer car accidents whose victims supply donor lungs.

Collaboration will also encompass clinical care, including consultations regarding challenging patients, as well an exchange of trainees, in both directions.

“We hope to send members of our team to Sheba to learn from their unique expertise,” Cypel said.

Onn pointed out that COVID has created new potential candidates for lung transplant. He is currently treating patients in Sheba’s designated post-COVID clinic who present with an unusual combination of symptoms: shortness of breath, chest pain and forgetfulness. Some, he said, have sustained irreparable damage to their lungs.

A growing number of COVID survivors are being referred to the lung transplant center. “We are in the process of identifying those who may be potential transplant cases,” said Levy.

He remarked that he is looking forward to working with his former colleagues and mentors from Toronto General. Looking back on his years spent in Toronto with his wife and four children, he admits that it was hard to leave.

“The Jewish community made us feel very much at home, and we still miss Toronto,” Levy said. “But I think we have a very important mission here in Israel.”

When the teams from both hospitals met one year ago to discuss collaboration, Cypel and Saute were delighted to discover that they both hail from the same city in southern Brazil.

“Although we didn’t meet in Brazil, Dr. Saute told me that he knew my grandparents quite well, and that was very emotional for me,” Cypel recalled. Saute added that they both had the same mentor in thoracic surgery, and thus, “we have the same ideas.”

Patients in both countries, and worldwide, can look forward to the fruits of this collaboration.


Sharon Gelbach grew up in Toronto, studied journalism at Carleton University, and moved to Israel in 1982. She lives in the Jerusalem area with her family. A writer, editor and translator, among her many projects are writing PR content for the Sheba Medical Center.

With a Stethoscope and a Spatula

Oct. 6, 2020

By SHARON GELBACH

The festivals of Sukkot, Simchat Torah and Shemini Atzeret are the pinnacle of the High Holidays, celebrating the gathering in of the harvest. But does the more-than-weeklong feasting with family and friends mean that we must resign ourselves to excess weight?

“Not at all,” pronounced Dr. Rani Polak, founding director of both the Institute of Lifestyle Medicine at Harvard University’s Spaulding Rehabilitation Hospital and of the Center of Lifestyle Medicine at Sheba Medical Center in Israel.

Dr. Rani Polak
Dr. Rani Polak

From his work teaching the little-known science of culinary medicine in Israel and the United States, Polak and his team have observed that once people learn not only what constitutes a healthy diet and how to acquire sustainable skills and techniques, “they can enjoy all the traditional foods while staying within the rubric of a healthy lifestyle and optimal weight.”

Polak is not your run-of-the-mill doctor. In the middle of his medical training, frustrated by the lack of direct connection with patients, he took a year off and traveled to Australia. There, he was able to pursue his passion for gourmet cooking, and completed a professional chef’s course at the famed Cordon Bleu cooking school.

In a seminal “aha” moment, it occurred to him that he could integrate his love of cooking with his medical knowledge to help promote good health – an understanding that led him back to medical school to complete his training, and subsequently, to a fellowship at Harvard.

Polak described what his Culinary Healthcare Education Fundamentals (CHEF) coaching program offers beyond information provided by a dietitian.

“Until very recently, the medical profession was focused mainly on knowledge – what constitutes healthy foods,” he explained. “A dietitian will tell you what your plate must look like, but not how to apply that knowledge.

“Look,” he continued, “Western civilization has access to the greatest abundance of food in the history of mankind, not to mention information and technology. And yet, obesity and diabetes have reached epidemic proportions, and we’re also seeing a steady rise in cancers and heart disease, conditions which can be prevented with lifestyle modifications, including proper nutrition. Clearly, there is a gap between what we know and what we do.”

Polak’s work addresses that gap through coaching that takes into account individual needs, habits and preferences. Obstacles are identified and skills are taught to reinforce constructive behaviour.

He and his team are currently in the midst of a four-year study researching the effects of home cooking on weight loss — all the more relevant these days given the newly aroused interest in cooking spurred by COVID lockdowns and restaurant closures.

Even more presciently, the team employed telemedicine (“We used Zoom long before anyone heard of the coronavirus,” Polak said) for cooking classes.

“When we started with telemedicine, I was skeptical. I’m not only a physician; I’m also a chef. I like to touch food, to taste it. Initially, we thought of it as a way of reducing costs and improving accessibility for people who lived far away. With time, however, we made an amazing discovery that was born out scientifically: enabling participants to learn and practice the skills in their home environment, using their own utensils and appliances, proved far more effective.

“Of course, it doesn’t have to be ‘either or.’ With our hybrid programs, we bring participants to a state-of-the-art teaching kitchen for the opening session. That way, we get to know one another and have a chance to socialize. Then, we continue with Zoom meetings, where we all cook together.”

Polak noted that the Mediterranean diet has been proven to have the highest adherence rate over time, and it’s the one used in his team’s study.

Still, he’s wary of a one-size-fits-all approach.

“I work together with other departments at Sheba, and sometimes patients are sent to me with doctors’ recommendations for a different diet, such as one low in carbs.

“Overall, though, I’ve found that when it comes to maintaining a healthy lifestyle in the long term, behavioral techniques are what will make it or break it.”

He believes that one of the most important behavioral skills to acquire is time management.

“Home cooking is by definition more time-consuming than buying ready-made or processed food, and of course, time is a rare commodity in our society. One important tip I teach is to cook in bulk, as simple as it sounds. Sometimes, that can mean just one ingredient; for example, instead of cooking a cup of legumes, cook the whole package, and freeze the rest as a shortcut for the next time. Your freezer is an important asset.”

Polak won’t discourage those who insist on their favourite traditional foods, even those that are high in fat and sugar.

“It really depends on the individual and how strict he decides to be. But there is no evidence-based study indicating that eating those foods very occasionally is harmful to health. Even the Mediterranean diet allows for some wiggle room. So, I’d say moderation is key.”


Sharon Gelbach grew up in Toronto, studied journalism at Carleton University, and moved to Israel in 1982. She lives in the Jerusalem area with her family. A writer, editor and translator, among her many projects are writing PR content for the Sheba Medical Center.

Israeli Experts on Back to School in the COVID Era

Sept. 9, 2020 – By SHARON GELBACH

As schools slowly open on different dates and in different forms, the CJR consulted a panel of experts from the Sheba Medical Center’s Safra Children’s Hospital in Tel HaShomer, near Tel Aviv, on commonly asked questions: Dr. Itai Pessach, director of the Safra Children’s Hospital at Sheba Medical Center; Dr. Galia Barkai, director of the department of Infectious Diseases in Children at Sheba Medical Center; and Prof. Doron Gothelf, director of the Department of Child and Teen Psychiatry.

Now that the children are going back to school, how can we prevent them from bringing home the coronavirus?

Dr. Galia Barkai

Dr. Barkai: The good news is that children, especially those under 10, have a significantly less chance of catching the virus and of becoming ill with it. Overall, the number of cases of children with COVID worldwide has been very low. At Sheba, the majority of the children were hospitalized for a different reason entirely and a routine test showed that they were COVID-positive.

Nevertheless, they certainly can be carriers as we’ve seen numerous times. What we need is collective responsibility, which implies, among other things, following the safety rules: Wearing masks, maintaining distancing (I don’t like to say “social distancing” because school is a social experience; but rather, physical distancing), and hand hygiene, which I think is the most important thing. Habituate children to hand-washing with soap or sanitizing with gel. Once we do this, we greatly reduce the chance of infection.

Dr. Itai Pessach

Dr. Pessach: Another important regulation that applies to older children is keeping them in capsules, and we’ve seen that this can significantly reduce the rate of infection.

In the coming few weeks, as summer turns to fall and we enter the flu and cold season, we have to be much more vigilant. It’s never a good idea to send a child with a runny nose, cough or fever to school. I know of many parents who would give a mildly ill child a Tylenol and send him to school; this is not an option these days. If a child exhibits any symptom that could be COVID, he must be kept at home as long as those symptoms persist.

Prof. Doron Gothelf

Dr. Barkai: The school bus can also be a source of infection. Try to make sure that the bus is not crowded. Children should have their masks on in the bus and sit as far away as possible from one another. If possible, the windows should be kept open.

What do you recommend for a child with asthma or a child with a weakened or suppressed immune system?

Dr. Pessach: Children with chronic illnesses or who have weakened immune systems due to special medications or chemotherapy are at higher risk of developing a severe case of coronavirus, but overall, the chances are still slight. That said, parents must consult with their health provider to receive specific advice and guidelines related to their individual issues.

How do you recommend that teachers keep themselves safe?

Dr. Barkai: First of all, teachers should know that if they wear a mask and the children also wear a mask, they are very well protected. We found that in the hospital, whenever infections did occur, they could be traced not to the clinical areas, but to the common rooms, where the staff took breaks. So, it’s the same thing at school. Teachers should adhere to safety rules in the classroom, but also in the teacher’s room. Teachers of children who are not of the age required to wear a mask can gain additional protection with a plastic shield. Nothing is 100 percent but I really think that is sufficient.

Dr. Pessach: I want to stress that masks do work. In the Safra children’s hospital, the medical staff was extremely strict about wearing masks and not one clinician caught COVID or even had to go into quarantine. If you wear a mask and a plastic shield, know that you are protected. This is how we protect high-risk patients.

How often should we change masks?

Dr. Pessach: The recommendation for disposable surgical masks is to change them twice or three times a day. At the hospital, we are required to switch every shift, which is every eight hours.

How can I keep my child safe while taking part in sports?

Dr. Barkai: It’s impossible to do sports with a mask because of the increased output of carbon dioxide. For this reason, sports are best done outside to reduce the chance of infection. Alternately, they can be done inside a large auditorium, where it is possible to keep a distance between students. If the only place for physical activity is inside the classroom, it’s better to forgo it.

How can I help my child who has to be in quarantine?

Prof. Gothelf: Quarantine is not a normal situation and it is never pleasant. The following are a few important steps to take:

1. First, explain to the child, in an age-appropriate manner, the reason for quarantine and its importance. When we grasp the significance of what we do, it gives us the strength to do it. Lacking a full explanation, the child is liable to imagine all kinds of scenarios. It’s also important to clarify to the child that he did nothing wrong, so that he shouldn’t feel guilty.

2. Try to keep up a regular routine that is as close to the child’s regular routine, including normal sleep/wake times.

3. Limit the child’s exposure to media. Children who read the news may become unduly anxious; it’s better for them to hear the news through the filter of their parents.

4. In the event there the school offers Zoom classes, try to encourage the child to participate so that he will continue to feel involved in the class and won’t fall behind with his schoolwork.

How can I prepare my child for the transition from preschool to first grade?

Prof. Gothelf: Children become anxious mainly when they don’t know what to expect. It’s Important to prepare a child for any transition, especially one in which there are COVID regulations added to the mix. Hang the school schedule on the fridge, tell him about the new rules at school and explain their importance. Personal example here is of utmost importance. You can’t expect your child to adhere to the rules if you don’t. 

Small children often have trouble managing with their masks. Make sure they fit well, that the elastic isn’t too loose or too tight, that the material doesn’t irritate the child’s skin. Allowing the child to choose a fabric mask in the color or design of their choice can help.

Preschoolers should have at least one visit to school before the start of the year to help them make the transition from kindergarten to school — to meet the teacher, learn where the washrooms are, etc. In the COVID era, schools have skipped this stage. Remember that and try to fill in those gaps by taking the child to school in the first days.

How can I help my child get the most out of distance learning?

Prof. Gothelf: Let me begin by saying that distance learning is challenging for both parents and children. Relax. Now is not the time to insist on children getting straight A’s. Let’s lower our expectations; our children will have plenty of time to catch up.

Unlike in a classroom situation, teachers cannot see when the children are experiencing difficulty. You as the parent must try to keep in touch with the teacher to keep her in the loop. Often, children need more help with distance learning, and this can be challenging for working parents. Try to get the help of an older sibling, or a neighbor. And again, keep in touch with the teacher. 


Sharon Gelback
Sharon Gelback

Sharon Gelbach grew up in Toronto, studied journalism at Carleton University, and moved to Israel in 1982. She lives in the Jerusalem area with her family. A writer, editor and translator, among her many projects are writing PR content for the Sheba Medical Center.