Tissue typing Laboratory and National Laboratory for Solid Organ Transplants

The Tissue Typing Laboratory is divided into 3 main areas:

1. National Organ Transplant Laboratory: 
A. Organ allocations from deceased donors: As the national laboratory, we are the sole facility in the country responsible for allocating organs from deceased donors, with a team of technologists and consultants available 24/7, throughout the year. 
B. Organs from living donors: Conducting compatibility tests for living kidney donors and potential recipients. 
2. Tissue Typing Unit for Stem Cell Transplants (Bone Marrow and Umbilical Blood) 
3. Paternity and other family relationship testing.

National Organ Transplant Laboratory

Director: Dr. Ronit Pasvolsky-Gutman, PhD

Following consent to donate organs, laboratory tests are done to match organs: kidneys, heart, lungs, and pancreas with the most compatible recipients and to exclude recipients who will be immunocompromised by the transplant. These tests are essential, both for living and deceased donors. The gold standard in reduction of the risk of organ rejection in transplants is a crossmatch test in which lymphocyte cells from the donor are incubated with the serum (blood without cells) of the potential recipient.  Cell death following this in vitro test (i.e. a "positive cross match") excludes the possibility of transplant for the specific potential recipient.  In addition, the laboratory performs routine tests, usually every three months for all patients on the national transplant lists in order to determine the antibody specificities and levels of the patients against potential donors.  This helps in performing a computer matching, in silico crossmatch test, prior to the actual cross match.

Bone marrow stem cell transplantation tissue typing unit

Director: Dr. Nina Svetlitzky, PhD

Performing tissue typing tests for bone marrow transplants
 

A bone marrow transplant is a widely used treatment modality for cancers like leukaemia or certain genetic conditions. This procedure can either be autologous, using the patient's own marrow, or allogeneic, from a matched donor. For a successful transplant, it is crucial that the tissue typing of the donor and recipient are compatible.
A patient's sibling has a 25% likelihood of being a tissue type match. If there are no siblings or no match among them, we look worldwide in database registries. These registries list individuals who have consented to donate bone marrow, increasing the possibility of finding a compatible donor with a matching tissue type for the patient.

The link between tissue typing and certain diseases
 

Some diseases, such as celiac disease, chronic arthritis, or eye inflammation, are linked to specific tissue markers. For instance, a particular eye disease might be linked to the HLA-A29 marker, and arthritis to HLA-B27.  Having these HLA typings increases the risk for several auto-immune conditions.

Cross-matching test in the context of recurrent miscarriages
 

One factor contributing to recurrent miscarriages may be the maternal immune system's rejection of the embryo. By conducting tissue typing tests and cross-matching the male's white cells with the female's serum, medical professionals can either confirm or exclude this as a cause, thus directing the appropriate course of treatment.

Paternity testing and other family relationships

Director: Dr. Ron Loewenthal, MD, PhD

Genetic family relationship tests are used to confirm or exclude a genetic relationship between individuals. Israeli law stipulates that these tests require a court order from a family court. 
Upon securing the court order, an appointment for the test can be arranged at thelaboratory. The tests are performed using either a blood or buccal smear from the individuals involved.
On the day of the sample collection, individuals must present proof of identification - either an ID card or passport. If the child's details are not on the ID card, the child's birth certificate is also required. Additionally, two recent passport photographs and the court order authorising the test must be provided.
In a paternity test, the DNA of the child and the alleged father are analyzed to determine if the man is indeed the biological father. Each person inherits half of their genetic attributes from their biological father and the other half from their biological mother. Should the child possess any genetic markers found in the mother but absent in the man, it conclusively indicates that he is not the father, suggesting the existence of another biological father.
On the other hand, if all the genetic markers tested in the child are also found in both the woman and the man, it can be determined with almost 100 percent confidence that the man is indeed the biological father.
A paternity test can be conducted even before birth, using amniotic fluid containing fetal cells. This procedure can be carried out through amniocentesis (around the 17th week of pregnancy) or chorionic villus sampling (CVS) (around the 10th week). It is important that the treating gynaecologist coordinates the test with the laboratory well in advance to ensure its successful execution.
The laboratory also has the capability to conduct complex tests using various genetic markers tailored to the type of genetic question being asked, confirming or refuting more complex genetic relationships, such as those to aunts or grandparents.
Testing can also be conducted when one or more individuals are overseas, such as in cases involving babies born through surrogacy, or during naturalisation procedures mandated by the Population Authority. Collection of samples from subjects abroad takes place at Israeli consulates. 
The results of these tests are completely confidential and are only shared with the courts.