Nechama Rivlin, the 73-year-old wife of Israel’s 10th President Reuven Rivlin, has undergone a lung transplant following a serious decline in her condition due to chronic pulmonary fibrosis. She received the lung from a 19-year-old young man, Yair Yehezkel Halbali, who drowned in Eilat.

Her condition is said to be stable at the Rabin Medical Center-Beilinson Campus in Petah Tikva near Tel Aviv. Her husband and children are with her. After the operation, she was put under anesthesia and ventilated until she becomes stronger and is able to breathe on her own.

Lung transplantation is a life-saving transplant that allows patients with end-stage lung disease to return to normal life without dependence on external oxygen supply. The complex operation took several hours and was performed by Prof. Dan Aravot, director of the cardiothoracic surgery department who was assisted by her personal physician, Prof. Mordechai Kremer, director of the hospital’s lung institute.

She had been waiting for some time for a lung; in recent months, her condition seriously declined. Since moving to Beit Hanassi (the President’s House) in June 2014, Nechama has been seen almost always wearing oxygen tubes connected to her nose from a portable oxygen-producing tank.

Pulmonary fibrosis occurs when lung tissue becomes damaged and scarred, making it progressively difficult to breathe and causing chronic shortness of breath. Rivlin has said it was a genetic condition, but added that her years of smoking in the past only made it worse.

The scarring can be caused by numerous factors, but in most cases, doctors can’t pinpoint what’s causing the problem. The lung damage can’t be fixed, but medications and therapies can sometimes help ease symptoms and improve quality of life.

After the operation, President Rivlin thanked “the dedicated medical staff at the Rabin Medical Center for their professional and warm treatment all along the way.”

Kramer said that after discharge from the hospital, lung-transplant recipients must regularly take drugs to prevent rejection by the body of the organ. Otherwise, they can usually return to a normal routine. After the recovery period, almost all patients return to full functioning, with good endurance and can return to work and full exercise.

Twenty years ago, life expectancy after such surgery was about five years on average, but today, it has lengthened by 10 to 15 more years in patients who take care of medication, regular follow-up and physical activity.

Aravot added that lung transplants involve a single lung, two lungs or a heart and a lung, depending on the disease that required the transplant. The Rabin Medical Center is the only hospital in Israel to perform lung transplants and has so far performed over 700 of them. Its success rate is 80% to 90%.

The implant itself is a complex operation performed after fully opening the chest, said Aravot. First, the blood vessels that connect the diseased lung/s to the heart and airways are cut off so as to remove the diseased organ/s from the patient’s body. Next, the lung is transplanted from the donor into the patient’s chest by connecting the bronchial arteries, arteries and veins of the donor’s lung to those of the patient. Surgery can take between four and 12 hours.

Rivlin was born on Moshav Herut that her parents helped to establish. Her mother, who had immigrated from the Ukraine, was widowed when Rivlin was a a child. She graduated from the Hebrew University in botany and zoology, where she worked as a researcher and later studied art history. She met and married Reuven Rivlin. They have three children – Rivka, Anat, and Ran – and several grandchildren. She is known to the public as being a very modest person, waiting on lines like anyone else and dressing simply.

As Israel’s First Lady she has paid much attention to environmental issues and created a community garden and a recycling system at Beit Hanassi. She has accompanied her husband on his presidential travels around the world despite her illness.