בס"ד Dor Yeshorim Fulfilling Our Responsibility to the Next Generation Dor Yeshorim, for over 26 years, has had one mission: premarital program is the best application of preventive medicine and the most successful application of genetic sciences to date, anywhere in the The total elimination of the occurrences of recessive genetic illnesses. world. To accomplish this mission, Dor Yeshorim utilizes a program that does no harm to participants, avoids their stigmatization, and is guided by halachah. The Dor Yeshorim program has become an integral part of the shidduch process in the Torah observant Ashkenazi Jewish community worldwide. Under the direction of Gedolei Yisroel and the world’s foremost medical Over 300,000 individuals have, since its inception, participated in the experts, Dor Yeshorim has managed to eliminate the incidence of Tay program, with over 22,000 individuals being screened and joining the Sachs disease, as well as other recessive genetic diseases common to the program every year. To date, more than 1,600 marriages of couples, where Ashkenazi Jewish community, while zealously guarding the privacy and both parties were carriers of a genetic mutation, and therefore risked having dignity of Jewish families. affected children, have been avoided. The impact of the Dor Yeshorim program is indisputable. After over 26 years Today it’s a given that a potential choson or callah doesn’t arrive at a of activity there are virtually no children born with Tay Sachs disease! This marriage decision without first ascertaining genetic suitability. Using the accomplishment is evidenced by the fact that Kingsbrook Medical Center, in Dor Yeshorim program can prevent disasters in future generations. New York, has closed its 16-bed Tay Sachs treatment unit for good. The Dor Yeshorim program is how we fulfill our responsibility to the next The world’s foremost medical experts agree that the Dor Yeshorim generation. What are recessive genetic diseases? The genetic attributes of each person comes from his or her parents. The tragedy and suffering that can ensue in such cases simply defies Those attributes are transmitted from one generation to the next, description. codified in the DNA of the genes that are found in every cell of the body. Sometimes a change – a mutation - occurs in the genetic data, The only way to prevent recessive genetic disease is to avoid a marriage resulting in a defective gene. of a ‘matching carrier’ couple. Both carriers can marry other, non-carriers, in total safety. One in every three to four people carries various gene mutations, with no ill effects. In fact, the person will not even be aware of it. This is Only the Dor Yeshorim program can give the peace of mind to a prospective because we all have a set of two ‘copies’ of every gene. As long as there choson and callah, that they can prevent the birth of children with these is only one gene mutation, no disease will occur, since the intact gene serious genetic diseases. of the pair ‘takes over’. A person having only one copy of the gene mutation is called a ‘carrier’. As long as both parents are not carriers, there is no danger of their child being affected by the mutation that Important notice: only one parent is carrying. Even if there has never been genetic disease in your family, you can The problem arises when both parents posses the same gene mutation. still be a ‘carrier’. Over 90% of affected children are born to parents In such cases, some of the children are in danger of inheriting a matched who have never even heard of genetic diseases before! set of two gene mutations. The Recessive Genetic Diseases That Listed below are diseases included in the Dor Yeshorim program and the Are Part of the Dor Yeshorim Program frequency of each disease among Jews of Ashkenazi descent. Disease Frequency The Dor Yeshorim program focuses on genetic mutations that cause severe Tay Sachs 1 of every 25 genetic diseases common in Jews of Ashkenazi descent. Large resources Familial Dysautonomia 1 of every 25 are invested in research to identify more mutations, endemic to different Cystic Fibrosis 1 of every 26 groups of Jews, and in developing screening methods to detect them in Canavan Disease 1 of every 36 program participants. Glycogen Storage Type 1a 1 of every 65 Dor Yeshorim also exerts great efforts, and is constantly expending Fanconi Anemia Type C 1 of every 75 resources, to improve the quality and reliability of the screening Mucolipidosis Type 4 1 of every 93 component of the program. Bloom Syndrome 1 of every 95 Niemann Pick A&B 1 of every 100 Tay Sachs (TS), Canavan Disease (CN), Niemann Pick (NP) Familial Dysautonomia (FD) All three are fatal metabolic dysfunctions that result from the body’s FD mainly affects the central nervous system, which is responsible for inability to break down certain substances. Eventually, these substances many of the body’s systems, such as blood-pressure stabilization, motor accumulate in the cells, causing progressive damage. The diseases manifest function, sensory nervous system and the ability to swallow and perspire, in various neurological symptoms that, after a few months, arrest the proper among other functions. Patients affected by FD are typically recognized Sick children rarely reach the age of five. Their by “tearless crying”. FD patients often experience low sensitivity to pain .ל"ע development of the child lives are short, devastating, suffering-filled years for both child and family. which puts them in danger of fractures, wounds and burns. As the disease There are no known cures or treatments. progresses, the digestive, respiratory skeletal, and circulatory systems are The genes for these diseases are very prevalent. The Tay Sachs genetic often affected as well. Familial Dysautonomia is incurable. mutiaton alone is present in one of every 25 Jews of Ashkenazi descent and Dor Yeshorim was actually a part of the successful effort to identify the one of every 100 Jews of North African descent. genetic mutations that cause the disease and the establishment of genetic tests to detect it. Cystic Fibrosis (CF) Cystic Fibrosis manifests itself in serious respiratory ailments as well as other health problems of varying severity. The lives of CF patients are filled with ongoing suffering and frequent, lengthy hospitalizations. Many times, CF patients require lung transplants to survive. Fanconi Anemia Type C Bloom Syndrome Fanconi Anemia manifests itself in severe anemia, congenital defects in the Bloom Syndrome is typified by dwarfism, a tendency towards malignant extremities and a tendency towards cancer and leukemia. In some patients tumors, chromosomal instability, hyper-sensitivity to sunlight and more. the disease causes mental retardation and dwarfism. The treatment entails Many Bloom Syndrome patients suffer from mental retardation as well. frequent blood transfusions and patients’ lives are filled with anguish. The The disease is more common among Jews of Ashkenazi descent than the only possible way to cure the disease is by transplantation of bone marrow general population. or umbilical cord blood stem cells. Mucolipidosis Type 4 Glycogen Storage Type 1a Mucolipidosis is a severe degenerative disease of the brain that hampers Patients with this disease lack the ability to break down glycogen (sugar). neurological and motor development and causes blindness. The symptoms This results in complicated diabetes and severe digestive disturbances. appear before age one. Some patients reach adulthood, but never develop Glycogen Storage frequently leads to liver tumors and can be fatal. beyond the level of a 12-18 month old. Screening methods and quality assurance Dor Yeshorim genetic screening employs the most extensive, complex, and expensive molecular DNA methodologies performed at top laboratories. Important notice: All screening is supervised by senior inspectors from beginning to end. Procedures and equipment adhere to the international ISO code Ethnic diversity and different countries of origin do not offer fail-safe 15189:2003 of professional labs. protection from genetic diseases, even if some diseases are not as common in a particular group. Are non-Ashkenazi populations protected Important notice: by the Dor Yeshorim program? The genetic screening offers protection only against the diseases that are Some of the diseases in the Dor Yeshorim program are found in non- part of the screening program. It is possible to perform some additional Ashkenazi populations as well, but are far less prevalent. Since the screening by special request (such as for deafness, Usher’s Syndrome, diseases are rarer, some of the mutations have not been identified yet. Nemaline Myopathy, and more). In cases where there have been genetic For this reason, screening can be less reliable for Jews of non-Ashkenazi problems or disease in the family’s history, it is imperative to make sure descent. that the disease/mutation is included in the Dor Yeshorim screening plan Dor Yeshorim, in conjunction with some of the world’s foremost genetic for you or your family member. researchers, is engaged in an effort to give the best possible answers in such cases as well. Rabbinical Approbations הנה ידוע ומפורסם בין רבנים ומורי הוראה בעלי ניסיון מהאסון והשמות שעשתה המחלה הנוראה טיי-זקס ועוד מחלות דם דומות בבתי ישראל כשרים וחרדים לדבר ה ואני הגבר כבר ראיתי משפחות חשובות מתמוטטות ר"ל ע"י שרואים עולליהם הולכים וחסרים בגיל שלוש עד שש ואין שום עזר להם עפ"י רפואה - וא"א בשום פעם להנצל מאסון זה רק ע"י זהירות לפני קישור השידוכין ע"י בדיקת הדם שיכולה להראות בעליל אם ח"ו דימיון זה נמצאים בדמיהם של הבחור והנערה ע"י קשר השידוכין - ומה שלא יקרה ע"י זווג אחר לבחור זה ולנערה זו.והנה קמו גדולי הרבנים בארה"ב של אמריקה לחזק חבורת אברכים יקרים וחשובים המוכרים לי היטב בשם "דור ישרים" ששמו להם למטרה הנעלה להציל משפחות שלימות מאבדון וכולם מסכימים שעפ"י התורה דבר גדול מאוד, ודרכם דרך נכונה לעשות את הבדיקות באופן סודי ביותר שגם הרופא הבודק לא ידע שמם ושאר דברים מועילים ל"דור ישרים" לפני אחבנ"י יה"ר שיסיר מחלה מקרבנו ככתוב: "אני ה רופאך".