Global Nephrology: Organ Donation in Israel

There is a very interesting article (Feb 16, 2012) by Dr. Danielle Ofri in the New York Times about proposed changes in the organ donation system in Israel.

The issue is that Israel ranks low (see Fig.1) in its organ donation rate as compared to Western countries because Jewish law proscribes desecration of the dead. This has generally been interpreted as “Judaism prohibits organ donation”.  As well, there were rabbinic issues surrounding the concept of brain death, the state in which organs are typically harvested. Consequently, many patients died waiting for organs.

As Ofri writes: “So Israel has decided to try a new system that would give transplant priority to patients who have agreed to donate their organs. In doing so, it has become the first country in the world to incorporate “nonmedical” criteria into the priority system, though medical necessity would still be the first priority.”

Fig.1
Source: Rieu et al, J Med Ethics 2010 

Dr. Ofri continues “The Israeli program was initiated by Dr. Jacob Lavee, a cardiothoracic surgeon who heads the heart transplant program of Sheba Medical Center in Tel Hashomer. In 2005, he had two ultra-Orthodox, Haredi Jewish patients on his ward who were awaiting heart transplants. The patients confided in him that they would never consider donating organs, in accordance with Haredi Jewish beliefs, but that they had absolutely no qualms about accepting organs from others. That Haredi Jews would not donate organs was a well-known fact in Israel. But this was the first time anyone had openly admitted the paradox to Dr. Lavee.

Dr. Lavee then worked with many stake-holders, including rabbis, ethicists, lawyers, academics and others to introduce a new law that goes into effect this year where if two patients have identical medical needs for an organ transplant, priority will be given to the patient who has signed a donor card, or whose family member has donated an organ in the past. He also pushed through a law that defines brain death in a manner that is acceptable to the vast majority of rabbis (though not the ultra-Orthodox Haredi), as well as local imams, making organ donation acceptable to a large segment of the population. The new also provides “fair compensation” for living donors that covers 40 days of lost wages, plus expenses related to the donation.

Dr. Ofri writes that “This was accompanied by a huge public awareness campaign about organ donation, with radio, TV, billboard and newspaper ads promoting the new priority system and countering the perception that Jewish law forbids donation. Shopping centers and coffee houses were blanketed with organ donation information.”

“The response was overwhelming, as people registered in droves as potential donors. During the 10 weeks of the publicity campaign, 70,000 Israelis registered for organ donation cards. The consent rate from families has already increased, and the number of organs available for patients has increased in parallel. Transplants have so far increased by more than 60 percent over all this year.”

Bottom-line: This article shows how different countries are trying innovative solutions to grapple with the lengthening waiting list for organs.