Israel Tries a New Method to Boost Donation of Organs

Aron Heller reports: Israel is launching a potentially trailblazing experiment in organ donation: Sign a donor card, and you and your family move up in line for a transplant if one is needed. The new law is thfirst of its kind in the world, and international medical authorities are eager to see if it boosts organ supply. But it has also raised resistance from within the chareidi community.

These opponents say it discriminates against them because halacha forbids the donation of organs, and while they are unlikely to get the law reversed, they have the political clout to slow its implementation.

Only 10 percent of Israeli adults hold donor cards, compared with more than 30 percent in most Western countries.

The actual rate of families donating a deceased’s organs is 45 percent, but in other countries it rises to 70 percent, according to Jacob Lavee, director of the heart-transplant unit at Israel’s Sheba Medical Center.

Religious considerations

The low rate of organ donation is thought to be partly driven by religious considerations.

Rav Yosef Sholom Elyashiv has paskened that organ donation before cardiac death is assur, but receiving lifesaving donations is mutar.

Lavee, the doctor who helped draft the law, hopes that a broader pool of organs will ultimately benefit everyone, but he acknowledges that one of his primary motivations is “to prevent free riders.”

Organ shortages

“This is the first time that a nonmedical criterion has been established in organ allocation,” he said. “It will rectify the unfairness of the situation where people who are unwilling to donate wait in the same line as those who are willing.”

The measure opens a new dimension in the worldwide quest to overcome organ shortages. One solution – a legalized organ market – is ethically fraught. Another is called “presumed consent,” where whoever doesn’t opt out is considered a donor.

Spain, France, Austria and Belgium have adopted the latter model and rank among the top European nations in percentage of deceased donations, according to a U.N. study. But experts here say “presumed consent” would have been much trickier to get through the Israeli Parliament.

Writing in the December issue of The Lancet, the British medical journal, Dr. Paolo Bruzzone of Sapienza University in Rome said the Israeli initiative made more sense. “Certainly, giving holders of donor cards priority in organ allocation sounds more acceptable than the introduction of organ conscription or financial incentives for organ donation,” he wrote.

Israel’s parliament passed its far more comprehensive legislation in 2008 by a wide margin, including votes from Shas, the mainstream ultraorthodox party, and it is to take effect after a huge campaign to explain the new regulations and their complicated point-based system to the public.

But Israel’s unwieldy system of coalition government makes implementation uncertain. Among UTJ’s lawmakers is Yaakov Litzman, who happens to be the deputy health minister (the top post is vacant).

Another is Moshe Gafni, who said the law is “antidemocratic.”

“If I can’t contribute organs because of my religious beliefs, the state shouldn’t be allowed to harm me,” he told the AP.

Definition of death

The debate derives from Judaism’s tricky definition of death.

Donation in Israel after cardiac death is rare and only done in special circumstances.

Robby Berman, founder and director of the Halachic Organ Donor Society, a Jewish organization based in New York, said frum Jews can’t have it both ways.

“Every Jew has a right to be against an organ donation, but then you can’t come and say ‘give me an organ.’ ”