Israel offers incentive to organ donors

Those who donate will go to the top of the queue if they later need a transplant

Israel is about to become the first country in the world to encourage citizens to sign organ donor cards by rewarding them with priority status should they later need a transplant.

The reward "provides an incentive for individuals to agree to help each other" according to one of its architects, Professor Jacob Lavee of Sheba Hospital near Tel Aviv who has written about it in the latest issue of the medial journal, The Lancet.

But the innovation has been criticised for violating the principle that medical care should be allocated solely on the basis of medical need. Critics have even likened it to buying organs.

The plan is aimed at boosting the woefully low Israeli organ donor rates. Only one in 10 Israelis have donor cards, according to Dr Lavee, compared to one in four in the United Kingdom and higher rates in other West European countries. "For 30 years we used medical criteria only and it has gotten us nowhere," said Dr Lavee. "People are dying every day on the waiting list."

According to the plan, those who have signed donor cards and their spouses and siblings are to be given priority for transplants.

Patients requiring an urgent heart, lung or liver transplant because of the gravity of their condition will continue to be given priority status, regardless of whether they or their relatives have signed donor cards. But if two people in urgent need are found to be equally suitable candidates, the person who signed the card or his relatives will get the organ transplant.

Dr Lavee says the plan will crack down on "free riders" among Israel's ultra-orthodox Jewish population who receive organ transplants but do not donate organs on the grounds that this violates their religious beliefs.

The plan was endorsed by the Knesset last year, and its implementation starts with a media blitz next month that will last for a year before it goes into effect.

But Assa Kasher, emeritus professor of professional ethics at Tel Aviv University, disagrees with the plan. "It is in the essence of medical treatment that you make decisions on the grounds of providing opportunity for the one in the worst condition or the one who will benefit most medically," he said.

"All other considerations are of no importance." Mr Kasher suggests that the incentive program "is a form of buying organs. There can be other benefits besides money. The concept of human dignity is that it shouldn't be property sold and bought."

Dr Lavee and his co-authors conceded in The Lancet article that they were contravening the principle that medical care should be given in accordance with medical need.

But they wrote: "If this policy results in the procurement of more organs for transplant, then it promotes a different but nonetheless important goal of modern medicine: achievement of maximum health."