In a controversial move, Israel is set to become the first country to give priority to patients for organ transplants based on non-medical criteria.

In response to a dearth of donations, one of the lowest in the developed world, Israel's parliament, the Knesset, passed a law that gives priority for transplants to people who signed organ donor cards and their immediate families.

Jacob Lavee, M.D. a transplant surgeon at Sheba Medical Center in Tel Hashomer, Israel, whose efforts helped spur passage of the new law, which goes into effect in January, discussed how it works in The Lancet on Thursday.

People who sign organ donor cards would gain priority points for transplants, moving up in the queue. Their first-degree relatives -- children, parents, siblings and spouse -- would also move up, gaining about half the point bonus of the signatory.

The biggest boost would go to first-degree relatives of deceased donors whose organs were actually used, as well as to so-called non-directed living donors: donors who, while alive, give an organ, like a kidney, to an organ bank and not to a particular recipient.

The Israeli National Transplant Council, which helped develop the law, also wanted living donors who gave an organ to a specific individual to receive priority, which the Knesset rejected. Dr. Lavee says the Ministry of Health is contesting the ruling on appeal.

But the new law doesn't affect everyone. Children under 18 and the mentally and physically impaired, who are unable to sign cards, keep their priority status.

And for most life-and-death cases, medical criteria still prevail. The law will not affect candidates for heart, lung or liver transplants who urgently need the new organ to live, although in choosing between two equally urgent cases, a card signatory will come ahead in the queue over a non-signatory.

Plus, most people aren't penalized for not already being signed donors. For the first year after the new plan goes into effect, patients, even those on transplant waiting lists, who sign donor cards will become eligible for prioritization after a one-year waiting period.

Grim statistics

In his article as well as in an editorial in the Israeli newspaper Ha'aretz also published Thursday, Dr. Lavee explains that Israel is facing a crisis. It has one of the lowest donation rates in the world, with only 8 percent of Israelis holding an organ donor card, as opposed to 30-40 percent of people in most Western countries.

Last January, of the 864 patients listed as needing a kidney, heart, lung or liver, only 221 received a transplant from a dead donor that year.

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