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In a Controversial First, Israel Allows Non-Medical Criterion for Transplants

by Brendon Nafziger, DOTmed News Associate Editor | December 21, 2009

The proportion of medically eligible brain-dead donors to actual donors is also lower than in the rest of the developed world, at about 45 percent. In the United States, the so-called conversion rate, the number of eligible donors who become actual donors, hovers at around 70 or 80 percent, according to a spokesman for the American Transplant Society.

In part, Israel has a low rate of donations because even if someone has signed a donor card, doctors still need permission from the immediate family before they can remove organs from the brain-dead donor. Plus, many religious Jews are opposed to organ donation. According to Ha'aretz, last year in response to the burgeoning popularity of donor cards, a religious group issued "life cards," which said the person's organ couldn't be removed after death.

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Quid pro quo

Still, many ethicists and surgeons are wary of a plan that appears to compensate donors for their efforts, a practice forbidden by most countries.

"Basically in the sense of right and wrong I support the idea if you're not willing to participate in the system as a donor, why should you be able to receive from a donor," says Robert Gaston, M.D. Dr. Gaston is professor of medicine and medical director of the Kidney and Pancreas Transplantation program at the University of Alabama at Birmingham and secretary-treasurer of the American Society of Transplantation. "At the same time, I try to keep in mind this is about patients, and patients are sick, and my job as a physician is to make them better, or help them get better, regardless of their motivation or what they've done in their previous life."

Dr. Lavee, writing in The Lancet, acknowledges the "new policy violates the definition of pure altruism, which requires no quid pro quo reward." But he thinks it achieves another worthy goal of medical care: providing maximum health.

Paolo Bruzzone, a surgeon with Sapienza Universita di Roma, writing in an accompanying commentary in The Lancet, says while he wouldn't recommend the policy for Italy, he acknowledges it is preferable to other schemes, such as the forced removal of organs from the dead, or financial incentives like paying for funerals or tax breaks.

Dr. Gaston agrees that Israel seems to be trying to strike a tricky balance.

"The idea of incentives to reward organ donation is something that is evolving throughout the world," says Dr. Gaston. "And it sort of lives in this gray zone between a purely altruistic view of organ donation, and I suppose the other end of the pole would be a market in organs that exists as a black market. Between those two poles, how do you do incentives in a way that truly incentivizes people willing to donate organs without compelling them to do so, or without coercing them to do so, or without making the entire thing a financial transaction?" he asks.