Israelis who sign an organ donor card will be given first priority for treatment if they themselves ever require an organ transplant, according to a new law about to be passed in Israel.
The unique law will come into effect in January 2010, says Prof. Jacob Lavee, director of the Heart Transplantation Unit at Sheba Medical Centre, writing in The Lancet.
In Israel, only 10 per cent of adults hold donor cards, compared to more than 30 per cent in many Western countries.
The rate of organ donations among brain-dead Israeli patients eligible to donate is also low: about 45 per cent during the past decade, much lower than the 70 to 90 per cent consent rate in most western countries.
So Israel has amended laws to boost donation rates. Not only will signers of donor cards be given priority, spouses and close relatives of those with signed donor cards will also move to the front of the line, even if they didn't sign their own cards.
Patients in urgent need of a heart, lung, or liver transplant will continue to receive priority. But if two such people are eligible for the same organ, the priority system will come into play.
Children under 18 and those unable to express their wishes due to physical or mental disability will retain their priority status, even versus an adult who merits priority because of the new law.
Lavee said the new policy "provides an incentive for individuals to agree to help each other." But he conceded that the new system was not ideal and violated the principle of "true altruism."
But he said: "If this policy results in the procurement of more organs for transplantation, then it promotes a different but nonetheless important goal of medicine - achievement of maximum health."
A huge public information campaign, in multiple languages and formats, is underway to educate Israelis on the new law.
The effects of the law will be evaluated over the next two years. If it doesn't result in an increase in organ donation, or if more potential organ donors and recipients die, "then policy and legal adjustments will be necessary," Lavee said.
In an accompanying Comment, Linda Wright of the University Health Network in Toronto, and Diego S Silva of the University of Toronto Joint Centre for Bioethics said it will be interesting to see whether new law affects donations rates.
"If Israel's initiative of incentives for donation actually makes a difference by producing more organs for transplantation, it will be instructive. We wait to see."
But they also criticized a stipulation in the law that by excluded special privileges for live donors of kidneys, liver lobes or lung lobes who donate their organs to a designated relative.
"Because the rise in donation rates in some countries during the past decade has partly been due to the increase in living donors, should we not be increasing our support for living donation?" they write.
