Friday, 13 January 2012

Israel as example: Organ donations

NZ's organ donation regime is an inefficient nightmare that kills people. Donor's wishes, expressed via their drivers' licence, aren't taken as binding and can be overturned by anyone claiming a connection to the potential donor. Even suggesting that folks signing up to be future organ donors get bumped up the waiting list gets folks riled up, though there were some encouraging noises two years ago about maybe allowing that Kiwi donors be compensated; similar calls for compensation came up in the UK last year. As it stands, Otago's med school is allowed to cover funeral costs for cadaveric whole body donations, but nobody's allowed to cover funeral costs for organ donors. There are all kinds of policies that would improve on the status quo but haven't been explored, at least in NZ.

Israel opened things up last year. Living donors are now paid 40 days' lost wages plus a very generous expenses allowance. Folks with family members on the waiting list can request to become living donors for other people on the list and are then matched with other folks in the same circumstances: a "chain of living donors" not unlike the American MatchingDonors service. Result?
Israel experienced a dramatic increase in the number of organ transplants in 2011, totaling 384, 68 percent higher than the previous year, although the number of transplants performed in 2010 was particularly low. Kidney transplants from deceased donors were 2.37 times greater in 2011, with 123 operations, than in 2010. There were 69 liver transplants from deceased donors in the past year, 2.15 times as many the previous year, 59 lung transplants, representing an 84 percent increase, and 23 heart transplants - 2.09 times the number in 2010.
The waiting list dropped from 1117 to 1041. The waiting list for cornea transplants was almost halved. And the number of people dying on the waiting list dropped from 124 to 105.

But they're not stopping there.
The Priority Law, which takes effect in April, will give holders of Adi donor cards priority if they ever need a transplant.
The number of cardholders has considerably increased recently following a publicity campaign touting the new law. Anyone signing the card before April will be immediately eligible for the benefit, while those signing after the law goes into effect will need to wait three years for eligibility after signing.
The number of organ donor signatures rose 71,229 during the year to a total of 632,300 while another 20,000 requests for the cards are being processed by the National Transplant Center.
But this could only work in a country with strong support for transplantation, right? Nope. Israel started around the bottom of the pack:
But despite the optimistic figures, Israel's rate of organ donations from the deceased remains at the bottom of the list for Western countries. According to a 2010 report by the National Transplant Organization and the World Health Organization, Israel had 31 organ donations per million residents, higher than Greece with 15 and Lebanon with 18, but lower than Austria, with the highest rate of 91, the U.S. (90 ), France (72 ), Britain (64 ), Germany (62 ), and even Turkey (43 ) and Iran (35 ).
There is no good reason we couldn't replicate their success. Cultural sensitivities among Maori about tapu and organ donation? Israel managed to pass this legislation despite some pretty serious opposition from the ultra-orthodox community.

Government inaction here condemns people to death.

Update: Alex at Marginal Revolution covered this while I was on summer holidays; I'd missed it. Ah well. Truth bears repeating.


  1. The only possible criticism that I can see against voluntary organ transplants is when there is some concern that they might not be "voluntary." Any evidence that you are aware of that hospitals are more likely to terminate patients if they are organ donors?

  2. Cultural sensitivities ought not be an issue anyway. If Maori and others with queer superstitions wish not to donate or receive organs then by all means don't become part of the scheme. I doubt that many would think it appropriate to make membership of an organ donation register mandatory.

  3. @BReedNZ: I've heard no evidence for it, despite that transplantation centres are profit centres for a lot of American hospitals. Think too in terms of comparative institutions: incentives for involuntary extraction go down a lot when the financial rewards associated with it are lower; the black market price is well above what a legal market price would be, or what a hospital could expect to net from a transplant. And, in a public system like New Zealand's, slack incentives for profit-making provide an additional cushion.

    @Lats: It's been held as a reason for not going forward, just as objections among the Ultra-Orthodox in Israel had there been.


  5. When our sons died (the first aged 20 weeks the second five years)we didn't think about organ donations and no-one suggested it. I don't know how I'd have reacted at the time but if I was in that position now I wouldn't hesitate. I'm a donor and hope my family will respect that should the opportunity arise.

  6. Interestingly, the increase appears to be entirely down to deceased donors. So the Priority Law seems to be the main driver, rather than the compensation for live donors or the matching chain.

    Or have I misread/misunderstood the original post, it is getting late on a Friday night.

  7. Private systems similar to Israel's priority law are in operation in New Zealand and the United States:

    New Zealand -

    United States -

  8. @Anon: The Priority law doesn't take effect until later this year, so that can't be it.

    @Dave: We just need to get the surgeons to recognize it here!

    1. So, the only policy changes provided incentives to live donors, but only a negligible amount of the increase in donations was from live donors. Are you suggesting these policy changes increased the number of deceased donations in some manner?

    2. @Anon: From the article: "Israel had 117 kidney transplants from living donors over the past year, 64 percent more than in 2010, according to the National Transplant Center's annual report. In August 2010 living donors began receiving compensation of several thousand shekels, which may have contributed to the increase."

  9. The Priority Law, which takes effect in April, will give holders of Adi donor cards priority if they ever need a transplant.

    Seems unfair to people whose organs are unfit for donation due to medical reasons (and who are aware of this while alive). Is this accounted for?

    1. I'd expect that anybody can sign on; it's up to the doctors to refuse the donation.

  10. Appendix 1:

    Come on, Eric. Have a heart!

    But seriously, this issue has legs. With an eye for the future, I suggest we keep an ear out for changes that are afoot, and arm ourselves with the facts before we vent our spleen. Let me know if you can lend a hand with this, because otherwise we are boned when things go tits up. At that point we may have to fight tooth and nail to continue to keep a finger on the pulse of the thing and avoid knee-jerk reactions. Unfortunately if that does happen we will all have to shoulder the blame as we made a rod for our own backs.

    1. And the award for most cliches in a single comment....

  11. @ Kadin - it's not about wether your organs are usable or not but that you OFFER them.
    Have a look at for more details and faq's on how this works.
    Only problem is in NZ that when we started LifeSharers the transplant doctors held a meeting soon afterwards and decided that their morals were higher than anyone elses and imposed a new rule that they would not take LifeSharers members organs (with the conditions attached.) They would rather a bunch of people die on the waiting list than accept that the organs belong to the donor and the donor wishes to increase the donor rate of NZ by directing that organs go first to other registered donors thus increasing the amount of people being donors.
    I'm sure if it was the doctors children who needed a transplant to survive they wouldn't be chucking away perfectly good organs just because the disagree with the donors views!