Priority Organs

New Zealand's organ donor service doesn't seem to like Israel's priority system.

I was on with Paul Henry this morning talking about organ donation rates and pointed to the Israeli system as something that New Zealand should consider.

ODNZ put out a press release making much of single-year changes in deceased donor rates from 2013 to 2014 in Israel and NZ: Israeli rates dropped while New Zealand's rose.

They're right that New Zealand's organ donation rate in 2014 was higher than it was in 2013. The one-year jump from 2013 to 2014 to 10.2 brought New Zealand all the way back to the average deceased donors per million population rates that the country enjoyed on average in the decade 1995-2004. In the decade 2005-2014, it's been more like 8.4.

What ODNZ misses is the big jump in organ donor sign-ups under the priority scheme:

Increasing domestic donations is a special challenge in Israel, where religious factors have historically constrained the organ supply. Despite a 300-year-old rabbinical ruling that an autopsy—and by extension, any post-mortem surgery—can be performed to save a life, many observant Jews consider the body inviolate in death. Taboos against mutilation are less of an issue in other Western countries, where consent rates—the percentage of brain deaths that result in donation—frequently exceed 70 percent. For most of the 2000s, Israel’s hovered around 45 percent—among the lowest in the developed world.

Today, however, Israel’s consent rates have jumped, to 56 percent in 2013—still low, but a shift that demonstrates a real turnaround in public opinion surrounding organ donation. The change is largely due to the public debate surrounding brain death that followed the highly publicized decision by the family of the Israeli soccer star Avi Cohen to disregard his wishes to donate his organs after a 2010 motorcycle accident left him brain dead—and to Israel’s adoption of a unique allocation system for organs that rewards those willing to donate. At a time when waiting lists are growing everywhere, including in the United States, Israel’s success has implications for a global transplant landscape that is in dire need of innovation.

The priority law also encourages living donation by giving donors the security that they'd be at the front of the queue should their remaining kidney - or any other organ - go bung later on.

The whole article over at Tablet Mag is well worth reading if you're interested in the Israeli system. It's a bit more complicated than one-year changes.

I'm guessing that ODNZ is a bit tetchy because a binding organ donor registry is again in political play. I'm more ambivalent about how much good that could do - or at least on its own. Combined with stronger payment for living donors, defraying funeral costs for cadaveric donation, and a priority system like Israel's, well it could be pretty effective.

Update: Me on that last point in the Herald.