Israel's remarkable new steps to solve its organ shortage.

Health and medicine explained.
Jan. 27 2010 4:47 PM

Kidney Mitzvah

Israel's remarkable new steps to solve its organ shortage.

(Continued from Page 1)

Another barrier to deceased donation has been the definition of death. Some ultra-Orthodox rabbis reject brain death as the definition of death because the ventilator is providing oxygen that allows the heart to beat for a few more days after brain death. They insist that the heart must cease to beat before a person can be pronounced dead—a condition making it difficult to obtain suitable organs in a timely manner. To facilitate donation, Israel passed a law in 2008 establishing "brain death" as the definition of death relevant for all legal purposes, including organ donation.

Why is Israel working so hard to increase donation now? Because Israelis can no longer participate in transplant tourism—that is, go abroad to obtain organs.

In 2008, a new law mandated that the Israeli Ministry of Health stop paying for transplants that were obtained in countries that themselves outlaw organ sales. This brought a stop to a policy that was in effect since 1998, when the ministry began covering the cost of transplants obtained from foreign donors. Israelis seeking organs had traveled to places such as Turkey, China, Eastern Europe, and the Philippines, though the exact number of transplant "tourists" is not known. As more Israelis received transplants this way, rates of donation by living relatives went down, according to the Ministry of Health.

Israel should be commended for moving to solve its organ problem, and save lives, by making two moral choices: first, to reduce transplant tourism; second, to provide compensation for deceased donation and priority ranking to encourage donations. This symmetry is critical to reducing the organ shortage in Israel and all over the world. Incentives must be paired with efforts to combat trafficking.

Alas, the World Health Organization, the Council of Europe, the United Nations, and the International Transplantation Society fail to grasp the need for such a two-pronged strategy. Instead, these groups endorse a strictly unilateral policy that bans organ trafficking. At first blush, yes, this seems reasonable. After all, corrupt brokers deceive indigent donors about the nature of surgery, cheat them out of payment, and ignore their post-surgical needs.


But clamping down on unlawful organ sales without first expanding the organ pool means more patient deaths, not less criminal activity. It drives corruption rings further underground or causes markets to blossom elsewhere around the globe. This is happening now. As China, Pakistan, and the Philippines have begun to curb illicit organ sales, places like Egypt, Eastern Europe, and South and Central America are becoming popular "tourist" sites.

Indeed, the global transplant establishment is so leery of benefiting donors or families directly—as in, for example, allowing Clara to use the 10,000 shekel to pay bills now that her husband is gone—that Israel had to put limits on how the cash was spent. I think this is too bad. Yafim would surely want his family to have some short-term financial cushion. Moreover, freedom to use the benefit as the family decides might be an even better incentive to donate.

Nonetheless, the compensation-for-memorialization is an important development that more countries should adopt.

When Gadi Ben Dror presented the check to Yafim's family, he said, "[We] owe the family our appreciation [which] we express with a gift. It's important to publicize their courage to donate organs in order to encourage others to donate as well." Within those sentiments lies the solution to the organ shortage: expressions of gratitude for a life-saving act intended to encourage others to do the same.

Sally Satel, M.D., a resident scholar at the American Enterprise Institute, is editor of When Altruism Isn't Enough: The Case for Compensating Kidney Donors


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