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.

Does Israel's plan to solve its organ problem work?
Does Israel's plan to solve its organ problem work?

This month, Israel launched a new policy to encourage organ donation: Anyone who registers to allow his organs to be taken posthumously gets slight priority if he needs one in the future. When two comparably ill patients are in need, the tie will go to the organ-donation cardholder. The new policy garnered publicity in the Australian, Canadian, South African, and British press.

Meanwhile, under the radar, another, more dramatic Israeli initiative took place: giving compensation to families of deceased organ donors.

On Jan. 20, the relatives of a 51-year-old deceased man named Nachis Yafim gathered to accept a check for 10,000 Israeli shekel (roughly $2,700) in recognition of his wife Clara's decision to allow his liver, kidneys, and lungs to be taken for transplantation. The funds will be used by Clara and their 10-year-old son to memorialize Nachis—by paying for his headstone, for example.

In legalizing such a "memorial," Israel thus becomes the first country in the world to reward deceased organ donors. The Organ Donation Law, passed by the Knesset in 2008, says that families who agree to donate the organs of deceased loved ones may accept money to "memorialize" the deceased. Currently, the Israeli Ministry of Health has allowed up to 50,000 shekel, or $13,400, to do so. The money—given by nonprofit groups and taken out of their own pool of charitable contributions—may be used in any way the families see fit to memorialize the deceased.

According to the law, the donor, while alive, must not have refused to become a posthumous donor. This quells anxiety about a family benefiting over the objections of the donor himself.

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The money for Nachis Yafim's family was given by ADI, a nonprofit organization outside of Tel Aviv that was established to encourage organ donation. It is named for Adi Ben Dror, who died of complications of kidney disease.

In the ceremony held in honor of Yafim, who emigrated from Russia and worked as a security guard in Be'er Sheva, Gadi Ben Dror, the director of ADI, said, in handing the check to Clara, "In this country we always talk about military heroism. ... [T]his is clearly a case of civilian heroism. [His organs] saved four lives. ... [T]he family should be blessed."

Donation at death is a big deal in Israel because of its infrequency. The country is lodged far down on the list of developed countries regarding the availability of deceased organs for transplantation: Nine donors per 1 million people. In comparison, that number is 35 in Spain and 25 in the United States. As of last year, only 8 percent of adult Israelis held organ-donor cards. In Europe, the rates are between 30 percent and 40 percent. In the United States, about 38 percent of adults with a driver's license were registered organ donors in 2009. In addition, the "conversion rate"—that is, the percentage of times a death meeting eligible criteria for donation becomes an actual donor—is 60 percent to 70 percent in the United States. (The rate depends, in large part, on whether families of deceased people agree when asked to give permission to retrieve the organs of loved ones—yes, even if one signs a card, hospitals will allow families to override the deceased donor's indicated preference.) In Spain, the conversion rate is around 80 percent. Israel's conversion rate is 45 percent.

Why such low rates? "Most Jews are under the mistaken impression that traditional Jewish law requires a body be buried whole at all costs," according to Robby Berman, director of the Halachic Organ Donor Society, an organization that encourages Jews all over the world to donate organs to the general population.

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