Israel is launching a potentially trailblazing experiment in organ donation: Sign a donor card, and you and your family move up in line for a transplant if one is needed. The new law is the first of its kind in the world, and international medical authorities are eager to see if it boosts organ supply.
Full AP story is here. The current organ donor rate in Israel is 10 percent, a figure that is thought to be driven by religious traditions. These traditions are likely why switching the default rule is a controversial move. More controversial than this proposal, anyway.
For an organ donor system to work, you need lots more potential organs, not lots more people who want one. That means the key to more organ donations is supply. But this design creates interesting perverse incentives. By moving up an entire family, this system allows one person to stand in for the demand of many. The incentive to move up is a strong one, and the possibility that a small group of new demanders are unlikely to increase the supply of organs, while driving up demand is a real one. In the article, Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania doubts “those signing donor cards would gain a significant advantage, because their queue would become much longer.”
Asked to expand on his thoughts, Caplan responded to a Nudge blog inquiry:
To be a cadaver organ donor you must die while on life support of a head injury permitting a brain death diagnosis with a relatively healthy body. Few deaths meet this description. Further to get an organ you must match for blood type and size of organ as well as usually antibody match. You also probably ought to be in geographic proximity to the donor. So offering an advantage to would be donors requires that you sign up huge numbers of donors to have a shot at getting a matched organ if you need one. But the more donors you sign up the less likely it is that anyone of them will gain an advantage in gaining access to an organ.
So at the end of the day the idea sounds good and in my view raises no ethical objection, but it is not readily implemented in the real world of transplant donation and allocation in terms of what it suggests will happen to those willing to identify as donors.
Hat tip: Peter Warnock.