Israel experiments with new organ donation nudge

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.

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  • http://www.lifesharers.org/ Dave Undis

    Registered organ donors in the United States can get preferred access to donated organs by joining LifeSharers at http://www.lifesharers.org. Membership is free. There is no age limit, and no one is excluded due to any pre-existing medical condition.

    Nothing could be fairer than giving organs first to organ donors. If you're not willing to register to be an organ donor, then you should go to the back of the waiting list if you ever need an organ.

    More importantly, putting organ donors first creates an incentive for non-donors to become donors. Thousands of Americans die every year waiting for organ transplants. Just about everyone would accept an organ transplant to live, but only about half of us have agreed to donate our organs after we die. It's no wonder there's such a large organ shortage.

  • adora

    Well, one donor can often benefit multiple patients in need. It is rare that a patient would be in queue to replace more than one organ. I'm not familiar with the subject, what is the average number of organs offered by donors? Maybe it outnumbers the number of family members/potential patients?

  • http://www.lifesharers.org/ Dave Undis

    Registered organ donors in the United States can get preferred access to donated organs by joining LifeSharers at http://www.lifesharers.org. Membership is free. There is no age limit, and no one is excluded due to any pre-existing medical condition.rn rnNothing could be fairer than giving organs first to organ donors. If you’re not willing to register to be an organ donor, then you should go to the back of the waiting list if you ever need an organ.rn rnMore importantly, putting organ donors first creates an incentive for non-donors to become donors. Thousands of Americans die every year waiting for organ transplants. Just about everyone would accept an organ transplant to live, but only about half of us have agreed to donate our organs after we die. It’s no wonder there’s such a large organ shortage.

  • http://www.lifesharers.org/ Dave Undis

    Registered organ donors in the United States can get preferred access to donated organs by joining LifeSharers at http://www.lifesharers.org. Membership is free. There is no age limit, and no one is excluded due to any pre-existing medical condition.

    Nothing could be fairer than giving organs first to organ donors. If you’re not willing to register to be an organ donor, then you should go to the back of the waiting list if you ever need an organ.

    More importantly, putting organ donors first creates an incentive for non-donors to become donors. Thousands of Americans die every year waiting for organ transplants. Just about everyone would accept an organ transplant to live, but only about half of us have agreed to donate our organs after we die. It’s no wonder there’s such a large organ shortage.

  • adora

    Well, one donor can often benefit multiple patients in need. It is rare that a patient would be in queue to replace more than one organ. I’m not familiar with the subject, what is the average number of organs offered by donors? Maybe it outnumbers the number of family members/potential patients?

  • adora

    Well, one donor can often benefit multiple patients in need. It is rare that a patient would be in queue to replace more than one organ. I’m not familiar with the subject, what is the average number of organs offered by donors? Maybe it outnumbers the number of family members/potential patients?

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