Preferred allocation for registered organ donors

Israel's 2008 Organ Transplant Law: continued ethical challenges to the priority points model

In 2008, responding to a widening gap between need and availability of transplant organs, Israel's Ministry of Health adopted a program of incentivized cadaveric organ donation. The Organ Transplant Law rewards individuals with prioritized access to organs on the condition that they participate in procurement efforts. Priority is awarded in the form of additional points allocated to the individual's organ recipient profile. Although Israel has experienced moderate gains in the years since the law's implementation, these have not been sufficient to satisfy the demand. Furthermore, the law faces logistical and ethical challenges. These challenges could potentially be resolved by shifting the organ procurement default to routine retrieval rather than the current default of presumed refusal to organ retrieval.This paper examines philosophical and practical challenges to the priority points policy and weighs whether Israel should consider an alternative policy of routine retrieval of transplant organs with the option to opt out of the donor pool.

Altruism, gift giving and reciprocity in organ donation: a review of cultural perspectives and challenges of the concepts

Living and deceased organ donation are couched in altruism and gift discourse and this article reviews explores cultural views towards these concepts. Altruism and egoism theories and gift and reciprocity theories are outlined from a social exchange theory perspective to highlight the key differences between altruism and the gift and the wider implications of reciprocation. The notion of altruism as a selfless act without expectation or want for repayment juxtaposed with the Maussian gift where there are the obligations to give, receive and reciprocate. Lay perspectives of altruism and the gift in organ donation are outlined and illustrate that there are differences in motivations to donate in different programmes of living donation and for families who decide to donate their relative's organs. These motivations reflect cultural views of altruism and the gift and perceptions of the body and death.

Priority in Organ Allocation to Previously Registered Donors: Public Perceptions of the Fairness and Effectiveness of Priority Systems

A priority system is one in which previously registered donors receive a preference in the allocation of organs for transplant ahead of those who have not registered. Supporters justify these systems on the basis that they are fair and will encourage donor registration. This article reviews existing studies of public reactions to priority systems, as well as studies of the extent to which the moral principle of reciprocity affects decision making in organ donation. The role of reciprocity in the public discourse surrounding the enactment of priority systems in Singapore and Israel is described. One factor that seems to have been relevant in these countries is the existence of a religious minority that is perceived as willing to take an organ but not to donate one. Although this perception may have fueled a resentment of perceived “free-riders,” concerns were raised about the social divisiveness of priority systems. In sum, people appear to be sensitive to the principle of reciprocity in the context of organ donation, but this sensitivity does not always translate into support for priority systems. Further research into whether public messaging about organ donation could be modified to encourage registration by appeal to the golden rule would be worthwhile.

Laypeople's ethical concerns about a New Israeli organ transplantation prioritization policy aimed to encourage organ donor registration among the public

A new policy recently enacted in Israel promises preferred status in receiving organs for transplantation to individuals who register to be organ donors and to their close family members. Proponents believe it will increase the supply of organs for transplantation from the deceased. Ethical issues were raised in government committees appointed to discuss the policy before its approval, but discussions among laypeople were not solicited. This study aimed to elicit laypeople's views about the policy by conducting thirteen group interviews and thirty-six individual interviews. Participants included religious and nonreligious people, immigrants, and Arabs. Some participants thought the law would contribute to fairness by prioritizing those willing to give, but others articulated ethical concerns that were not emphasized by scholars, in particular that the policy would add to the erosion of social solidarity, increase divisiveness, and enable people to abuse the system. Mistrust in the health care system emerged as a prominent reason for not registering as an organ donor. Implications about the importance of transparency in the organ transplantation system as a basis for an information campaign, social norms regarding organ donation, and the public's involvement in policy issues on organ donation are discussed.