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Mor E, Bloom M, Ghinea R, Anteby R, Pasvolsky-Gutman R, Loewenthal R, Nachmani I, Hod T. The Impact of the Donor Card Holder Prioritization Program on Kidney Allocation in Israel. Transplantation 2024; 108:1430-1439. [PMID: 38277264 DOI: 10.1097/tp.0000000000004916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND Since 2014, as part of a priority program within the Israeli Transplant Law, additional points were given to waitlisted candidates with donor cards. We assessed the impact on deceased donor kidney allocation. METHODS This study enrolled all patients older than 18 y who underwent deceased donor kidney transplantation (January 2016-December 2019). Data were obtained from the National HLA Tissue Laboratory registry at the Sheba Medical Center. Patients were grouped by donor card status (ADI group) (not signed, 0 points; relative signed, 0.1 points; patient signed, 2 points; and relative donated, 9 points). The primary outcome was waiting time until kidney transplantation with and without the additional score. RESULTS Four hundred forty-four patients underwent kidney transplantation during the study period: 281 (63%) were donor card holders (DCH) and 163 (37%) were not DCH. DCH with extra points waited 68.0 (±47.0) mo on average, compared with 94.6 (±47.3) mo for not DCH ( P < 0.001). Donor card signers had a shorter time until transplant in a multivariable model. Without extra points, 145 recipients (32.6%) would have missed organs allocated to higher-scored candidates. Allocation changes occurred in 1 patient because of an additional 0.1 points, in 103 candidates because of an additional 2 points, and in 41 candidates because of an additional 9 points. CONCLUSIONS Additional DCH scores improved allocation and reduced waiting time for donor card signers and those with donating relatives. To enhance fairness, consideration should be given to reducing the score weight of this social criterion and raising scores for other factors, especially dialysis duration.
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Affiliation(s)
- Eytan Mor
- Renal Transplant Center, Sheba Medical Center, Tel Hashomer, Israel
- Department of Surgery B, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Israel
| | - Meitar Bloom
- Faculty of Medicine, Tel-Aviv University, Israel
| | - Ronen Ghinea
- Renal Transplant Center, Sheba Medical Center, Tel Hashomer, Israel
- Department of Surgery B, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Israel
| | - Roi Anteby
- Department of Surgery B, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Israel
| | - Ronit Pasvolsky-Gutman
- Faculty of Medicine, Tel-Aviv University, Israel
- Tissue Typing Laboratory, Sheba Medical Center, Tel Hashomer, Israel
| | - Ron Loewenthal
- Faculty of Medicine, Tel-Aviv University, Israel
- Tissue Typing Laboratory, Sheba Medical Center, Tel Hashomer, Israel
| | - Ido Nachmani
- Department of Surgery B, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Israel
| | - Tammy Hod
- Renal Transplant Center, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Israel
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Martin DE. Rethinking Priority for Prodonation Behaviors in Organ Allocation-Lessons From the Israeli Experience. Transplantation 2024; 108:1281-1282. [PMID: 38809429 DOI: 10.1097/tp.0000000000004932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
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Boas H. How did organ donation in Israel become a club membership model? From civic to communal solidarity in organ sharing. Monash Bioeth Rev 2023; 41:49-65. [PMID: 37689590 PMCID: PMC10754737 DOI: 10.1007/s40592-023-00179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/11/2023]
Abstract
Figuring out what pushes individuals to become organ donors has become the holy grail of social scientists interested in transplantations. In this paper I concentrate on solidarity as a determinant of organ donation and examine it through the history of organ donation in Israel. By following the history of transplantation policies since 1968 and examining them in relation to different types of solidarities, this paper leads to a nuanced understanding of the ties between solidarity and health policy. Attempts to foster an all-encompassing consensus on the definition of brain death yielded the Transplantation and the Brain-Respiratory Death Laws of 2008. It was hoped that a wide "civic solidarity" would render Israel self-sufficient in its organ economy. However, the failure of the law led to the breakdown of civic solidarity in organ donation. As a result, initiatives such as the priority policy and non-directed living organ donations, developed out of a narrower conception of solidarity. Juxtaposing these initiatives sheds light on macro level processes for policy makers and suggests solidarity as a key bioethical concept to understand organ donation policies.
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Affiliation(s)
- Hagai Boas
- Ben Gurion University of the Negev, Beersheba, Israel.
- The Van Leer Jerusalem Institute, Jerusalem, Israel.
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Tarabeih M, Marey-Sarwan I, Amiel A, Na'amnih W. Posthumous Organ Donation in Islam, Christianity, and Judaism: How Religious Beliefs Shape the Decision to Donate. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231183191. [PMID: 37311213 DOI: 10.1177/00302228231183191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Evidence indicates that the religious beliefs of patients, potential donors, family members, and healthcare professionals play an important role in deciding to donate an organ. We aim to summarize the religious views of Christians, Muslims, and Jews on organ donation contributing to the decision-making process. Different approaches to this topic worldwide are presented, providing helpful information for medical professionals. A literature review was conducted regarding the view of Israel's leadership of the three largest religions on organ transplantation. This review revealed that all Israeli central religious leaders have a positive view on organ donation. However, various aspects of the transplantation process (such as consent, brain death, and respect for the dead body) must be carried out as each religion prescribes. Thus, understanding the different religious views and regulations on organ donations may help reduce religious concerns about transplantation and narrow the gap between the need and the availability of organ donations.
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Affiliation(s)
- Mahdi Tarabeih
- School of Nursing Science, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Ibtisam Marey-Sarwan
- Sakhnin Academic College for Teacher Education, and the Hebrew University in Jerusalem, Sakhnin, Israel
| | - Aliza Amiel
- School of Nursing Science, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Wasef Na'amnih
- School of Nursing Science, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Albertsen A. Priority for Organ Donors in the Allocation of Organs: Priority Rules from the Perspective of Equality of Opportunity. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2023:7180803. [PMID: 37235745 DOI: 10.1093/jmp/jhad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Should priority in the allocation of organs be given to those who have previously donated or declared their willingness to do so? This article examines the Israeli priority rule in light of two prominent critiques of priority rules, pertaining to failure to reciprocate and unfairness. The scope and content of these critiques are interpreted from the perspective of equality of opportunity. Because the Israeli priority rule may be reasonably criticized for unfairness and failing to reward certain behaviors, the article develops an adjusted priority rule, which removes and adjust the elements in the Israeli priority rule deemed problematic. However, such a priority rule is complex to the extent that it may fail to increase donation rates and furthermore introduce new concerns of fairness, as the better off may be better able to navigate the complex adjusted priority rule.
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Copeland H, Knezevic I, Baran DA, Rao V, Pham M, Gustafsson F, Pinney S, Lima B, Masetti M, Ciarka A, Rajagopalan N, Torres A, Hsich E, Patel JK, Goldraich LA, Colvin M, Segovia J, Ross H, Ginwalla M, Sharif-Kashani B, Farr MA, Potena L, Kobashigawa J, Crespo-Leiro MG, Altman N, Wagner F, Cook J, Stosor V, Grossi PA, Khush K, Yagdi T, Restaino S, Tsui S, Absi D, Sokos G, Zuckermann A, Wayda B, Felius J, Hall SA. Donor heart selection: Evidence-based guidelines for providers. J Heart Lung Transplant 2023; 42:7-29. [PMID: 36357275 PMCID: PMC10284152 DOI: 10.1016/j.healun.2022.08.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 01/31/2023] Open
Abstract
The proposed donor heart selection guidelines provide evidence-based and expert-consensus recommendations for the selection of donor hearts following brain death. These recommendations were compiled by an international panel of experts based on an extensive literature review.
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Affiliation(s)
- Hannah Copeland
- Department of Cardiovascular and Thoracic Surgery Lutheran Hospital, Fort Wayne, Indiana; Indiana University School of Medicine-Fort Wayne, Fort Wayne, Indiana.
| | - Ivan Knezevic
- Transplantation Centre, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David A Baran
- Department of Medicine, Division of Cardiology, Sentara Heart Hospital, Norfolk, Virginia
| | - Vivek Rao
- Peter Munk Cardiac Centre Toronto General Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Michael Pham
- Sutter Health California Pacific Medical Center, San Francisco, California
| | - Finn Gustafsson
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sean Pinney
- University of Chicago Medicine, Chicago, Illinois
| | - Brian Lima
- Medical City Heart Hospital, Dallas, Texas
| | - Marco Masetti
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Agnieszka Ciarka
- Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Institute of Civilisation Diseases and Regenerative Medicine, University of Information Technology and Management, Rzeszow, Poland
| | | | - Adriana Torres
- Los Cobos Medical Center, Universidad El Bosque, Bogota, Colombia
| | | | | | | | | | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | - Heather Ross
- University of Toronto, Toronto, Ontario, Canada; Sutter Health California Pacific Medical Center, San Francisco, California
| | - Mahazarin Ginwalla
- Cardiovascular Division, Palo Alto Medical Foundation/Sutter Health, Burlingame, California
| | - Babak Sharif-Kashani
- Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - MaryJane A Farr
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luciano Potena
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | | | | | | | | | | | - Valentina Stosor
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Kiran Khush
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Tahir Yagdi
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Susan Restaino
- Division of Cardiology Columbia University, New York, New York; New York Presbyterian Hospital, New York, New York
| | - Steven Tsui
- Department of Cardiothoracic Surgery Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Daniel Absi
- Department of Cardiothoracic and Transplant Surgery, University Hospital Favaloro Foundation, Buenos Aires, Argentina
| | - George Sokos
- Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Brian Wayda
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Joost Felius
- Baylor Scott & White Research Institute, Dallas, Texas; Texas A&M University Health Science Center, Dallas, Texas
| | - Shelley A Hall
- Texas A&M University Health Science Center, Dallas, Texas; Division of Transplant Cardiology, Mechanical Circulatory Support and Advanced Heart Failure, Baylor University Medical Center, Dallas, Texas
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Doerry K, Oh J, Vincent D, Fischer L, Schulz-Jürgensen S. Religious and cultural aspects of organ donation: Narrowing the gap through understanding different religious beliefs. Pediatr Transplant 2022; 26:e14339. [PMID: 35735257 DOI: 10.1111/petr.14339] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 04/10/2022] [Accepted: 04/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The supply of viable organ donations falls significantly below the demand. Discrepancies concerning the availability of transplants cannot be explained solely by the various consent models used in different countries. There is evidence that religious beliefs of patients, potential donors, and healthcare professionals also play an important role in the decision-making process. However, to date, very little research has been conducted on the consequences of specific religious beliefs on transplantation rates. The aim of this review was to outline the religious views of Christians, Muslims, Jews, Hindus, and Buddhists on organ donation. Additionally, different approaches to address this topic throughout the world are presented and can function as a helpful background for medical professionals. METHODS The umbrella organizations of the five largest religious movements were asked for written statements concerning the subject of organ transplantation, and a literature review was performed. RESULTS All German religious umbrella organizations have a positive view on organ donation, if certain rules are respected. Particularly, deceased donations are supported as a sign of altruism, love, and respect for another human being. Different aspects of the transplant process (e.g., consent, brain death, and respect for the dead body) are particularly stressed in some religions. CONCLUSIONS In general, the religious groups addressed here are in favor of organ donations. Nevertheless, there are important particularities to be considered. Hopefully, understanding the different religious views on organ donations will help in reducing religious concerns about transplantation and narrowing the gap between the need and the availability of organ donations.
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Affiliation(s)
- Katja Doerry
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jun Oh
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Deirdre Vincent
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Fischer
- Department of Visceral Transplantation, University Medical Center Hamburg Eppendorf, Hamburg, Germany
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8
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Azuri P, Tarabeih M. Religious Worldviews Affecting Organ Donation in Israel. Transplant Proc 2022; 54:2047-2056. [DOI: 10.1016/j.transproceed.2022.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
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Ashkenazi T, Stoler A, Mor E. The Effect of Priority Given to Donor Card Holders on the Allocation of Livers for Transplant-Evidence From 7 Years of the Israeli Priority Program. Transplantation 2022; 106:299-307. [PMID: 33675314 DOI: 10.1097/tp.0000000000003730] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Israeli Transplant Law grants priority in organ allocation to patients signing a donor card. Liver transplant candidates get additional 2 points on their Model for End Stage Liver Disease score for signing a donor card, 0.1 points for a relative holding a card, and 5 points if a relative donated an organ. We studied the effect of the priority program on waiting list mortality and allocation changes due to priority. METHODS Using Israeli Transplant data of 531 adult liver transplant candidates with chronic liver disease listed between 2012 and 2018 we compared waitlist mortality and transplant rate of candidates with and without priority. Then we analyzed liver allocations resulting from additional priority points and followed outcome of patients who were skipped in line. RESULTS Of the 519 candidates, 294 did not sign a donor card, 82 signed, 140 had a relative sign, and for 3, a relative donated an organ. The rates of waitlist mortality in these 4 groups were 22.4%, 0%, 21.4%, and 0%, respectively, and the transplant rates were 50%, 59.8%, 49.3%, and 100%, respectively. Of the 30 patients who were skipped because of priority, 24 subsequently underwent transplant, 2 are on the waiting list, and 4 died within 0.75, 1.75, 7, and 17 mo. CONCLUSIONS The 2 points added to the Model for End Stage Liver Disease score were associated with lower waitlist mortality and higher transplant rate for candidates signing a donor card without significantly affecting access to transplant during allocation. Further research and consideration of optimal policy when granting priority for candidates signing a donor card should continue.
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Affiliation(s)
- Tamar Ashkenazi
- Israel Transplant Organization, Ministry of Health, Tel-Aviv, Israel
| | | | - Eytan Mor
- Transplant Center, Department of Surgery B, Sheba Medical Center, Ramat Gan, Affiliated with Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
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10
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Glas A. Join the Lone Kidney Club: incentivising live organ donation. JOURNAL OF MEDICAL ETHICS 2021; 47:618-622. [PMID: 32060210 DOI: 10.1136/medethics-2019-105999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/28/2020] [Accepted: 02/02/2020] [Indexed: 06/10/2023]
Abstract
Given the dramatic shortage of transplantable organs, demand cannot be met by established and envisioned organ procurement policies targeting postmortem donation. Live organ donation (LOD) is a medically attractive option, and ethically permissible if informed consent is given and donor beneficence balances recipient non-maleficence. Only a few legal and regulatory frameworks incentivise LOD, with the key exception of Israel's Organ Transplant Law, which has produced significant improvements in organ donation rates. Therefore, I propose an organ procurement system that incentivises LOD by allocating additional priority points to the living donor on any transplant waiting list. I outline benefits and challenges for potential recipients, donors and society at large, and suggest measures to ensure medical protection of marginalised patient groups.
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Affiliation(s)
- Annet Glas
- Max Planck Institute of Neurobiology, Martinsried, Germany
- Graduate School of Systemic Neurosciences, Ludwig Maximilian University of Munich Faculty of Biology, Martinsried, Germany
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11
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Policy in pediatric nephrology: successes, failures, and the impact on disparities. Pediatr Nephrol 2021; 36:2177-2188. [PMID: 32968856 DOI: 10.1007/s00467-020-04755-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/10/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
Pediatric nephrology has a history rooted in pediatric advocacy and has made numerous contributions to child health policy affecting pediatric kidney diseases. Despite this progress, profound social disparities remain for marginalized and socially vulnerable children with kidney disease. Different risk factors, such as genetic predisposition, environmental factors, social risk factors, or health care access influence the emergence and progression of pediatric kidney disease, as well as access to life-saving interventions, leading to disparate outcomes. This review will summarize the breadth of literature on social determinants of health in children with kidney disease worldwide and highlight policy-based initiatives that mitigate the adverse social factors to generate greater equity in pediatric kidney disease.
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Commentary: The Effect of Priority Given to Donor Card Holders on the Allocation of Livers for Transplant - Evidence from 7 Years of The Israeli Priority Program. Transplantation 2021; 106:243-244. [PMID: 33675316 DOI: 10.1097/tp.0000000000003731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Kurleto P, Skorupska-Król A, Broniatowska E, Bramstedt KA. Exploring the motives of Israeli Jews who were living kidney donors to strangers. Clin Transplant 2020; 34:e14034. [PMID: 32652718 DOI: 10.1111/ctr.14034] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 01/10/2023]
Abstract
Non-directed living donors are individuals who donate a kidney to a recipient with whom they have neither a genetic nor emotional relationship. Israel legalized this type of donation in 2008. After this law was implemented, living donations significantly expanded. The aim of this article was to determine the motivations, characteristics, and perioperative experiences of non-directed living donors in Israel. Three online questionnaires (own questionnaire, Rosenberg Self-Esteem Scale (RSES), Rushton Self-Report Altruism Scale) were distributed to 180 Jewish kidney donors with the help of Matnat Chaim organization. One hundred and fifteen responses were received (69.3% response rate). The motivation for most donors (60%) was a strong willingness to help and a desire to do good. The majority of donors (78.3%) reported their health status as unchanged after donation; however, 16.5% experienced clinical problems (eg, wound infection, more pain than expected), and 5.2% experienced psychological complications. About 18% reported their health to improve after donation. Most (80%) inspired someone else to also become a kidney donor. This study breaks the myth that Jews do not support organ donation. In fact, their high level of altruism and their positive experience with donation has propelled the practice of non-directed donation in Israel.
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Affiliation(s)
- Paulina Kurleto
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Agnieszka Skorupska-Król
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Elżbieta Broniatowska
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
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Zaltzman J. Ten years of Israel's organ transplant law: is it on the right track? Isr J Health Policy Res 2018; 7:45. [PMID: 30068388 PMCID: PMC6069893 DOI: 10.1186/s13584-018-0232-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/29/2018] [Indexed: 11/29/2022] Open
Abstract
The Israeli organ donor law was established in 2008. In the ensuing 10 years there have been some improvements in deceased donation and living donor rates and a reduction in the unethical practice of transplant tourism. There is, however, controversy regarding increased access to transplant for those who have been living donors, who are family members of deceased donors, or who have registered their intent to donate. The issue of routine retrieval versus obtaining consent for organ donation has also been raised. This commentary will address these issue, and propose some steps for improvement of the current Israeli organ donation system.
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Affiliation(s)
- Jeffrey Zaltzman
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada. .,Chief Medical Officer transplant, Trillium Gift of Life Network, Toronto, Ontario, Canada. .,University of Toronto, Toronto, Ontario, Canada.
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