Israelis are about to be presented with a stark choice by their Health Ministry: sign up for a donor card, or you may find yourself at a disadvantage if you ever need a transplant.
The National Transplant Centre, the ministry’s transplant authority, is working on a NIS 3.5 million (£600,000) advertising campaign spelling out the ramifications of legislation to encourage organ donation which is unlike any other in the world.
In accordance with a 2008 law, Israel is preparing to start giving people who carry donor cards an advantage in assessment for organs should they need a transplant.
In all Western states, health authorities use a points system to assess eligibility for transplants, giving points on criteria such as the change in quality-of-life for the potential recipient and likelihood of a successful transplant.
According to the Israeli law, card-carriers will receive extra points. In effect this means that if a card-carrier and non-carrier are deemed by doctors to be equally eligible for a single organ, the card-carrier will clinch it.
If card carriers provide organs on death, their relatives will also have an advantage should they come to need transplants. The rationale for this is that donors’ families must give the final ok for the removal of organs.
The National Transplant Centre will launch its advertising campaign in the next three months. Once it begins, there will be a one-year recruitment period for donors, after which the law will come into force.
Some believe that this could be the solution to a major problem in Israel — only 10 per cent of the population carries donor cards, compared to 30 to 40 per cent in other Western countries.
The law is “a mechanism to enhance solidarity in society by giving a disincentive to free riders”, said Noam Zohar, Bar Ilan University philosophy professor and director of the university’s graduate bioethics programme.
Prof Zohar was a member of the ethics panel convened by the National Transplant Centre. Its members were far from unanimous on the merits of the law. Another panellist, Tel Aviv University philosophy professor Asa Kasher, said he regards it as a “slippery slope” towards potential recipients of organs being assessed on their contribution to society in other areas, such as army service or volunteer work.
“My major claim is that medical decisions should be made on the grounds of medical considerations alone and that no other considerations should enter the picture,” he said.
This spring, the National Transplant Centre plans to roll out another programme, also approved by the Knesset in 2008, to compensate people who donate organs during their lifetime. They will receive, from state funds, their full salary for a month-long recuperation period as well as other benefits such as a contribution to recovery time in a hotel. National Transplant Centre director Tamar Ashkenazi said that the compensation will ensure that donors are not out of pocket and insisted that it “is not a sum that can convince poor people to donate [for money]”.
But Dr Kasher said that it sets a dangerous precedent. It “starts with a marginal benefit, then becomes something more, and then the selling of organs,” he said.