Israel tries a new method to boost donation of organs

JERUSALEM — 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. But it has also raised resistance from within Israel's ultraorthodox Jewish minority.

These opponents say it discriminates against them because their religious convictions forbid the donation of their organs, and while they are unlikely to get the law reversed, they have the political clout to slow its implementation.

Only 10 percent of Israeli adults hold donor cards, compared with more than 30 percent in most Western countries.

The actual rate of families donating a deceased's organs is 45 percent, but in other countries it rises to 70 percent, according to Jacob Lavee, director of the heart-transplant unit at Israel's Sheba Medical Center.

Religious considerations

The low rate of organ donation is thought to be partly driven by religious considerations. Most rabbis have no problem with transplants to save lives; their objection is to profiting from or needlessly mutilating cadavers.

But 99-year-old Rabbi Yosef Sholom Elyashiv takes a different view, and he is one of ultraorthodox Jewry's most influential leaders, claiming 100,000 followers among Israel's 6 million Jews. Elyashiv forbids organ donation before cardiac death, but allows his followers to receive lifesaving donations.

Lavee, the doctor who helped draft the law, hopes that a broader pool of organs will ultimately benefit everyone, but he acknowledges that one of his primary motivations is "to prevent free riders."

Organ shortages

"This is the first time that a nonmedical criterion has been established in organ allocation," he said. "It will rectify the unfairness of the situation where people who are unwilling to donate wait in the same line as those who are willing."

The measure opens a new dimension in the worldwide quest to overcome organ shortages. One solution — a legalized organ market — is ethically fraught. Another is called "presumed consent," where whoever doesn't opt out is considered a donor.

Spain, France, Austria and Belgium have adopted the latter model and rank among the top European nations in percentage of deceased donations, according to a U.N. study. But experts here say "presumed consent" would have been much trickier to get through the Israeli Parliament.

Writing in the December issue of The Lancet, the British medical journal, Dr. Paolo Bruzzone of Sapienza University in Rome said the Israeli initiative made more sense. "Certainly, giving holders of donor cards priority in organ allocation sounds more acceptable than the introduction of organ conscription or financial incentives for organ donation," he wrote.

Israel's parliament passed its far more comprehensive legislation in 2008 by a wide margin, including votes from Shas, the mainstream ultraorthodox party, and it is to take effect after a huge campaign to explain the new regulations and their complicated point-based system to the public.

But Israel's unwieldy system of coalition government makes implementation uncertain. One of its members is an ultraorthodox party made up of Elyashiv's followers. Among its lawmakers is Yaakov Litzman, who happens to be the deputy health minister (the top post is vacant).

Another is Moshe Gafni, who said the law is "antidemocratic."

"If I can't contribute organs because of my religious beliefs, the state shouldn't be allowed to harm me," he told the AP.

Definition of death

The debate derives from Judaism's tricky definition of death.

Most leading Orthodox rabbis — as well as Israeli law — agree that a person dies when his brainstem stops functioning. A minority opinion, endorsed by Elyashiv, holds that as long as a person's heart beats he or she is alive and therefore the organs cannot be harvested.

Donation in Israel after cardiac death is rare and only done in special circumstances.

Robby Berman, founder and director of the Halachic Organ Donor Society, a Jewish organization based in New York, said ultraorthodox Jews can't have it both ways.

"Every Jew has a right to be against an organ donation, but then you can't come and say 'give me an organ.' "