#345 2008 · Israeli Ministry of Health / Knesset · Organ transplantation policyincentive-flip
Israel offered no moral appeal for organ donation, just a promise: register now, jump the queue if you ever need an organ yourself
the problem
Too few Israelis registered as organ donors, and families often refused
background
Every country running a donor-registration system relies on the same pitch: sign up out of altruism, because it might save a stranger's life someday. Israel's registration and family-consent rates lagged behind much of Europe under that pitch, and the country's transplant waiting lists kept growing.
Heart-transplant surgeon Jacob Lavee, working with economists Alvin Roth and Judd Kessler, pushed for a different lever entirely: instead of asking people to give without expecting anything back, tie donor status to a concrete return — priority if the tables were ever turned.
the move
Israel's 2008 Organ Transplantation Law, with priority allocation taking effect in 2010, gives registered donors — and, after a three-year wait, their first-degree relatives — bonus priority points on the transplant waiting list if they ever need an organ themselves. Anyone who had already donated an organ, or whose immediate family member became a deceased donor, receives top priority immediately, no waiting period. The pitch to the public shifted from 'help a stranger' to 'this list favors people who are already on it.'
the payoff
The clearest attributable effect is on the harder of the two numbers: family consent to donation after death, which is where most registration campaigns fail even when the deceased carried a donor card. Consent rose from roughly 42% in 2007 to 62% by 2016. Donor-card sign-ups spiked during the 2011–2013 publicity push but later leveled off, and Israel's overall deceased-donor rate — about 10 per million people in 2016 — still trailed most Western European countries, so the law changed behavior at the family's bedside more clearly than it changed the national donation rate.
what came after
Studied extensively by Lavee, Roth, Kessler and Stoler (published research includes *Incentivizing Organ Donor Registrations with Organ Allocation Priority*) as one of the few real-world tests of reciprocity-based, rather than altruism-based, donor policy; later papers also documented people exploiting timing loopholes in the priority rules, prompting ongoing amendments to the law.
filed under
references
- [1]PMC — Israel's 2008 Organ Transplant Law: continued ethical challenges to the priority points modelAmerican Journal of Transplantation (PMC), 2018pmc.ncbi.nlm.nih.gov
- [2]PMC — Ten years of Israel's organ transplant law: is it on the right track?Israel Journal of Health Policy Research, 2018pmc.ncbi.nlm.nih.gov
- [3]If You Do Not Give – You Will Be the Last One to Get! A New Organ Allocation Policy in Israel Enhances Organ DonationJournal of Heart and Lung Transplantation (ScienceDirect), 2016jhltonline.org