Israel boosted organ donor consent by giving donors priority for transplants

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.

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.'

Gave registered donors and their relatives priority points on the transplant waiting list, turning altruism into a reciprocal arrangement with a personal stake.

Reciprocity gave people a self-interested reason to register, not just a moral one.

Priority points made the benefit tangible and personal, increasing motivation.

The mechanism worked at the bedside where altruistic appeals had failed, raising family consent.

It required no new infrastructure, just a rule change, making it low-cost.

For mutual-aid pools, tie participation to a concrete future benefit rather than appealing to altruism alone.

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.