Abstract
Across the globe, there is a shortage of donor organs for patients with
end-stage organ disease. In most countries, organ donation is stagnant. Over the
years, different approaches have been attempted with variable success. Most have
focused on media appeals to encourage organ donation. A more direct means to try
to improve organ donation would be to reward individuals who either agree to
donate (in the event of their brain death) or authorized donation of their
next-of-kin. For example, in Singapore (which has an ‘opt out’
organ donation system, whereby, all citizens are considered eligible for
donation unless they formally ‘opt out’ of consideration),
priority for transplant is given to individuals who have not opted out (
1
). A different system was recently
implemented in Israel where citizens were rewarded for either donor registration
or authorizing donation for their next-of-kin. Israel, like most countries has
an ‘opt in’ donation system whereby organ donation is not
presumed and requires specific authorization by registration of the individual
(prior to brain death) or authorization by next-of-kin. Specifically, the
Israeli law provided two incentives: 1) patients waitlisted for solid-organ
transplant who had previously registered as an organ donor ≥ 3 years
before listing received higher transplant priority; and 2) first-degree
relatives of individuals who either donated an organ while alive or authorized
donation for their next-of-kin were granted higher transplant priority. Stoler
et al. reviewed changes in organ donation before and after implementation of
this novel national policy (
2
).
