From Israel, a radical way to boost organ donation

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 ultra-Orthodox 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.

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 ultra-Orthodox 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."

"This is the first time that a non-medical 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.

Luc Noel, coordinator of clinical procedures at the World Health Organization in Geneva, praised the Israeli law for its educational value and for introducing a "community spirit" to the field of organ donations.