Subscribe to Print Edition | Thu., September 10, 2009 Elul 21, 5769 | | Israel Time: 22:44 (EST+7)
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No givers and thus no takers
By Dan Even
Tags: National Transplant Center 

Participants at the monthly meeting organized by Israel's National Transplant and Organ Donation Center (Adi) for families of organ donors, were upset. They were insulted by the recent accusations printed in a Swedish newspaper to the effect that Israel had harvested organs from a Palestinian killed by the army. Preposterous as the article was generally acknowledged to be, the subject matter raised once again the entire fraught issue of organ transplants in the country.

"My nephew's organs were donated to Arabs," said Maya Kaveh, a Jewish woman from Herzliya. "There's no racism here." Said Yefim Pozoarik of Holon, whose son Cpl. Yaniv Pozoarik was killed a year and a half ago by a stray bullet: "When they asked us to donate his organs, we agreed immediately. A young Israeli Arab received his heart, and we're in contact with him. He calls me and my wife Mom and Dad."

The organ transplant law passed in Israel in May 2008 stipulated that every committee charged with determining a patient's brain death include a rabbi, and that living donors and families of the deceased receive financial compensation of some NIS 18,000.
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Ostensibly the willingness to donate organs is on the rise - the number of people with Adi donor cards increased by 7 percent in the past two years, to about 510,000 people - but there are still long lists of people awaiting transplants. According to Tamar Ashkenazi, who coordinates the subject at the Health Ministry's National Transplant Center, this is to be expected: "The people who sign the donor cards are healthy today. It will take a long time until we reap the fruits of the present public relations campaign [to sign up potential organ donors] in the schools and the army."

Today, the majority of families of brain-dead patients - 57.9 percent - do not agree to donate the organs of their loved ones, mostly for reasons of religion or tradition. This percentage places Israel in 22nd place, among 24 countries providing data, in terms of residents' willingness to donate organs in such circumstances. According to the latest report of the European Union's transplant council, in 2007 only Turkey and Great Britain had a higher proportion of refusals than Israel: 58.7 percent and 60.2 percent, respectively. In Greece, the percentage drops to 43.5, and in Norway, 22 percent refuse. The lowest rates of refusal were registered in Spain - 16.8 percent; Cuba, with 11.5 percent; and in Ireland, where a negligible 8.2 percent are unwilling to donate organs.

Meanwhile, in light of the local shortage of organs, many Israelis in need of donated organs travel abroad.

"Starting next January," says Prof. Yaacov Lavie, president of the Israel Transplant Association and director of the heart transplant unit at the Sheba Medical Center in Tel Hashomer, "anyone who signs a donor card will receive preference in the allocation of organs, should they have a need. The card will become a type of transplant insurance."

Regarding the article in the Swedish newspaper, Lavie says it's "a fabricated piece of nonsense," but adds: "We could be accused of that, in light of the ease in which trade in organs is accepted, when it comes to local patients who seek solutions in a country where there is such commerce."

In the past the Abu Kabir Institute of Forensic Medicine in Tel Aviv was also accused of removing organs from bodies without the families' consent, and there was a suspicion of trafficking activity. A Health Ministry investigatory committee determined that although organs had in fact been removed without agreement, there was no trafficking per se.

While the transplant law was passed last year, the stipulation concerning financial compensation - which may well greatly encourage organ donation from living donors - has yet to be approved by the Finance Ministry. Should the treasury give the green light, compensation will be granted retroactively to all donors and their families starting from May 2008.

That same month the Declaration of Istanbul on Organ Trafficking and Transplant Tourism was also published. It was signed by 77 countries, including Israel, and included a clause designed to prevent trafficking in organs - by making it a criminal offense punishable by three years in prison.

Organizations of patients waiting for transplants have recently begun to make critical noises about the declaration, because as a result of its prohibition of trafficking, health maintenance organizations are no longer approving rebates for organ transplants conducted abroad, as they once did - regardless of the source of the donated organ. At present, for a rebate to be given, a confirmation is required from the foreign hospital at which the operation is carried out, declaring there was no trafficking involved. At the same time, there has been a decrease in activity by local intermediaries, who used to initiate contact between patients and living donors (mainly of kidneys). Furthermore, the Health Ministry committee that approves transplants for altruistic reasons, which used to approve 80 percent of requests for such operations in Israel, now approves only 20 percent, in order to prevent trafficking.

Israelis still travel to Colombia for liver, heart and lung transplants. Organ donation is the rule in every case of brain death in Colombia, unless the family expresses opposition, and for that reason, Israel's Health Ministry has ruled that organs received in Colombia do not come from what is defined as trafficking. Kidney transplants for Israeli patients are also performed in Ecuador and Kazakhstan - where there are suspicions of trafficking. The cost for the procedure can be as high as NIS 140,000.

Many other countries, including the Philippines and Kosovo, are no longer a destination for people seeking transplants, in light of the activity of Prof. Francis Delmonico, an adviser on organ transplants to the World Health Organization, who fought in the past against the harvesting of organs from condemned prisoners there. At present an Israeli agency is checking the possibility of arranging for transplants in countries of the Eastern European bloc, with organs from deceased donors.

"The situation today is worse than before the transplantation law was passed," said Amos Canaf, chairman of the Israel Kidney Transplant and Dialysis Organization. "If in the past, Israelis had the option of undergoing [kidney] transplants abroad, today people don't travel overseas to do them, there are more patients treated with dialysis and there is also an increase in the number of those who die. Nobody cares about the patients, and people are dying here."

The difficult transplant situation led in June to the resignation of the Israel Transplant Center's chairman, Prof. Gabriel Gurman. In his letter of resignation, which was published in Haaretz, Gurman blamed the center's administration for such failures as its inability to forge ties with relevant medical organizations abroad or to channel funding to local hospitals for activities to promote donations. There was an unprecedented discussion, at a conference held two weeks ago at the Health Ministry, concerning regulations for allocation of organs donated in Israel to foreign residents and Palestinians; in principle, people who are not citizens or residents of the country cannot receive organs for transplant in Israel. The one exception was a Palestinian boy who underwent a lung transplant from a donor, whose lungs were not suitable for any of the Israeli candidates at the time.

"In the areas of the Palestinian Authority, there is at present no system for donating and transplanting organs," a ministry position paper stated, "while those who can afford it are flown abroad."

The Health Ministry discussion touched on the subject of allocating organs to tourists whose condition deteriorates suddenly while they are visiting, and also on the issue of whether to inform an organ-donating family that their donation is earmarked for a foreign citizen or a patient from a hostile country. The ministry's deputy director general, Dr. Boaz Lev, appointed a team to examine the latter question.

Yusra Ashour of Jaffa, who lost two of her children in a car accident and donated their organs, could not see why such considerations are relevant.

"I never thought about whether I was donating organs to the other side," she said at the meeting organized by Adi last week. "Now it's the month of Ramadan, a month of giving, and as a Muslim Arab, as far as I'm concerned whoever gives life, it's as though he gave to the whole world."
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