Ethical Amendments to the Israeli Organ Transplant Law

Abstract

To the Editor:We thank Dr. Shabtai for his thoughtful remarks (1). ThenewlyamendedIsraeliOrganTransplantLawassignsthreelevels of priorities in organ allocation to candidates fortransplantation based upon their previous attitudes towardorgandonation.Toppriorityisgrantedtocandidateswhosefirst-degree relatives donated organs after death or tocandidates who have been themselves live kidney or liver-lobe donors. Second priority is granted to candidates whohave registered as organ donors at least 3 years prior ofbeing listed. Finally, the law grants a third and lowestpriority to candidates who have not signed the donor cardthemselves but whose first-degree relatives have regis-teredasorgandonorsatleast3yearsprioroftheirlisting(2).While admittedly the Israeli law mandates the approval ofthe deceased’s next of kin for organ donation even if thedeceased was aregistereddonor, the Israeli practice so farhas shown that families of deceased persons who havebeen registered donors have traditionally approved organdonation and with only rare exceptions never vetoeddonation as they consider the deceased’s signature onthe donor card as a signed will. As the Israeli law regardingorgan donation is an opt-in law, it is assumed that those insocietywhoreallyopposeorgandonationafterdeathmaketheir wish and belief known to their relatives who wouldtherefore abstain from approving their organ donation andwould not be incentivized to do so only to be rewarded bypotential future prioritization in organ allocation. In spite ofthe legal request for approval of the deceased’s organdonation by his relatives, the act is still considered as ahighly altruistic one which benefits society at large andshould therefore be considered worthy of being rewardedby a reciprocal prioritization.Dr. Shabtai has correctly pointed out that the originalversion of the Israeli law has been indeed flawed bygranting priority in organ allocation only to candidates whohavebeennondirectedlivingkidneyorliver-lobedonors(2).However, he regretfully failed to notice that we havereported (3) that a recent Parliamentary amendment to thisclausehasbroadenedtheprioritizationtoanylivingdonor—directed and nondirected alike—so that candidates whohave previously donated an organ (kidney, liver lobe or lunglobe) which they are now in need of are now granted toppriority in the allocation of these organs. This legalamendment is in accordance with the original recommen-dationsofthespecialmultidisciplinaryadvisorycommittee,which included philosophers, ethicists, lawyers, socialscientists, representatives of the main religions, transplantphysicians and coordinators, to give priority to all livingdonors (4).Incidentally, this committee’s recommendations did notincludethecurrentthirdandlowestlevelofprioritywhichisgranted to candidates who have not signed the donor cardthemselves but have first-degree relatives who have doneso, which was added by the Parliament. This prioritizationcategory has already been previously rightfully criticized byus as well as by others (4,5) and will hopefully be amendedin the future.J. Lavee