Israel's organ donation law

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The World's Aaron Schacter reports on a new law in Israel that aims to encourage organ donation by giving donors preferential treatment should THEY ever need a new organ.

MARCO WERMAN: Organ transplants save lives but far more people need hearts, lungs and kidneys than can get them. Today, we're going to examine two controversial strategies for addressing this global organ shortage. In a few minutes, we'll hear about Iran's strategy. First though, we got Israel where a new law tries to encourage organ donation by penalizing those who don't sign up to donate. The World's Aaron Schacter reports.

AARON SCHACTER: Judith Nussbaum is an organ recipient. The 71 year old resident of a seaside community near Tel Aviv got a kidney four years ago.

JUDITH NUSSBAUM: It's phenomenal. I don't take naps. I go on very long walks and hikes and treks so never did it before.

SCHACTER: Nussbaum is now a crusader for organ donation. She gives talks all over Israel, encouraging people to sign donor cards. That way, their hearts, lungs, livers, kidneys can be made available, should they die in a car accident or in another way that leaves the organs healthy enough for transplant but Nussbaum says it's a hard sell, even to her friends.

NUSSBAUM: Some of my friends say to me I won't even sign the card. My children don't want me to do it which I think is a cop out for I don't want to do it. Others say oh, you can't desecrate the body. You can't delay the burial. I think it's all based on misconceptions, why it's important and what the manifestations are.

SCHACTER: The main manifestations of this reluctance to donate are a severe organ shortage and a long list of Israelis waiting for organs who can't get them and will die waiting. Many countries face similar problems, but it's especially severe here and in response, Israel has taken what some see as drastic action. It's a new law nicknamed ?Don't Give, Don't Get.? At the Sheba Medical Center just outside Tel Aviv, Jacob Lavee is a transplant surgeon. He helped write the new law and explains how it works.

JACOB LAVEE: If there will be two candidates for an organ who need an organ urgently and a similar medical condition and this happens almost on a weekly basis, the one who has signed the organ donor card will be prioritized.

SCHACTER: In other words, if you're not willing to sign a donor card now, you'll be less likely to get an organ later if you need one. This represents a big shift from the way Israel used to distribute organs, in the way most countries still do. In the U.S. for instance, an organ is generally matched with a recipient based on objective medical criteria. Blood type, the size of the organ, how long the patient has been waiting. Israel is now adding a more subjective factor, in essence how willing the patient was to help others in times of need. Lavee admits the new law may sound cruel but polls show Israelis support it. He believes it will increase organ donation. After all, it encourages people to sign donor cards for reasons that go beyond altruism.

LAVEE: Right now in the U.S. and other European or any other Western country, organ donation is based on true altruism and this new law truly is not pure altruism.

SCHACTER: But some Israelis fear that the new ?Don't Give Don't Get? law will hurt them.

JACOB WEINER: I'm Orthodox. I cannot give.

SCHACTER: Rabbi Jacob Weiner heads an organization called the Jerusalem Center for Medicine & Halachic or Jewish law. He says under his interpretation of Jewish law, he cannot donate his organs or those of his family members. That's because surgeons harvest organs from patients whose hearts still beat and lungs still breathe with mechanical help, even though the brain has ceased to function. Doctors call the condition brain death. But ultra-Orthodox Jews like Rabbi Weiner don't consider these people truly dead, which means removing their organs is murder. So Rabbi Weiner says he won't sign an organ donor card but he is willing to accept an organ. Weiner says a patient declared brain dead by a team of physicians and taken off life support has already been killed so why not use those organs to save a life, including that of an Orthodox person. Weiner says the new law sends a punitive message to people like him.

WEINER: Well okay Rabbi, if you're not going to give, I'm not going to give you, you're not going to be able to receive. It's not me that doesn't want to give. I want to save people's lives. I'm bound by my tradition. To us, the ethics of medicine is not discrimination. Whoever needs it the most, they're the ones who get it.

ROBBIE BERMAN: This is discrimination if you want to call it that which I don't but if you want to call it discrimination, it's a discrimination against people that have decided to be part of the problem, not part of the solution.

SCHACTER: Robbie Berman heads an organization that encourages Jews to donate organs, called the Halachic Organ Donor Society. He says people who are unwilling to sign donor cards but are willing to take organs are hypocrites, regardless of their reasons.

BERMAN: There are many Orthodox rabbis that support organ donation. These people have chosen to be part of the religious group that tends to reject it. Fine, that's their right, go ahead and reject it but don't then come and claim that you want to get benefits from it.

SCHACTER: Advocates of the new law say even Israelis who don't sign donor cards may come out ahead in the end. If the law works as intended and dramatically boosts rates of donation, that would mean more organs for everyone. The Israeli law contains another incentive to boost donation, a financial one. The law allows the state to pay families up to $13,000 for donating a loved one's organs. Advocates of organ donation around the world will be watching to see if Israel's new incentives are worth copying. The big question, will appealing to people's self-interest make for a better system than relying on altruism alone? For The World, I'm Aaron Schacter, Jerusalem.