Transforming Transplantation: Research from Israel

When I was twelve years old, my older sister, Laura, passed away suddenly from a cancerous brain tumor. She was an organ donor and saved a woman named Trish, who lives halfway across the country in New York. Witnessing the miraculous effects of organ donation has inspired my passion for learning about and advocating for organ donation.

As a student at Washington University in St. Louis, organ donation has become a main focus of my campus experience — both in and out of the classroom. I founded a student group, called SODA: Student Organ Donation Advocates, that promotes organ donation on campus and in the community to more than 500 individuals per year.

I began studying organ donation during a management class freshman year, when we discussed the worldwide shortage of organs. I learned about the various strategies each country employs — public campaigns, opt out systems, forced choice, and financial incentives — to help reduce this shortage. Israel’s model stood out from the rest. Unlike any other country in the world, non-financial incentives are used to encourage organ donor registration.

During my sophomore year I contacted Dr. Rafael Beyar, Chairman of Israel’s Adi National Transplant Center, to seek a summer internship in order to learn about Israel’s organ donation system. I have since developed a research project, with grant funding from the Office of Undergraduate Research, to study Israel’s use of non-financial incentives.

What are non-financial incentives? In the United States, organ donation operates on a principle called “pure altruism” — making a donation without the expectation of receiving something in return. My family decided to donate my sister’s liver because it was the right thing to do.

In Israel, however, individuals can receive a higher spot on the organ waiting list if they, too, support organ donation. It operates on a principle called “reciprocal altruism” — making a donation with the expectation of receiving something in return later. Priority is allocated as follows:

  • Highest Priority: An individual has been a living organ donor themselves or the individual has a first degree relative who has donated an organ
  • Middle Priority: An individual has been registered as an organ donor for at least three years
  • Lowest Priority: An individual has a first degree relative that has been registered as an organ donor for at least three years

I designed my research project to investigate how Israelis have reacted to this system of prioritization. Are they familiar with the new law? Do they support it? Why do they feel this way?

Sometimes I ask myself, “How would my family have reacted knowing that Laura’s liver donation could potentially benefit us later in life?”

Over the past six months I have delved into the organ donation literature, created a survey and had it translated into Hebrew, interviewed Israeli experts, and will soon be analyzing the data and summarizing my research findings.

A highlight of my research was interviewing Dr. Jacob Lavee, the President of the Israel Transplantation Society, and the visionary behind Israel’s prioritization system. In 2005, he had treated an ultra-orthodox patient who was waiting for a heart transplant. This man admitted that even though he was willing to receive a heart, he did not approve of his own family members agreeing to donate theirs. This is called the “free-rider” problem — patients willing to receive an organ but not donate one — and is particularly relevant in Israel because of religious concerns regarding organ donation. In my family’s scenario, it would be like Trish, the recipient of Laura’s liver, not having been willing for her family members or herself to donate an organ.

Upon seeing this injustice, Dr. Lavee submitted a proposal to the Israeli Parliament to prioritize individuals who support organ donation. Parliament then requested a multidisciplinary committee to investigate the proposal and eventually the Organ Transplant Law, a three-tiered prioritization system, was developed.

The law’s success has been astonishing. At the end of my interview, Dr. Lavee explained that within five years Israel’s consent rate has increased from 40% to 60% among potential organ donors. His next goal is for that rate to increase from 60% to 80%. “It’s going to be very difficult, but again, if you would have asked me years ago if I would have imagined that within five years we would jump from 40% to 60%, I would have said no way. So you have to dream.”

Now that I have collected 500 survey responses from among the Israeli population, I will analyze these perceptions about the new prioritization system. By sharing my data and conclusions with organ donation professionals in Israel and the United States, I will be contributing to the knowledge about how to reduce the organ shortage, hopefully helping to save more lives.

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