ITS 2012 Report – Marked increase in national organ donation rates in Israel

by Maria Dalby – New legislation which recognises and defines the concept of brain death has allowed Israel to nearly double the number of transplantations of organs from deceased donors in the course of a single year. Other new laws provide incentives for living organ donation and prevents transplant tourism which until recently had been rife in Israel. Professor Jacob Lavee from the Israeli Ministry of Health has been one of the initiators behind the new legislation; in a well-attended morning session, Professor Lavee outlined the changes and showed the dramatic impact they have had on transplantation in Israel.

For a long period of time prior to the new laws, Israel had been one of the countries in the West with the lowest organ donation rates. The main reason for this was thought to be cultural and religious objections to the concept of brain death in some parts of Israeli society, although often without any similar doubts regarding accepting donated organs which gave rise to accusations of ‘freeriding’. Add to this an insurance system which effectively encouraged transplant tourism through generous targeted reimbursement of transplantations performed abroad, often in countries where organ trading could be suspected, and it is easy to see why leading Israeli transplant clinicians were eager to implement changes at the heart of the legislative framework.

In March 2008, the Israeli Parliament passed two laws into legislation with immediate and profound relevance to organ transplantation: the Brain Death Law, which defines the precise circumstances under which brain death can be declared and the procedure for doing so, and the Organ Transplantation Law which comprises a number of unique clauses, including:

• A total ban on reimbursement of transplant operations performed abroad in contravention of local regulations.
• Permitting organ allocation programmes to prioritise candidates who have signed a donor card or given consent for organ donation on behalf of a deceased next of kin.
• Insurance reimbursement schemes specifically designed to remove disincentives to living organ donation, covering loss or earnings, travel costs and medical costs. during a follow-up period, together with a limited amount of psychological counselling.

The full impact of these new laws was evident in the Israel National Transplant Center annual report for 2011. During this year there were 89 deceased organ donors across Israel, compared with only 60 in 2010, representing an increase in organ donation rate from 7.8 to 11.4 donors per million population (p<0.0001). Likewise in 2011, 267 organ transplantations from deceased donors were performed, compared with 157 in 2010 (Figure 1). The overall consent rate for organ donation from deceased donors rose from 49% in 2010 to 55% in 2011. The number of kidney transplantations with organs from living donors rose from 71 in 2010 to 117 in 2011. And as the initiators of the law change had hoped, the impact on the transplant waiting list has been apparent: for the first time in a decade, the total number of patients waiting for an organ transplant dropped from 1,117 in January 2011 to 1,041 in January 2012, and the total number of patients who died on the waiting list dropped from 124 in 2010 to 105 in 2011.

The number of individuals signing a donor card had been steady at around 45,000 per annum for a long time; however, in 2011 it rose to an unprecedented 70,000 which represents an increase from 10% to 12% of the adult population. In addition, the number of patients who had a kidney transplantation abroad has dropped from a total of 155 back in 2006 to the lowest ever number of 26 in 2011, indicating that transplant tourism had been brought to an almost complete halt simply by banning its reimbursement. Professor Lavee concluded that in only a short time, the new legislation had been able to turn around a worrying trend in Israel.

Figure 1. Organ transplantation from deceased donors.

Jacob Lavee, Israel National Transplant Center, Tel Aviv, Israel