donderdag 12 januari 2012

Israel as example: Organ donations

NZ's organ donation regime is an inefficient nightmare that kills people. Donor's wishes, expressed via their drivers' licence, aren't taken as binding and can be overturned by anyone claiming a connection to the potential donor. Even suggesting that folks signing up to be future organ donors get bumped up the waiting list gets folks riled up, though there were some encouraging noises two years ago about maybe allowing that Kiwi donors be compensated; similar calls for compensation came up in the UK last year. As it stands, Otago's med school is allowed to cover funeral costs for cadaveric whole body donations, but nobody's allowed to cover funeral costs for organ donors. There are all kinds of policies that would improve on the status quo but haven't been explored, at least in NZ.

Israel opened things up last year. Living donors are now paid 40 days' lost wages plus a very generous expenses allowance. Folks with family members on the waiting list can request to become living donors for other people on the list and are then matched with other folks in the same circumstances: a "chain of living donors" not unlike the American MatchingDonors service. Result?
Israel experienced a dramatic increase in the number of organ transplants in 2011, totaling 384, 68 percent higher than the previous year, although the number of transplants performed in 2010 was particularly low. Kidney transplants from deceased donors were 2.37 times greater in 2011, with 123 operations, than in 2010. There were 69 liver transplants from deceased donors in the past year, 2.15 times as many the previous year, 59 lung transplants, representing an 84 percent increase, and 23 heart transplants - 2.09 times the number in 2010.
The waiting list dropped from 1117 to 1041. The waiting list for cornea transplants was almost halved. And the number of people dying on the waiting list dropped from 124 to 105.

But they're not stopping there.
The Priority Law, which takes effect in April, will give holders of Adi donor cards priority if they ever need a transplant.
The number of cardholders has considerably increased recently following a publicity campaign touting the new law. Anyone signing the card before April will be immediately eligible for the benefit, while those signing after the law goes into effect will need to wait three years for eligibility after signing.
The number of organ donor signatures rose 71,229 during the year to a total of 632,300 while another 20,000 requests for the cards are being processed by the National Transplant Center.
But this could only work in a country with strong support for transplantation, right? Nope. Israel started around the bottom of the pack:
But despite the optimistic figures, Israel's rate of organ donations from the deceased remains at the bottom of the list for Western countries. According to a 2010 report by the National Transplant Organization and the World Health Organization, Israel had 31 organ donations per million residents, higher than Greece with 15 and Lebanon with 18, but lower than Austria, with the highest rate of 91, the U.S. (90 ), France (72 ), Britain (64 ), Germany (62 ), and even Turkey (43 ) and Iran (35 ).
There is no good reason we couldn't replicate their success. Cultural sensitivities among Maori about tapu and organ donation? Israel managed to pass this legislation despite some pretty serious opposition from the ultra-orthodox community.

Government inaction here condemns people to death.

Update: Alex at Marginal Revolution covered this while I was on summer holidays; I'd missed it. Ah well. Truth bears repeating.

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