Altruism Does Not Underlie Israeli Organ Transplant Law

American Journal of Transplantation


D. Shabtai*
Article first published online: 26 APR 2013
DOI: 10.1111/ajt.12241
The authors' report of increasing availability of transplantable organs in Israel [1] is noteworthy and encouraging; they attribute this rise to the recently passed Organ Transplantation Law. However, even while achieving such noble goals, this law cannot be rightly justified as predicated upon the notion of reciprocal altruism, as the authors claim it to be.

Signing a donor card is not an altruistic action per se, since Israeli law mandates that the actual donation depend upon the consent of the donor's proxy or next of kin and cannot be undertaken without their approval [2]. But even if considered to be altruistic, it should rightly be attributed to the donor. The law however, assigns transplant priority even to first degree relatives of a deceased organ donor. While the original donation was motivated by a sense of altruismâ€"it was the altruism of the donor himself or herself, not their first degree relatives. Assigning transplant priority status to these relatives does not reflect reciprocity, but rather appears to incentivize these relatives to agree to the donation in the first place.

Additionally, the law completely disregards the continued care of live directed kidney donors, even as the authors note an increase in such donations. The United Network for Organ Sharing advocates a policy of giving living organ donors priority in receiving a transplant themselves should they ever need one, which the authors cite as a paradigmatic model for organ allocation. The Israeli law however, specifically excludes the vast majority of live organ donors from any transplant priority, should they themselves ever require an organ transplant [3]. Oddly, the Israeli law assigns transplant priority only to live organ donors to unspecified recipients, excluding most live donors, who are indeed aware of the designated recipients of their organs.
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