No Give, No Take in Israel

In January, Israel will become the first country in the world to give people who sign their organ donor cards points pushing them up the transplant list should they one day need a transplant.  Points will also be given to transplant candidates whose first-degree relatives have signed their organ donor cars or whose first-degree relatives were organ donors.

In the case of kidneys, for example, two points (on a 0-18 point scale) will be given if the candidate had three or more years previous to being listed signed their organ card.  One point will be given if a first-degree relative had signed and 3.5 points if a first-degree relative had previously donated.

In Entrepreneurial Economics I argued for a point allocation system like this–which I called a "no give, no take" system–as a way to increase the incentive to sign one's organ donor card.  One advantage of a no-give, no take system over paying for organs is that most people find this type of system to be fair and just–those who are willing to give are the first to receive should they one day be in in need.  

The new policy will be widely advertised in Israel and will be transitioned into place beginning in January.  I think this new policy is very important.  If organ donation rates increase in Israel, I expect that other countries will quickly follow suit.

By the way, is it peculiar that the two countries in the world with the best organ donor systems are now Israel and Iran?

Hat tip to Dave Undis whose Lifesharers group (I am an advisor) is working on implementing a similar system in the United States.


Do you get points if you're a Palestinian, and your relatives had their organs harvested?

What about the differential impact on different races or religions? Won't there be whining about "Human Rights"?

Does signing a donor card count, even if for medical reasons your organs can't be used? How about if that's true, but you didn't know it?

Who, exactly, is accounting for these 'points'?
Where, exactly, are they recorded?
How, exactly, is the program financed?

So, what happens if you're a generous soul who would otherwise donate any and all of your organs, if it weren't for a lack of proper viral screening in donated blood in the early '80's? If you have a blood-borne illness, your organs can't be used as far as I know. So what happens to those people? Do you get points for being sick? And what happens if you need a new, let's say, liver because of that illness? Now your priority is lower than someone who drank his liver away but their whole family donated kidneys. How does that work?

For those interested, I argued for an organ donation preference system here:

A couple of people are worried about religion. Is there one that does not allow you to give an organ, but does allow you to receive?

"Is there one that does not allow you to give an organ, but does allow you to receive?" I don't know, but I have heard mutterings in Britain about some groups who seem entirely happy to receive and deeply reluctant to donate. I have no idea whether it's true - the censorship laws that apply to everything to do with race and religion mean that I don't expect ever to see a factual account. Many people, I guess, knowing that the truth will never be uttered by officialdom, just suspect the worst.

Why should your priority on an organ donation list have anything to do with your family members? Should a person that would be more than happy to donate their organs be punished because their parents and siblings won't? Also, doesn't this give an advantage to people from large families because they can earn more points by sheer numbers?

Wow, this is more controversial than I would have thought, which is why, I suppose, that cash markets for organs are not allowed. I personally can't imagine not signing up to be an organ donor; I can see not forking over a kidney while alive, but who needs an organ after death anyway? Even those with tainted organs could be donors for recipients who have had the same issues, thus making everybody a potential donor.

Funny nobody has made this comment yet....

An MR post a couple of days ago said:

We identify the marginal effect of religious identity on economic choices by measuring how laboratory subjects‘ choices change when their religious identity is made salient to them. We find that Protestantism increases contributions to public goods. Catholicism decreases contributions to public goods, decreases expectations‘ of others‘ contributions to public goods, and may decrease risk aversion. Judaism increases reciprocity. We find no evidence of religious identity effects on discount rates or generosity in a dictator game.

( )

duh. why should those willing to donate their organs be more eligible for organs? If everyone that needed an organ signed a binding agreement to donate their organs, you get multiple organs coming in for every one leaving the system. There's no way a shortage could persist.

Will people sign cards when they are young and then renege closer to death

Well I understand that the ideal organ donor is a young adult dying of a severe accident or road crash while on life support. People in that situation are often not capable of reneging, what with being unconscious or even already braindead. There are some people who after a severe accident are still conscious for a bit but eventually die from their injuries, but how many of them will be both thinking about organ donation, as opposed to messages for their loved ones, or trying to survive, and be interested in reneging rather than drawing comfort from the thought that their organs will assist someone else's survival?

People who are dying of things that will take long enough to kill them as to give time for rethinking your organ donor plans, how many of them are likely to have organs still fit for implantation? And of those who do, how many will be willing to renege?

Would it be naive to believe that no matter the points a high level bureaucrat, politician, or military person will get the organs he or she wants?

Actually 1 in 3 in the UK kidney transplants are from living donors. Spain has the highest donation rate from the register. They know how to deal with relatives of the deceased and are able to encourage a lot more donations than other countries.

I feel governments have not done nearly enough to encourage people to sign the register. Here in the UK a few adverts have appeared on TV, but in talking to people they get fed up with them and view them as almost emotional blackmail adverts.

As for Undis Lifesharers campaign to make an elitist group, even doctors do not agree with his methods.

Thank goodness it is not legal in the UK. Here the most needy get the organ regardless of whether they have signed the register or not. Also as regards kidney donation, 1 in 3 comes from a Living Donor. Having an opt out system is far better than opt in. Wales has now gone for that, hopefully the UK will follow. Perhaps if we taught people to not be so selfish then maybe more would sign without having to be bribed.

As Caplan says "...we believe the transplant system should neither reward nor punish people for their personal decisions or beliefs," Caplan said he considers the LifeSharers' concept impractical. With only about one in 1,000 deaths leading to a viable organ for transplant, millions would need to sign up to have enough organs to offer those who pledge to donate."

Outstanding article it is actually. We have been waiting for this tips.

Article very interesting, thanks for information.

Comments for this post are closed