No-give, No-take in Israel

In Entrepreneurial Economics I argued for a “no give, no take” system for organ donation–people who signed their organ donor cards would be given priority over non-signers should they one day need an organ. The idea has an element of justice to it but the primary goal is to increase the incentive to sign one’s organ donor card.

Israel recently adopted this policy by giving extra points on the allocation system to people who previously signed the organ donor card. In the case of kidneys, for example, two points (on a 0-18 point scale) are given if the candidate had three or more years previous to being listed signed their organ card.  One point is given if a first-degree relative had signed and 3.5 points if a first-degree relative had previously donated.

It’s early but so far the policy appears to be very successful:

Due to the population’s surge of interest in obtaining an organ donor card, the Adi-National Israel Transplant Center has extended through March 31 the deadline to register as a donor and receive special benefits.

…During the past few weeks, Adi’s phone system has collapsed several times due to the high demand.

Since Adi decided to give preferential treatment to those registering as a potential organ donor, tens of thousands of people have registered, raising the number of potential donors to over 600,000. Until last year, the rate of registration was among the lowest in the Western world.

Hat tip to David Undis whose excellent group Lifesharers (I am an adviser) is implementing a private version of no-give, no take in the United States.

Here is my piece on Life Saving Incentives and here are previous MR posts on organ donation.


People are funny. We can't trade money. But we can trade livers for kidneys. Whatever works with people.

People are skeptical of moral fairness in the way money is distributed, but not healthy or failing organs?

Yeah, silly.

Perhaps because livers and kidneys are more equally distributed than shekels and dollars?

I'm going with people didn't even think that logically.

These are the people after all who think it would be a disaster to have more organs available because rich people would exploit the poor for the $10k or so a kidney would cost.

…So their solution is to prevent poor people from, if they so choose, selling their redundant kidneys for $10,000, a sum that would make them significantly less poor? Next maybe they'll want to outlaw employing poor people. They could be exploited, dontchaknow.

The Jews have historic and religious reasons to be hesitant to support organ donation. The last phrase in the article is troublesome at best.

They and the Muslims may be really squeamish about engineered porcine organs.

Is there a kosher certification for medical items? Not organs probably but tablets, capsules etc. must run into some pretty grey zones' eh?

Actually, it's not that complicated. The commandment is "you shall live by them". Any commandment other than idolatry, adultery, and murder must be ignored to save a life. So a pig heart value is completely kosher. Similarly for medicine. Medical cures using non-kosher animals are specifically discussed in the Talmud (tractate Yoma), in a section studied every Yom Kippur.

Of course, there are extremists in every religion, as well as well-intentioned people who are not well educated.

The primary issues with organ transplants have to do with the sacredness of the body, an series of scandals (including one in my own county in Texas), and events in the '40s.

American blacks are also more reticent to donate organs than average.

A simpler solution is to change organ donation from an opt-in system to an opt-out system, the way it is in some countries.

The "simplest" solution would perhaps be to make organ donation mandatory... I'm a donor, for what it's worth, but I would have problems with an opt-out system that presumes my body becomes property of the state in the absence of other arrangements. Less troubling is a "mandatory choice" system, in which no one can get a driver's license (for instance) without explicitly agreeing or refusing to become an organ donor.

Alex Tabarrok supports a very good idea for organ donation. Priority is given to those who have agreed to be organ donors or have actually been an organ donor.
In Israel a person needs points to get to the top of the waiting list for an organ. By agreeing to donate or having donated, they receive points points towards this goal.
Save Lives Now New York thinks this is a good idea. Since there is a dramatic shortage of organs for transplant, anything to get more should be considered. In the United States there have been poll after poll showing Americans are for transplantationj but somehow this never transplates into donor registeries. Why? No one is sure. Thsi method of encouragement to register seems a natural. You don't have to but if you do, your chances are increased that you will get an organ transplant.

Why doesn't presumed consent pass; who's the opposing lobby?

Many say that you’re not supposed to harvest the organ until the person is actually dead. Others point out that success rates are much higher when the donor is still alive! Gruesome as that may be.

So part of the problem is disagreement over what constitutes death. Is “brain death while the heart continues to beat” the state of death, or is “the heart is no longer beating” the state of death?

If you hold with the latter, you may be reluctant to opt-in, especially if the State and/or local medical authorities officially hold with the former.

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