By Adam Brimelow

BBC News health correspondent

Organs for transplant are in short supply Israel is to become the first country to give donor card carriers a legal right to priority treatment if they should require an organ transplant. The law has been changed to try to boost donation rates, as there is a shortage for organs for donation. Partners and close relatives of those with signed donor cards will also move up the queue, The Lancet medical journal reports. Critics say patients should be treated on the basis of clinical need. Writing in The Lancet, Professor Jacob Lavee, of the Sheba Medical Centre, one of the leading advocates for the reform, describes Israel's organ donation statistics as "grim". We would have serious concerns about a system that would move away from treating patients on the basis of clinical need

Dr Vivienne Nathanson

British Medical Association Only one in 10 adults in Israel carries a donor card. In the UK about one in four adults is on the organ donor register. In 2006, the Israel National Transplant Council established a special committee, including ethicists, philosophers, religious representatives and transplant surgeons to review the problem. Their proposal to bring in non-medical criteria for organ allocation required legislation by the Israeli parliament. Under the planned point-based system, people who have signed a donor card will be given priority for a transplant. Their partners and other close relatives will also qualify. However, there will be no preference for live donors who give to a chosen recipient rather than the wider waiting list. Urgent cases Patients requiring an urgent transplant because of their serious condition will continue to have priority, regardless of the new points-scheme. But if there are two people in this situation who are equally suitable for a donated organ, the priority system will come into play. Professor Lavee said the new policy "provides an incentive for individuals to agree to help each other". It is important that donated organs are available for those who need them most

Mubeen Bhutta

British Heart Foundation But he acknowledged that it violated the principle of "true altruism", and the "ideal" of care being provided solely according to medical need. However, he concluded that this was a price worth paying. He said: "If this policy results in the procurement of more organs for transplantation, then it promotes a different but nonetheless important goal of medicine - achievement of maximum health." Misgivings Dr Vivienne Nathanson, head of science and ethics at the British Medical Association, voiced strong misgivings. "We would have serious concerns about a system that would move away from treating patients on the basis of clinical need," she said. "Once you start prioritising certain groups, for example those that sign up to the organ register, patients who are really sick and in danger of dying if they don't receive an organ may end up being pushed to the back of the queue". And Mubeen Bhutta, Policy Manager at the British Heart Foundation, said: "This interesting new law in Israel highlights the challenges facing countries around the world seeking to increase the availability of donated organs. "However, it is important that donated organs are available for those who need them most. Presumed consent The BMA and BHF both support the introduction of presumed consent, where instead of opting into donation by signing a register - as happens in the UK - people would be required to state if they did not want their organs to be used for transplantation. This approach also has the strong backing of the Chief Medical Officer for England, Professor Sir Liam Donaldson, who announced this week that he would step down from the post next May. "I would love to see presumed consent on organs," he said. "This prissiness about the idea of giving organs to somebody after you have died - I think it's something that's not supported by the public." The Department of Health in England says the UK's organ donation system has to ensure that patients are treated equally and fairly, based on their need and the importance of achieving the closest possible match. A spokesman said: "More people are signing up to the organ donor register than ever before but, despite this, three people die every day while waiting for a transplant and more donors are needed. "We aim to see donor rates increase from 800 donors to 1,400 donors per year by March 2013, and 20 million people on the organ donor register by 2010, working towards 25 million by 2013." Preparations for the new policy in Israel will start in the new year with a publicity campaign. The new arrangements will come into force in January 2011, with priority going to all those who have had a signed donor card for at least a year.



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