Organ transplantation in Israel

Organ transplantation in Israel is regulated by two laws passed in 2008. The first law defines "brain death" as an indication of death for all legal purposes, including organ donation. A second law provides financial and other benefits to living donors and outlaws organ trafficking. Despite this, due to the large population of observant Jews in Israel and misconceptions about what is permissible under Jewish law, the rate of organ donation in Israel is significantly lower than in most Western countries.

Legal status

Until 2008, there was no law prohibiting organ trafficking in Israel.^[1] In 2008, the Knesset approved two laws designed to regulate organ donations. The first law defines brain-respiratory death as a situation in which person who has no blood pressure, fails to breathe without external life support systems and has no response from the pupils or any other reflexes is declared dead by two certified doctors.^[2]

The second law provides for various benefits to living organ donors, such as monetary reward from the state in the amount of 18,000 NIS (roughly US$5,000), priority on the transplant list should they require a future organ donation,^[3] waived self-participation fee for any medical service resulting from the donation, and the attainment of a "chronic patient" status, which entitles the holder to additional medical benefits. In addition, the law criminalizes organ trafficking, receiving compensation for organs, or acting as an organ broker.^[2] This law was cited as a model by proposed 2009 legislation in the US.^[4]

Organizations

Israel operates a National Transplant and Organ Donation Center, established in 1993 as an institute of the Ministry of Health.^[5] The center incorporates the ADI organization, founded by private citizens, which maintains a database of donors and sponsors donor cards. As of 2009, the database contains around 500,000 names of donors, about 10% of Israel's adult population.

Since some religious Jews feel the 2008 law does not properly address halachic questions, Israel's Chief Rabbinate has decided to issue an organ donor card of its own, which allows organ harvesting from the potential donor only if brain death is determined according to the strictest letter of the law - for example by requiring that brain death be confirmed using electronic equipment rather than just the determination of a physician.^[6]

The Halachic Organ Donor Society is active in Israel trying to raise awareness about Halachic acceptance of brain-stem death and support of organ donation. Most Israelis are secular but when it comes to death, most turn to Orthodox rabbis to seek guidance. That is why Israel has one of the lowest organ donor rates in the Western world. The Halachic Organ Donor Society has succeeded in recruiting more than 230 rabbis to register for organ donor cards. It has given presentations to over 30,000 Jews around the world to encourage them to donate organs to the general public.

Prevalence of donations

Due to the large population of orthodox Jews in Israel, organ donation is a controversial issue. The rate of agreement to organ donation is only 45%, which is 50% lower than the rate in most Western countries.^[7] The percentage of people who hold an organ donation card in Israel is only 10 percent;^[8][9] in Western countries the rate is 30-40%. As a result, there are about 1,000 Israelis currently on the "waiting list" for organs, and it is estimated that roughly 10% of them die annually, due to a lack of donations.^[3]
Yaakov Levi, the director of the Heart Transplant Unit at Sheba Medical Center has called for organs to be allocated first to those who are willing to donate their own organs and have possessed a donor card for several years. This call was accepted and incorporated into the 2008 law. According to the New York Times, "Organ donation rates in Israel are among the lowest in the developed world, about one-third the rate in Western Europe, in large part because of what Health Ministry officials and doctors describe as a widespread impression that Jewish religious law prohibits transplants as a 'desecration of the body.'" ^[10]

Organ trafficking

Main article: Organ trade

According to organ trade expert Nancy Scheper-Hughes of Organ Watch (in 2001), Israel had become a "pariah" in the organ transplant world. The lack of donations due to Jewish custom heightened the disparity between the supply and demand of organs. This led to the popularity of "transplant tourism" in which patients in need of organs travel to medical centres abroad to receive organs.^[11] Prior to the 2008 law prohibiting it, some Israeli organ brokers advertised on the radio and in newspapers. Kidneys, which are the most traded organ, may fetch up to $150,000 for brokers who usually pay the donors far less.^[10]. Nancy Scheper-Hughes said to the media that Israeli "tentacles" reach around the world with bank accounts around the world. She was criticized for the antisemetic tone of her remarks. She also said to the media that an Israeli doctor told her that Jews buying organs from gentiles was payback for the Holocaust. She has since said that the doctor said it in jest.

Levy Izhak Rosenbaum of Brooklyn was alleged in July 2009 to have been conspiring to arrange the sale of an Israeli citizen's kidney for $160,000.^[10] According to the complaint, Rosenbaum had said that he had been involved in the illegal sale of kidneys for 10 years. Acting US Attorney Ralph Marra said "His business was to entice vulnerable people to give up a kidney for $10,000 which he would turn around and sell for $160,000". Anthropologist and organ trade expert Nancy Scheper-Hughes claimed that she had informed the FBI that Rosenbaum was "a major figure" in international organ smuggling 7 years ago, and that many of Rosenbaum's donors had come from Eastern Europe. She also heard reports that Rosenbaum held donors at gunpoint to ensure they donated their organs.^[7]

The Jewish weekly newspaper The Forward reported in the wake of this scandal that an Organ Trafficking Prohibition Act of 2009, sponsored by Democratic Senator Arlen Specter of Pennsylvania, has yet to be officially introduced in the U.S., but that its proposed language cites Israel as a model of a country that has enacted a law providing benefits for organ donors.^[4]

The lack of regulations against organ trafficking prior to 2008 made Israel a focal point for the international organ trade. Israelis are given up to $80,000 to pay for organs abroad.^[12]

In the 1990s, many organ brokers performed the transplants in Turkey and sourced donors from Moldova, Romania and Russia. However, some patients died and the Turkish and European media exposed the practice, forcing brokers to move to South Africa and China, among other places.^[10]

In 2004 a South African organ trading operation providing American, Iranian and Israeli recipients with organs from Brazilian, Russian and Romanian donors was raided by authorities in South Africa and Brazil, who arrested 15 members of the ring including a recipient and a donor. The donors were paid $10,000 for a kidney, while the recipients were charged $120,000 to receive one.^[10][13] The ring was allegedly controlled by an Israeli, Ilan Peri, who was arrested for tax evasion by the Israeli government who claims he owes $5 million and also for submitting false invoices to a government health plan for the South African organ donor operations.^[10][13]

In April 2010, six Israelis were charged with running an international organ trafficking ring and breaking promises to donors to pay for their removed kidneys.^[14] One of the arrested suspects is a retired army general, Israeli police said. The traffickers offered up to $100,000 per kidney but in at least two cases didn't pay the donors after the organs were surgically removed, police said.^[14]

As a result of all the abuses of the illegal market in human oragns, there is a growing movement of activists in Israel and in America to legalize a Government-regulated program to offer financial incentives to people to for living kidney donations and to families for deceased donations from brain-stem dead donors. This movement is headed, amongh other organizations, by the Alliance for Organ Donor Incentives.

The Aftonbladet accusations

Main article: 2009 Aftonbladet Israel controversy

In August 2009 the Swedish tabloid Aftonbladet published an article alleging that in 1992 the Israeli Defense Force took organs from Palestinians who died in Israeli custody.^[15] The allegations were denied by Israel, and the article caused a diplomatic row between Israel and Sweden.^[16] In December an interview was broadcast on Israeli television during which Israel's chief pathologist, Dr. Yehuda Hiss, discussed the harvesting of organs in the 1990s at the Abu Kabir Forensic Institute.^[17] The interview was followed by a confirmation from Israeli officials that organs were taken in the 1990s without the permission of families of the deceased. Officials denied that the practice continued, and noted that both Israeli and Palestinian organs were taken without permission. "We started to harvest corneas for various hospitals in Israel," Israel's chief pathologist, Dr. Yehuda Hiss said in an interview on Israel's Channel 2 network. "Whatever was done was highly informal. No permission was asked from the families," he said.^[18]

References

1. ^ Scot Klarenbach et al. (January 16, 2006). "A Review of the Economic Implications of Living Organ Donation: Donor Perspectives and Policy Considerations" (PDF). http://www.ccdt.ca/english/publications/background-pdfs/Economic_Living_Organ_Donor_Klarenbach.pdf. Retrieved 2009-08-29. 
2. ^ ^{a b} Knesset approves organ donation law
3. ^ ^{a b} Organ Donation: Legal, But Still Controversial^{[dead link]}
4. ^ ^{a b} Guttman, Nathan (2009-08-05). "Kidney Donation Scandal Sparks New Debate Over Specter’s Organ Legislation". The Forward. http://forward.com/articles/111473/. 
5. ^ Organ donation and transplantation, Orit Brawer Ben-David, p.143, Greenwood Publishing Group, 2005
6. ^ Organ donation to get halachic approval
7. ^ ^{a b} Levi, Yaakov (2007-12-02). "Compensation for organ donation". Haaretz. http://www.haaretz.com/hasen/pages/ShArt.jhtml?itemNo=824553&contrassID=2&subContrassID=4&sbSubContrassID=0&listSrc=Y. 
8. ^ Israel Ministry of Health - ADI
9. ^ Coaster campaign encourages organ donation
10. ^ ^{a b c d e f} Rohter, Larry (2004-05-23). "THE ORGAN TRADE: A Global Black Market; Tracking the Sale of a Kidney On a Path of Poverty and Hope". New York Times. http://www.nytimes.com/2004/05/23/world/organ-trade-global-black-market-tracking-sale-kidney-path-poverty-hope.html?pagewanted=2. Retrieved 2010-05-20. 
11. ^ "The organ of last resort". UNESCO Courier. July 2001. http://www.unesco.org/courier/2001_07/uk/doss34.htm. 
12. ^ Rohter, Larry (2004-05-23). "THE ORGAN TRADE: A Global Black Market; Tracking the Sale of a Kidney On a Path of Poverty and Hope". New York Times. http://www.nytimes.com/2004/05/23/world/organ-trade-global-black-market-tracking-sale-kidney-path-poverty-hope.html?pagewanted=3. Retrieved 2010-05-20. 
13. ^ ^{a b} "12 arrested over international kidney scam". Independent Online (South Africa). http://www.int.iol.co.za/index.php?art_id=ct20040116211225279O6252174&set_id=1&click_id=13&sf=. 
14. ^ ^{a b} The Associated Press: Israeli police arrest 6 organ trafficking suspects
15. ^ Aftonbladet: "Our sons are plundered of their organs"
16. ^ Boudreaux, Richard (2009-08-24). "Article about organ harvesting sparks Israel-Sweden tiff". Los Angeles Times. http://articles.latimes.com/2009/aug/24/world/fg-israel-sweden24. Retrieved 2010-02-21. 
17. ^ AP: "Israel harvested organ in '90s without permission"
18. ^ "Israel harvested organs without permission, officials say - CNN.com". CNN. 2009-12-21. http://www.cnn.com/2009/WORLD/meast/12/21/israel.organs/. Retrieved 2010-05-20. 

External links

• National Transplant and Organ Donation Center and ADI organization