D.S. Goldberg, J.D. Trotter

Across the globe, there is a shortage of donor organs for patients with end-stage organ disease. In most countries, organ donation is stagnant. Over the years, different approaches have been attempted with variable success. Most have focused on media appeals to encourage organ donation. A more direct means to try to improve organ donation would be to reward individuals who either agree to donate (in the event of their brain death) or authorized donation of their next-of-kin. For example, in Singapore (which has an 'opt out' organ donation system, whereby, all citizens are considered eligible for donation unless they formally 'opt out' of consideration), priority for transplant is given to individuals who have not opted out (1). A different system was recently implemented in Israel where citizens were rewarded for either donor registration or authorizing donation for their next-of-kin. Israel, like most countries has an 'opt in' donation system whereby organ donation is not presumed and requires specific authorization by registration of the individual (prior to brain death) or authorization by next-of-kin. Specifically, the Israeli law provided two incentives: 1) patients waitlisted for solid-organ transplant who had previously registered as an organ donor > 3 years before listing received higher transplant priority; and 2) first-degree relatives of individuals who either donated an organ while alive or authorized donation for their next-of-kin were granted higher transplant priority. Stoler et al. reviewed changes in organ donation before and after implementation of this novel national policy (2). This article is protected by copyright. All rights reserved.