Incentivized Altruism

Only one in ten Israeli adults is an organ donor and the country is addressing the situation with an innovative new policy. Organ donors and their close relatives will now receive priority if they require a transplant. Jacob Lavee of the Sheba Medical Center said the new policy “provides an incentive for individuals to agree to help each other.” The policy will be widely publicized and will take effect in January 2011. (HT: Marginal Revolution) [%comments]

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COMMENTS: 36


  1. Tristan says:

    This makes so much sense, it should be in place everywhere. If you’re a registered organ donor then you get put ahead of all the non-organ donors on the transplant list.

    It’s a pretty straightforward hypocrisy test, if you don’t think organ donation is a good idea, you shouldn’t get to add an “*except if I’m on the receiving end” disclaimer. Also, if you end up receiving an organ, you should automatically have to consent to being an organ donor in the future.

    I think children should be exempt until they get their driver’s license (at least here in the US where that’s the first time anyone usually makes this choice), but other than that it sounds like a great idea.

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  2. frankenduf says:

    is it kosher?!- i.e. i wonder about the ethics- ill presume the talmud has nothing to say on the matter

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  3. Jim says:

    I like it. No money exchanges hands. There doesn’t seem to be a way to exploit it. They only way to profit from it is when you or a loved one needs an organ.

    Blood donations used to be similar, at least here in NJ. But they seem to have done away with it.

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  4. Jonathan Baird says:

    Wow. Go Israel! Add the ability for donors to get paid, and it would be the more efficient system possible.

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  5. Katie Cunningham says:

    A good idea, but what about those that can’t donate for some reason? I’m not even talking about the inability to donate for religious reasons: some conditions make it impossible to donate one’s organs.

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  6. Avi says:

    Seems like the old rabbinical rulings on when death occurs and desecration of the body both before and after death would make this tricky for traditional religious Jews.

    So before this rule, only the less-religious Jews (and other faiths) would donate, but everyone would accept transplants, so all the benefit went one way. This rule could even things out a bit.

    Even religious Jews have a duty to save lives, though, and maybe this will encourage them to see organ donation as a mitzvah rather than a desecration.

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  7. Eric M. Jones says:

    There are decisions like this that make great sense for society at large, and make no sense at all to the individual.

    Another example is mammograms. Society recommends fewer and later, but an individual’s best choice would get them earlier and more often.

    Another example is gun ownership. Society recommends against it. But the individual is better served with one than without one.

    So anyway, I am against donating my organs, but I’m sure happy to have you donate yours.

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  8. JBM says:

    I agree that it makes sense, but what happens when people argue that they are not an organ donor because of their religious beliefs? Personally I’d say “tough luck” to those making that argument, but constitutionally there might be some serious debate there.

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  9. Jonathan Baird says:

    Shouldn’t one religiously opposed to donating organs also be religiously opposed to receiving them? This shouldn’t harm them in any way. If your religious system prevents you from donating but not receiving… tough, get a better religion.

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  10. Kevin H says:

    Sounds pretty good. I’m not sure exactly how the law is handled, but hopefully there’s a lag time, so you need to be on the donor list for 2 years or something before you get the benefits to prevent people from signing up the day they learn the need an organ.

    My friend came up with a related idea (half in jest, as is his M.O.) that we should make everyone sign something today stating if they believe in stem cell research, and then give future stem cell based treatments only to those who support it now.

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  11. Another David says:

    I would support this in any country other than Israel. But the fact of the matter is that Judaism forbids organ transplant (I decided to register as a donor anyway). I don’t think that the Jewish homeland should be offering incentives to those who break the laws that bind the people together. It would be like subsidizing non-kosher food.

    Imagine if in the US non-Christians were given a free pass at drunk driving check points on Christmas…

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  12. Avi says:

    #5 and #8 – the donor status comes in when there is a tie in other considerations, that is, the possible recipients have about the same need, distance, age, etc. That works for me.

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  13. Neil (SM) says:

    #5 >> “…some conditions make it impossible to donate one’s organs.”

    But those conditions don’t prevent someone from being *listed* as an Organ Donor. When that person actually dies, it’s up to someone else to disqualify them.

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  14. Neil (SM) says:

    #11 If someone’s religion forbids organ transplant, than what does he care if he doesn’t get first priority to receive an organ transplant?

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  15. Zach says:

    I complete agree with this law, however I feel that it does not go far enough. If I were the law-maker for our country, I would say that anybody who refuses to be an organ donor is completely prohibited from receiving any kind of transplant.

    I completely understand #7′s comment, and he is basically explaining why there should be these kinds of laws in place. Not donating an organ might cause somebody slight displeasure (the thought of knowing that their body will be ripped open the second they die), but cause somebody else extreme good (living longer). However, because the stupid hippies in Congress don’t want to do what is necessary, they let the ones who choose to exercise their right to refuse their organs profit, while they laugh at those who are the Good Samaritans.

    Personally, I’m an organ donor. Mainly because I see it is minimal harm to myself that could help somebody else out. I would just hate for myself or a loved one to be passed over for somebody who is not moving along the process.

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  16. David Chowes, New York City says:

    Given my perception of human nature we usually care only
    about ourselves. Then family and close friends and in quickly decending order the remainder of people.

    So, this seems to me to be a pragmatic solution which has the potential to save lives.

    A viable argument against this idea is that transplant volunteers would be disproportionatly consist of the poor and desparate.

    My conclusion: even with my reservation, my response is yes!

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  17. hmmm... says:

    Is it still altruism if it’s incentivized?

    Also, yes to this! And donor status should be counted from the registration period before your condition was diagnosed – keep people from last minute changes to game the system.

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  18. Chris Colenso-Dunne says:

    I’m not a registered organ donor because I don’t want my organs to be donated to whoever most needs them.

    Rather, I want my organs to be donated to those who most deserve them.

    Who decides the deserving? In the case of my organs, I do.

    So, I don’t want my organs going to smokers, to alcoholics or other drug addicts, to those with a criminal record, to anyone who belongs to a religious group or is a republican.

    Finally, if one of my own should fail, I am not interested in receiving an organ – whether from one of my banned groups or from anyone else.

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  19. Miles Jacob says:

    I choose NOT to be a donor precisely because I do not agree with the system of prioritization of whose lives are more worth saving, and adding more moral criteria to that system only makes it less likely I would want to become a donor.

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  20. Tom Landgraf says:

    I support this policy because it requires people to make a decision about organ donation. The default scenario – relying on a pool of altruistic donors (and their survivors who often override the deceased’s organ donation wishes) – has give us the current situation where demand far exceeds supply.

    The best way to ration a limited supply of organs is to prioritize willing donors and their immediate families at the top of the list.

    I suggest an addition to this policy: people who abuse their bodies with illegal drugs, alcohol, tobacco, etc should not be allowed to donate their organs.

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  21. Straydingo says:

    what a brilliant idea

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  22. Shai says:

    As an Israeli with an eye on the Ogran donation debate, something even more interesting came to mind. Today, it was published that a new application will allow users to sign-up for the donor community using their iPhone. Here’s a link to the *Hebrew* atricle….

    http://www.ynet.co.il/articles/0,7340,L-3824415,00.html

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  23. Dave Undis says:

    In the United States, registered organ donors can get preferred access to donated organs by joining an organ donor network named LifeSharers.

    If you agree to offer your organs first to other LifeSharers members, you’ll get preferred access to the organs of every other member of the network. As the LifeSharers network expands, your chances of getting an organ if you ever need one keep going up — if you are a member. LifeSharers already has over 13,000 members.

    Giving organs first to organ donors creates an incentive for non-donors to become donors. This increases the supply of organs and saves more lives. Saving the maximum number of lives should be the primary goal of our organ donation/transplantation system.

    Giving organs first to organ donors also makes the system fairer. People who aren’t willing to donate their own organs should go to the back of the transplant waiting list as long as there is an organ shortage.

    If you want to donate your organs to other organ donors, you can join LifeSharers at http://www.lifesharers.org or by calling 1-888-ORGAN88. Membership is free. There is no age limit. No one is excluded due to any pre-existing medical condition.

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  24. Gordon says:

    Something needs to be done to improve donor levels – but it is a mine field.

    Can’t pay for human parts – morally wrong
    Can’t use an opt-out stand point (my personal favourite) – what about the civil rights?

    This is a good middle ground for upping the incentive, I fully support this as too many people have the attitude that they want the security of receiving blood/organs if they need them but are put off donating for what ever reason.

    I’m almost with Zach on this one – you’ve got to pay to play

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  25. Tkwon says:

    This is such an ingenious plan that I wonder why it hasn’t been adopted earlier in other countries…

    Possible negative side-effects from such a policy:
    -People who have a history of having to need organ transplants will donate(since they are the most likely to benefit from this policy)
    -Generally already unhealthy people may donate, which may lower the “quality” of donated organs
    -Wealthy people may manipulate medical records by paying off poorer people to donate their organs and have that transaction listed as if they were the donors (wild specualation, I know).

    Despite possible side-effects, I still think this is a brilliant plan. So much good can come from this if properly enforced

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  26. Matt says:

    “Incentivized altruism” is an oxymoron. Altruism is the unselfish desire to help others. Getting a collateral benefit from doing it removes the altruism. This is perverse.

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  27. Pete Forde says:

    @hmmm….: Altruism is charity when you know you’ll be recognized, while selflessness is giving without expecting anything in return.

    Altruism is responsible for many acts of good in the world, but the folks behind these acts have come to expect public recognition ranging from verbal thanks to public monuments in their name.

    So, this is altruism in the extreme sense.

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  28. David Barg says:

    The Orthodox Jewish objections to organ donation are not necessarily as clear cut as presented. There are various Rabinic opinions on the matter. In any case, Israel often has a need to pick a path toward policy in the face of religious strictures, usually compromise and sensitivity rules. The beautiful thing here is that as in medical research and its generous social activism, Israel once again leads the world.

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  29. Mike McNamara says:

    #8> “But those conditions don’t prevent someone from being *listed* as an Organ Donor. When that person actually dies, it’s up to someone else to disqualify them.”

    Not entirely true — for example, an HIV+ person cannot be listed as an organ donor.

    (Of course, in this case, most often HIV+ people aren’t given priority on such lists because it’s still considered a “waste” to give them a necessary organ, but that’s another discussion for another time…)

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  30. Walt French says:

    I’m surprised that a practice in Israel – a theocracy where commenters above say believers should not donate organs – gets dozens of favorable comments in the US, where the dominant ethical beliefs, as interpreted by Ethics Panels, seems to favor “judge not, lest ye be judged.”

    Ignoring these glaring inconsistencies seems calculated to generate blaring irrelevancies.

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  31. Amnon says:

    So the orthodox are entitled to receive a donation but forbidden to donate? How convenient. Let the self-righteous rot at the end of the line. I’d rather donate my organs to a cat.

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  32. Zach says:

    Well, keep in mind, the decision of being or organ donor or not is done when you’re a teenager (or whenever you get your driver’s license). When I was 17, I got my driver’s license and I checked off the box that said that I would like to be an organ donor.

    A new system that they could put into place would require a new licensee to check off organ donor in order to get the right to receive organs. Additionally, if you did it when you first could, you would forever have more priority for donations. Those who change their minds, and decide to enter into the system and donate later would receive lesser priority for transplants. Obviously prior to donation the quality of the organs would be tested and if they weren’t up to snuff they would be discarded (or possibly given to the people who didn’t sign up). Additionally, you could possibly give the worse organs to the people lower in the priority list who wouldn’t get it otherwise (with their signed consent).

    I think that system would be fair, and cut down on people who knew that they were sick suddenly buying into the system to receive the benefit.

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  33. www.princetoncryo.com says:

    I have a cousin who has ALS, and stem cells are going to be the key to his cure. We follow religion too, but I don’t see the harm in taking benefit of new discoveries. Medical science is booming only because people need it and it is high time fundamentalists should change their stand.

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  34. K Sheridan says:

    This is the first of two posts – this one will address issues of eligibility, the second will address religious restrictions.

    First, alcoholics and drug addicts may find themselves in a pickle if they are ever in need of organs. Hospitals may refuse requests for inclusion on a transplant list because of drug or alcohol use. For example, most (if not all) transplant hospitals will require proof of extended sobriety if a patient’s liver failure (and thus their need for a transplant) is attributed to alcohol abuse.

    On a more personal note, I was shocked by the last two paragraphs of Mr. Colenso-Dunne’s comment. Organ donation is a medical procedure. The idea that because someone is Republican or religious that their organs are medically beneath you ridiculous, and the idea that just because someone is Republican or religious does not mean that your organs are more than they medically deserve similarly preposterous and obscenely selfish.

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  35. K Sheridan says:

    Second post, on religious issues. I’ve chosen to focus on Judaism, since the original post was about a new policy enacted in Israel.

    A rabbi associated with the Conservative movement led a seminar series on medical ethics not too long ago at a synagoge near my home, and one session was devoted to organ donation. He explained that answer Judaism can give about organ donation is that the preservation of life overrides every other mitzvoh, including the prohibition of the desecration of the body. In fact, the preservation of life is one of the three mitzvoh that are so important that they may come before the preservation of one’s own life. Therefore, most branches and movements of Judaism not only allow but encourage organ donation, assuming that certain provisions (like the identification of a specific recipient and the verification of death for brain-dead donors, and the assurance of a low risk of death for live kidney/liver donors) are fulfilled.
    Disclaimer: There are, of course, other interpretations, but my understanding is that the above perspective on organ donation is the most widely accepted view by far.

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  36. hilary says:

    They sorted out that people that donate their organs get first go when they need organs. I understand this but there will be some problems to sorted out.Here’s one.

    Obviously children can’t sign up until they are around 16 or get a drivers license. Imagine a 16 yr old driver (that has become a organ donor) takes a 16 yr old friend (that hasn’t signed up to be a organ donor but plans to when she get her drivers license) to go for a drive. While driving there is an accident and both of the teenagers sustain heavy injuries. They are rushed to hospital where they both need the same organ transplant.If there is only one in the hospital. Who will get the organ?

    The driver that is a organ donor

    or the passenger that is not a organ donor but is a victim of a accident that the driver might have caused?

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