Family Consent for Organ Donations in Israel Declines After Surprise Spike in 2011

Number of people waiting for transplants goes up, annual report from Israel National Transplant Center shows.

Dan Even
Dan Even
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Dan Even
Dan Even

Consent by families to donate organs of brain-dead kin has declined in Israel after a surprise spike in 2011, and the number of people waiting for transplants has gone up, according to the annual report from Israel National Transplant Center.

In 2012, 57 families agreed to donate organs of relatives who had been declared brain dead, compared to 89 families who had given such consent the previous year. However, the 2011 figure marked a surprise peak in organ donations; the 2012 level was a return to the 2010 level, of 60 donors.

In 2012 only half the families who were asked to donate an organ from their loved one agreed to do so, the same rate as in the previous several years. 2011 saw an encouraging rise in consents to 55 percent. But the transplant center reported that out of 183 patients in 2012 who had been declared brain dead in hospitals, the families of nearly one third were not asked directly about organ donation because of their refusal to accept the brain death as death for all intents and purposes.

The rate of organ-donation refusal in Israel is still significantly higher than elsewhere in the world. In France the rate is 32 percent, in Italy 31 percent, in the United States 22 percent, in Spain 16.8 percent, in Ireland 8.2 percent and in Hungary 4.3 percent.

In 2012 there were 277 organ transplants from deceased donors in Israel, down 28 percent from 2011 (with 384 transplants ) but up 21 percent from 2010 (228 transplants ). The number of kidney donations from living donors has also gone down slightly, from 117 in 2011 to 108 last year.

The transplant center report notes a marked decline in brain death in 2012. The center said the reasons were still being studied, but might be associated with the overall decline in the number of deaths in traffic accidents by 23 percent in 2012.

National Transplant Center director Prof. Rafael Biar said: "We are working on all levels to raise awareness of organ donation and increase consent rates of families to donate the organs of their loved ones who have died."

One of these methods is showing encouraging signs. After a new law was passed, people who signed an organ donor card by April 1, 2012, were given immediate priority on the waiting list for organs and do not have to wait the otherwise requisite three years before they are given priority. In 2012, 52 people received priority for organ donations in this way.

A total of 72,489 people signed a donor card in 2012. On a special drive that coincided with election day last month, 32,000 more people signed a card. By the end of 2012, a total of 717,826 had signed organ donor cards, an increase of 13 percent over the previous year. Meanwhile, the number of people waiting for organs continues to rise and now stands at 1,114 - 7 percent more than last year. Among them are 755 people waiting for a kidney, a 3 percent rise over last year; 164 people waiting for a liver, 21 percent more than last year; 94 people waiting for a heart transplant, a figure that has not changed significantly in the past two years; and 90 people waiting for lung transplants, 28 percent more than last year. There are also 11 people waiting for a combined kidney and pancreas transplant, a number that has likewise remained stable over the past two years. There are also 730 Israelis waiting for a corneal transplant.

In 2012, 91 patients died while they were on the waiting list - 32 while waiting for a kidney, 25 for a liver, 16 for a heart and 18 for lungs. However, fewer people on the waiting list died in 2012 compared to 2011, when 105 people died before a donor could be found.

According to the transplant center, the rate of patients on the transplant list who die is lower than in European countries that are members of the organ-donation mediation and allocation organization Eurotransplant. In Holland the rate is 11.2 percent, in Austria, 10.6 percent and in Germany 8.9 percent.

The chairman of an association of activists for the rights of kidney patients, Avi Avraham, harshly criticized the findings of the transplant center's annual report, which showed a 54 percent decline in transplants from deceased persons and an 8 percent decline in transplants from living donors. "The figures are grave, but not surprising. The association has warned of the seriousness of the situation at the Knesset and in the state comptroller's report in May." Avraham said there was a dire need to increase the number of living donors, which was "the best solution to remove the patient from the dialysis cycle and improve the patient's and the family's quality of life." Avraham also called for resources to be channeled toward increasing donations from living people, and for a change in the law so that donors who are not first-degree relatives of the patient can also donate a kidney under state supervision.

A surgical team works on a transplant.Credit: AP

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