'Chain of Living Donors' Proposed to Cut Wait for Organ Recipients

Work is underway on a major initiative to increase organ transplants in Israel. This response follows the May 2008 law that formally outlawed organ trafficking and virtually closed the door on funding of transplants abroad by the health maintenance organizations.

The Israel Transplantation Society, with a membership of more than 100 organ transplant specialists, is launching the program with the cooperation of Prof. Francis Delmonico, of Harvard University, president of the International Transplantation Society and a consultant to the World Health Organization on organ donations and organ trafficking.

Delmonico came to Israel for a meeting earlier this week of the Israel Transplantation Society and the Catalonia Transplantation Society.

The Israeli organization has decided to adopt the "chain of living donors" model for situations in which a relative is found not to be a match for an individual in need of a kidney - 50 percent of the cases. In recent years in Israel, a system has developed in which donors who are not a match for their relative give a kidney to another patient who is a match in exchange for the kidney their relative needs from another donor.

With Delmonico's help, the Israel Transplantation Society wants to adopt the Dutch model of the system, creating a national network, or chain of living donors. In Holland, the system has allowed 42 percent of patients whose relatives are incompatible to receive a kidney.

Delmonico, who is also medical director of the New England Organ Bank, has been operating a project since November with three other organ transplant groups in the United States, which has shortened the waiting list.

Dr. Alexander Yussim, president of the Israel Transplantation Society and head of renal transplantation at Beilinson Hospital, Petah Tikva, says: "When a donor comes to Israel from the United States to donate a kidney to a boy named Moshiko, only Moshiko benefits. When a chain of living donors is created, a number of patients can benefit and the waiting list can be shortened."

Yussim was referring to a case in 2004, when Moshiko Sharon, 10, received a kidney from an altruistic donor, a 38-year-old American man who had read about his condition, found he was compatible and came to Israel for the surgery.

Although Israel and Catalonia have approximately the same number of inhabitants, the rate of deceased donors in Israel (10 per million residents ) is much lower than in Catalonia (40 per million residents ).

Delmonico explains that in Catalonia, a person who has been declared clinically dead is connected in the field to life support and is transported to the hospital. The family is then approached about donating the victim's organs.

Delmonico believes that such action could be possible in Israel with the cooperation of Magen David Adom and the hospitals.

As long as organs could be bought abroad, there was no need for the system, but now that HMOs no longer fund transplants abroad, the system is needed, Delmonico says.

"In Israel there are 260 transplants a year, and there are enough human resources to double or triple that number," Yussim says.

Organs could also be harvested from terminally ill patients who have asked that their lives not be artificially maintained. In the United States, when families agree, such patients are disconnected from life support only after their organs are harvested.

In recent years, patients in Israel wait for a kidney an average of 4.3 years; for a liver, 2.2 years; and for a heart or lungs, five and a half months.

Yussim says public relations is important, but PR does not actually raise the number of organs donated. Only in half the cases where patients have signed an organ donor card, he says, do the families actually allow the harvesting of organs when brain death is declared. In other countries, the figure is as high as 80 percent.

Delmonico, who works internationally to reduce trafficking in human organs, has visited Israel before and was instrumental in promoting the May 2008 law mandating a prison term of up to three years for organ trafficking.

Delmonico says each country should see to organ transplants for its own citizens and should not need support from other countries, and that Israel should also adopt this thinking.

Delmonico says the law preventing Israeli HMOs from funding transplants abroad is a significant step against organ trafficking, and he hopes the United States will adopt the same approach.