Bad Idea: Non-donors get kebabbed

Israel's plan to allow would be-donors to jump the transplant queue is ethically dubious

Organ donation is a sticky business, as much intellectually as in the literal sense. Almost all of us would accept an organ if we needed one, but getting people to register as donors is not quite as easy. Sheer laziness is probably the main reason, but for many people the idea of having body parts removed after death is troubling. Understandably so, perhaps: most of us find it hard enough to countenance lending someone a jumper, never mind giving a stranger our eyes.

We need a new solution to the global donor shortage, and Israel thinks it has the answer: to incentivise. As of this month, Israeli donor card holders and their close relatives will be able to jump the transplant queue, should the need arise. The policy is discussed in the Lancet, where Jacob Lavee and colleagues outline the benefits of the scheme.

By putting would-be donors on a sort of hospital guest list, Israel - whose donor list comprises just 10 per cent of the population, an even sorrier headcount than for most western countries - hopes to create a system through which "everyone will benefit". Lavee et al foresee a sharp rise in the overall number of organs available; so even "people who do not sign a donor card, while disadvantaged, will nonetheless be better off". From a British perspective, it is an uncomfortable idea. The NHS is founded in part on the principle that medical care should be allocated according to need, not ability to pay - which should surely extend to non-monetary forms of payment. But using non-medical criteria to assign medical treatment is ethically ambiguous for any nation.

As the Lancet report's authors note, creating a donor hierarchy is hardly in keeping with the ideal of "pure altruism" in medicine - or rather "altruism", as it is not measured on a sliding scale. More importantly, critics question whether the incentive will actually increase the number of organs available at all. There is often a religious aspect to the decision not to donate: many Jewish people (and Christians) object to interfering with a body after death. A donor card is not a binding agreement, so family members can refuse to donate a dead relative's organs even if the person carried one. If the desire to leave the body intact is based on cultural beliefs, it is unlikely that the opportunity to queue-jump would alter these.

Here in the UK, a paltry quarter of us are registered donors. "Presumed consent" - opting out rather than opting in - may provide the solution. But until it does, appeals to conscience will have to do. If laziness, not moral discomfort, is stopping you sharing, you can bypass the debate at Registering takes about 45 seconds.

This article first appeared in the 04 January 2010 issue of the New Statesman, Gaza: one year on