Points mean prizes: priority points, preferential status and directed organ donation in Israel

The introduction of Israel's new Organ Transplantation Act in 2010 has enabled the development of a unique priority point system aimed at motivating individual's to donate their organ. The priority point system rewards those who are willing to donate an organ with preferential status and an increased chance of receiving a donor organ, should they come to be in need of one. Preliminary evidence suggests it has considerable public support among Israelis, who appear willing to redress the challenge posed by those who are willing to accept an organ but not willing to donate. Since the Act's introduction Israel has witnessed record numbers signing donor cards and there has been a significant increase in the actual numbers of transplants.One aspect of the new Israeli system that has hitherto not much been considered is its tendency towards a communitarian model of organ donation and the implications this change in emphasis may have for the existing 'opt-in' model based upon autonomy and consent. Gil Siegel draws our attention to this aspect when he sets out his defence of a proposal he refers to as 'directed organ donation to other registered donors', which encourages community responsibility without affecting the established commitment to consent and individual freedom.This commentary provides a brief overview of the new Act and its priority point system. It also examines Siegel's proposal and considers the implications it may have for equity and justice, personal choice and dispositional authority. It is argued that although the proposal brings with it several inevitable hurdles for policy makers these are not insurmountable. Rather, its extraordinary potential to save life and avoid suffering should prompt urgent action at policy level. If such a scheme was successfully implemented in Israel it would represent a landmark change in organ donation and allocation policy, and set an example from which we all could learn.