[THE WILLINGNESS TO DONATE ORGANS IN ISRAEL 1997-2022]

In 1997, the transplant coordination system was established, with each hospital working to detect candidates for organ donation, coordinate tests to determine brain death and to approach the family to donate organs, while providing accompaniment and emotional support to family members.

In 1997, the rate of consent for organ donation was 42%. A survey of attitudes among the general public (n =758) conducted in 1999 revealed that 60% of the Israeli public were willing (absolutely 40% and quite willing 24%) to donate organs. The main barrier to donation was the religious factor, followed in descending order by the desire to be buried intact, the fear of mutilation of the body, the fear of dealing with the issue of death, the fear of the evil eye, the fear of causing suffering and pain to the deceased, and a lack of confidence that the doctors would do everything to save the "donor". The factors that might influence the willingness to donate include knowing that the donation saves lives, giving preference to family members to receive organs for transplant, the belief that the organs of the deceased continue to live in someone else's body. An increase in signatures on a donor card might be achieved if the signature is accessible and the knowledge that it is possible to retract after signing. As a result of this survey the transplant center operated on two main levels, one of which was to increase the willingness to contribute among the general public, and the other to improve skills for obtaining consent from a family in the hospital. The marketing strategy was based on the findings of the study, while transforming the act of contributing from the heroic to normative, the right thing to do. The signatures on the donor card were made accessible in accordance with technological advances, religious centers were established for Jews and Muslims, an information campaign was established regarding the determination of brain death, and more. In the hospitals, a model was developed for approaching the family, training and simulations were carried out. The consequences of these activities led to an increase in the actual rates of consent to donate, from 44% in 2000-2004 to 62% in 2016-2020. This considerable increase may also be the result of a dramatic increase in Adi donor card signatures by about 700,000 between 2005 and 2019. In 2006, the Ministry of Health approved a digital signature of the Adi card, and following the accessibility of the signature, the rate of signatures increased significantly. In 2022 the accessibility to the donor card was significantly upgraded by the possibility to sign at the same time as completing other government official online forms. The Transplant Law of 2008 further encouraged the signing of a donor card and in 2012 the section of the law granting precedence to signees of the donor card was implemented. In addition, in recent years, social media has occupied a significant place in conveying messages and this is also being utilized to increase awareness and readiness to sign. In conclusion, in order to increase the response rate to donations, we must continue to invest in increasing the willingness to donate by various population groups as well. An annual advertising budget will significantly help.