Journal of Bioethical Inquiry

, Volume 9, Issue 4, pp 479–497 | Cite as

Factors Encouraging and Inhibiting Organ Donation in Israel

The Public View and the Contribution of Legislation and Public Policy
  • Daniel SperlingEmail author
  • Gabriel M. Gurman
Original Research


Although transplantation surgeries are relatively successful and save the lives of many, only few are willing to donate organs. In order to better understand the reasons for donation or refusing donation and their implications on and influence by public policy, we conducted a survey examining public views on this issue in Israel. Between January and June 2010, an anonymous questionnaire based on published literature was distributed among random and selected parts of Israeli society and included organ recipients, organ donors, soldiers, university and high school students, and the general population. The analysis of 799 questionnaires revealed that, although 74.7 percent have not signed a donor card, 60.8 percent of participants consider doing so. Additionally, 54.3 percent of respondents objected to giving or receiving compensation for donation, and, if at all, priority in transplantation care is the most desired form of such compensation. The health status of the donor and knowing that donation saves lives or that there exists a shortage of organs for transplantation are the two factors most affecting motivation to donate. Lack of information, relatives’ views on donation, and type of organ involved in donation are factors most inhibiting donation. Willingness to donate is significantly affected by the proximity of the recipient to the donor. With regard to most organs, their contribution to one’s sense of “self” and its symbolic role strongly affects motivation to donate, except for donation to relatives. Compensation for organ donation has little effect on motivation to donate during life and after death. Our findings suggest new ways to construct a more effective public policy on this issue.


Organ donation Transplantation Compensation for organ donation Health policy 



We would like to acknowledge the financial support of the Research Fund at Soroka University Medical Center and the help and advice of Dr. Or Catz in providing the statistical analysis for this study and of Mr. Ofir Lang (M.A.) for his superb administrative assistance. We also wish to thank Ms. Tamar Ashkenazi at the Israel Transplant Center for coordinating organ recipients and donors to participate in the survey and the many high school directors and teachers whose cooperation and good will enabled high response rates among high school students.

Statement of Competing Interests

The authors report no competing interests.


  1. Abadie, A., and S. Gay. 2006. The impact of presumed consent legislation on cadaveric organ donation: A cross country study. Journal of Health Economics 25(4): 599–620.PubMedCrossRefGoogle Scholar
  2. Anderson, M.F. 1995. The future of organ transplantation: From where will new donors come, to whom will their organs go? Health Matrix 5(2): 249–310.PubMedGoogle Scholar
  3. Baughn, D., J.R. Rodrigue, and D.L. Cornell. 2006. Intention to register as organ donors: A survey of adolescents. Progress in Transplantation 16(3): 260–267.PubMedGoogle Scholar
  4. Beard, T.R., D.L. Kaserman, and R.P. Saba. 2004. Limits to altruism: Organ supply and educational expenditures. Contemporary Economic Policy 22(4): 433–441.CrossRefGoogle Scholar
  5. Brug, J., M. Van Vugt, B. van Den Borne, A. Brouwers, and H. Van Hooff. 2000. Predictors of willingness to register as an organ donor among Dutch adolescents. Psychology & Health 15(3): 357–368.CrossRefGoogle Scholar
  6. Cherry, M. 2005. Kidney for sale by owner: Human organs, transplantation, and the market. Washington, D.C.: Georgetown University Press.Google Scholar
  7. Coppen, R.F., R.D. Van der zee Jouke, and S.K. Gavers. 2010. The potential of legislation on organ donation to increase the supply of donor organs. Health Policy 98(2–3): 164–170.PubMedCrossRefGoogle Scholar
  8. den Hartogh, G. 2011. Priority to registered donors on the waiting list for postmortal organs? A critical look at the objections. Journal of Medical Ethics 37(3): 149–152.CrossRefGoogle Scholar
  9. Dworkin, G. 1994. Markets and morals: The case for organ sales. In Morality, harm and the law, ed. G. Dworkin, 155–161. Boulder: Westview Press.Google Scholar
  10. European Commission. 2003. Human organ transplantation in Europe: An overview.
  11. European Commission. 2006. Organ donation and transplantation: Policy options at EU level: Consultation Document, June 27. Scholar
  12. European Commission. 2007. Special Eurobarometer: Europeans and organ donation.
  13. Falomir-Pichastor, J.M., J.A. Berent, and A. Pereira. 2011. Social psychological factors of post-mortem organ donation: A review of detriments and promotion strategies. Health Psychology Review. doi: 10.1080/17437199.2011.570516.
  14. Farrell, A.-M., D. Price, and Q. Muireann. 2011. Organ shortage: Ethics, law and pragmatism. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  15. Gargano, G., A.M. Nagy, and M.M. Rowe. 2004. Identity and motivation predict behavior and intention of organ donation. American Journal of Health Studies 19(4): 241–245.Google Scholar
  16. Goyal, M., R.L. Mehta, L.J. Schneiderman, and A.R. Sehgal. 2002. Economic and health consequences of selling a kidney in India. Journal of the American Medical Association 288(13): 1589–1593.PubMedCrossRefGoogle Scholar
  17. Gurman, G.M. 2008. Organ transplantation in Israel of 2007—reality and vision [published in Hebrew]. Harefuah 147(5): 417–421.PubMedGoogle Scholar
  18. Halpern, S.D., A. Raz, R. Kohn, M. Rey, D.A. Asch, and P. Reese. 2010. Regulated payments for living kidney donation: An empirical assessment of the ethical concerns. Annals of Internal Medicine 152(6): 358–365.PubMedGoogle Scholar
  19. Hayes, J. 2010. News: Public to be asked its views on ethics of incentives for organ donation. BMJ 340: c2182. doi: 10.1136/bmj.c2182.PubMedCrossRefGoogle Scholar
  20. Hughes, P.M. 2009. Constraint, consent and well-being in human kidney sales. The Journal of Medicine and Philosophy 34(6): 606–631.PubMedCrossRefGoogle Scholar
  21. Jan, S., K. Howard, A. Cass. 2010. A proposal to increase deceased organ donation through an altruistic incentive. BMJ, August 30.
  22. Johnson, E.J., and D.G. Goldstein. 2003. Do defaults save lives? Science 302(5649): 1338–1339.PubMedCrossRefGoogle Scholar
  23. Kerstein, S.J. 2009. Autonomy, moral constraints and markets in kidneys. The Journal of Medicine and Philosophy 34(6): 573–585.PubMedCrossRefGoogle Scholar
  24. Lavee, J., T. Ashkenazi, G. Gurman, and D. Steinberg. 2009. A new law for allocation of donor organs in Israel. The Lancet 375(9270): 1131–1133. doi: 10.1016/S0140-6736(09)61795-5.Google Scholar
  25. Lawlor, M., I. Kerridge, R. Ankeny, T.A. Dobbins, and F. Billson. 2010. Specific unwillingness to donate eyes: The impact of disfigurement, knowledge and procurement on corneal donation. American Journal of Transplantation 10(3): 657–663.PubMedCrossRefGoogle Scholar
  26. Matas, A.J. 2004. The case for kidney sales: Rationales, objections and concerns. American Journal of Transplantation 4(12): 2007–2014.PubMedCrossRefGoogle Scholar
  27. Meranda, A. 2008. Knesset approves organ donation law., March 25.,7340,L-3523461,00.html.
  28. Ministry of Health. 2011. Israeli Transplant Center—ADI.
  29. Mocan, N., and Tekin, E. 2005. The determinants of the willingness to be an organ donor. National Bureau of Economic Research Working Paper No. 11316, May.
  30. Mossialos, E., J. Costa-Font, and C. Rudisill. 2008. Does organ donation legislation affect individuals’ willingness to donate their own or their relative’s organs? Evidence from European Union survey data. BMC Health Services Research 8: 48. doi: 10.1186/1472-6963-8-48.PubMedCrossRefGoogle Scholar
  31. Rodrigue, J.R., D.L. Cornell, and R.J. Howard. 2006. Attitudes toward financial incentives, donor authorization and presumed consent among next-of-kin who consented vs. refused organ donation. Transplantation 81(9): 1249–1256.PubMedCrossRefGoogle Scholar
  32. Sanford, J.T., and J.T. Rocchiccioli. 2003. Cash for kidneys: The use of financial incentives for organ donation. Policy, Politics & Nursing Practice 4(4): 275–280.CrossRefGoogle Scholar
  33. Satel, S., ed. 2008. When altruism isn’t enough: The case for compensating kidney donors. Washington, D.C.: AEI Press.Google Scholar
  34. Saunders, B. 2010. Normative consent and opt-out organ donation. Journal of Medical Ethics 36(2): 84–87.PubMedCrossRefGoogle Scholar
  35. Schweda, M., and S. Schicktanz. 2009. The “spare parts person”? Conceptions of the human body and their implications for public attitudes towards organ donation and organ sale. Philosophy, Ethics, and Humanities in Medicine 4: 4. doi: 10.1186/1747-5341-4-4.PubMedCrossRefGoogle Scholar
  36. Sharp, L.A. 2006. Strange harvest: Organ transplants, denatured bodies, and the transformed self. Berkeley: University of California Press.Google Scholar
  37. Sperling, D. 2008a. Me or mine? On property from personhood, symbolic existence and motivation to donate organs. In Organ transplantation: Ethical, legal and psychological aspects—towards a common European policy, ed. W. Weimar, M.A. Bos, and J.J. van Busschbach, 463–470. Lengerich: PABST Science Publishers.Google Scholar
  38. Sperling, D. 2008b. Posthumous interests: Legal and ethical perspectives. Cambridge: Cambridge University Press.Google Scholar
  39. Sperling, D. 2009. Israel’s new Brain-Respiratory Death Act: One step forward or two steps backward? Reviews in the Neurosciences 20(3–4): 299–306.PubMedGoogle Scholar
  40. Spital, A. 2005. Conscription of cadaveric organs: We need to start thinking about it. American Journal of Transplantation 5(5): 1170–1171.PubMedCrossRefGoogle Scholar
  41. Spital, A., and J.S. Taylor. 2008. Routine recovery: An ethical plan for greatly increasing the supply of transplantable organs. Current Opinion in Organ Transplantation 13(2): 202–206.PubMedCrossRefGoogle Scholar
  42. Taylor, J.S. 2005. Stakes and kidneys: Why markets in human parts are morally imperative. Farnham, Surrey, U.K.: Ashgate.Google Scholar
  43. Taylor, J.S. 2009a. The unjustified assumptions of organ conscripters. HEC Forum 21(2): 115–133.PubMedCrossRefGoogle Scholar
  44. Taylor, J.S. 2009b. Autonomy and organ sales, revisited. The Journal of Medicine and Philosophy 34(6): 632–648.PubMedCrossRefGoogle Scholar
  45. U.S. Department of Health and Human Services. 2009. OPTN/SRTR annual report: Transplant data 1999–2008.
  46. Verble, M., and J. Worth. 1997. Biases among hospital personnel concerning donation of specific organs and tissues: Implications for donation discussion and education. Journal of Transplant Coordination 7(2): 72–77.PubMedGoogle Scholar
  47. Verheijde, J.L., M.Y. Rady, J.L. McGregor, and C. Friederich-Murray. 2009. Enforced of presumed-consent policy and willingness to donate organs as identified in the European Union survey: The role of legislation in reinforcing ideology in pluralistic societies. Health Policy 90(1): 26–31.PubMedCrossRefGoogle Scholar
  48. Wilkinson, S. 2003. Bodies for sale: Ethics and exploitation in the human body trade. New York: Routledge.Google Scholar
  49. Yea, S. 2010. Trafficking in part(s): The commercial kidney market in a Manila slum, Philippines. Global Social Policy 10(3): 358–376.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  1. 1.The Federmann School of Public Policy and Government and Braun School of Public Health & Community MedicineThe Hebrew University of JerusalemJerusalemIsrael
  2. 2.Ben Gurion University of the NegevBeer ShevaIsrael

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