Abstract:This paper draws attention to a current trend of masked conditional-nationalist living kidney donation in Israel, to which the local transplant system has been turning a blind eye. The paper seeks to make the international transplant and bioethics communities aware of this disturbing trend. It also explains why it is wrong and suggests how to tackle it. Finally, it calls on the Israeli system to bring the practice to a halt for the benefit of all parties involved.
“…The last group included reciprocity‐based strategies and conditional nondesignated donations as mechanisms to increase organ donation. Limited evidence demonstrates that reciprocity‐based strategies (eg, strategies that prioritize individuals or their family members for registering their intention to donate organs or for actually donating organs as a living or deceased donor during organ allocation) increase deceased donor registrations and donations .…”
Section: Discussionmentioning
confidence: 99%
“…Recent studies suggest that reciprocity‐based strategies may encourage ABO blood group and HLA‐compatible donor–recipient pairs to participate in kidney paired donation programs . Conditional nondesignated donation schemes that allow donors to limit organ allocation to prespecified groups of candidates (eg, members of a religious or ethnic group) were rejected because such strategies violate the basic ethical principle of nondiscriminatory organ allocation.…”
Existing methods of academic publication provide limited opportunity to obtain stakeholder input on issues of broad interest. This article reports the results of an experiment to produce a collaborative, crowdsourced article examining a current controversial issue in transplant medicine (hereby referred to as the "C4 Article"). The editorial team as a whole selected the topic of organ allocation, then divided into six sections, each supported by an individual editorial team. Widely promoted by the American Journal of Transplantation, the C4 Article was open for public comment for 1 month. The nonblinded editorial teams reviewed the contributions daily and interacted with contributors in near-real time to clarify and expand on the content received. Draft summaries of each section were posted and subsequently revised as new contributions were received. One hundred ninety-four individuals viewed the manuscript, and 107 individuals contributed to the manuscript during the submission period. The article engaged the international transplant community in producing a contemporary delineation of issues of agreement and controversy related to organ allocation and identified opportunities for new policy development. This initial experience successfully demonstrated the potential of a crowdsourced academic manuscript to advance a broad-based understanding of a complex issue. K E Y W O R D S disparities, donors and donation, editorial/personal viewpoint, organ transplantation in general, waitlist management 1 | INTRODUC TI ON This manuscript is the result of an experiment to produce a collaborative, crowdsourced article examining a current and controversial issue in the field of transplantation. This C4 Article examines the issue of organ allocation. The perennial shortage of organs impacts all aspects of transplantation from basic research to health policy. Unlike other areas of medicine in which the need for care exceeds available resources, the scarcity of organs for transplantation cannot be rectified by a simple injection of funds. The rationing of available lifesaving organs is a reality of contemporary transplant medicine achieved through organ allocation rules. Principles of both utility and justice inform these rules. In the context of organ allocation, these principles are frequently in conflict. Periodic review of organ allocation policies ensures the optimal balance of the principles of justice and utility, and ensures policies are consistent with the values of all stakeholders. This C4 Article provides a unique opportunity to acquire broad stakeholder input on several key issues related to organ allocation policy. Contributors examined six issues selected by the editors, including who should determine organ allocation policy, which policies should be adopted to increase organ utilization, what is the minimal acceptable outcome for an organ transplant, what role should patient choice play in organ allocation policy, should nonmedical factors be used in organ allocation policy, and which policies should be advanced...
“…The last group included reciprocity‐based strategies and conditional nondesignated donations as mechanisms to increase organ donation. Limited evidence demonstrates that reciprocity‐based strategies (eg, strategies that prioritize individuals or their family members for registering their intention to donate organs or for actually donating organs as a living or deceased donor during organ allocation) increase deceased donor registrations and donations .…”
Section: Discussionmentioning
confidence: 99%
“…Recent studies suggest that reciprocity‐based strategies may encourage ABO blood group and HLA‐compatible donor–recipient pairs to participate in kidney paired donation programs . Conditional nondesignated donation schemes that allow donors to limit organ allocation to prespecified groups of candidates (eg, members of a religious or ethnic group) were rejected because such strategies violate the basic ethical principle of nondiscriminatory organ allocation.…”
Existing methods of academic publication provide limited opportunity to obtain stakeholder input on issues of broad interest. This article reports the results of an experiment to produce a collaborative, crowdsourced article examining a current controversial issue in transplant medicine (hereby referred to as the "C4 Article"). The editorial team as a whole selected the topic of organ allocation, then divided into six sections, each supported by an individual editorial team. Widely promoted by the American Journal of Transplantation, the C4 Article was open for public comment for 1 month. The nonblinded editorial teams reviewed the contributions daily and interacted with contributors in near-real time to clarify and expand on the content received. Draft summaries of each section were posted and subsequently revised as new contributions were received. One hundred ninety-four individuals viewed the manuscript, and 107 individuals contributed to the manuscript during the submission period. The article engaged the international transplant community in producing a contemporary delineation of issues of agreement and controversy related to organ allocation and identified opportunities for new policy development. This initial experience successfully demonstrated the potential of a crowdsourced academic manuscript to advance a broad-based understanding of a complex issue. K E Y W O R D S disparities, donors and donation, editorial/personal viewpoint, organ transplantation in general, waitlist management 1 | INTRODUC TI ON This manuscript is the result of an experiment to produce a collaborative, crowdsourced article examining a current and controversial issue in the field of transplantation. This C4 Article examines the issue of organ allocation. The perennial shortage of organs impacts all aspects of transplantation from basic research to health policy. Unlike other areas of medicine in which the need for care exceeds available resources, the scarcity of organs for transplantation cannot be rectified by a simple injection of funds. The rationing of available lifesaving organs is a reality of contemporary transplant medicine achieved through organ allocation rules. Principles of both utility and justice inform these rules. In the context of organ allocation, these principles are frequently in conflict. Periodic review of organ allocation policies ensures the optimal balance of the principles of justice and utility, and ensures policies are consistent with the values of all stakeholders. This C4 Article provides a unique opportunity to acquire broad stakeholder input on several key issues related to organ allocation policy. Contributors examined six issues selected by the editors, including who should determine organ allocation policy, which policies should be adopted to increase organ utilization, what is the minimal acceptable outcome for an organ transplant, what role should patient choice play in organ allocation policy, should nonmedical factors be used in organ allocation policy, and which policies should be advanced...
“…In an ideal world, all organ donations would be unconditional and allocated based solely on the recipient's need (85). However, in reality, the majority of organ donations, both from living and deceased donors, are conditional.…”
Section: Living Kidney Donation and Nationalismmentioning
IntroductionKidney transplantation has become the most cost-effective treatment for patients with end-stage kidney disease (ESKD) and offers them the highest quality of life. Yet, kidney donation is often inaccessible due to cultural and traditional beliefs about organ donation. The goal of our study is to assess the value of kidney donation using the Willingness to Accept (WTA) technique. We also aim to understand the factors influencing an individual’s willingness to donate an organ.MethodsA self-administered survey was completed by 985 participants from the general public. The quantitative method and survey design that were chosen used descriptive, correlational, nonparametric, and multivariate statistical tests.ResultsMost of the respondents, 895 (90.9%) are not willing to donate a kidney while alive. Four hundred and five (41.1%) of the respondents are not willing to donate a kidney after their death, while the rest are willing to donate their kidney after their death without financial compensation. The same attitude applies to the donation of a kidney from their relatives. Significant predictors from the results of the logistic regression model in predicting the lowest (minimal) amount that will encourage donation of one kidney after death were: Marital status; Nationality; Adi card holder; Knowing people who need a kidney donation; confidence in the medical staff; and consideration of the family’s opinions regarding organ donation.DiscussionUsing cost benefit analysis (CBA), with the aim of evaluating the willingness of individuals to accept payment for innovative medical procedures, such as kidney donation, allows an assessment of the perceived value of the medical procedure and enables policymakers to decide whether to allocate funds or offer subsidies for kidney donation, given the limited healthcare resources available. During our research, we found that most participants did not support the commercialization of organs. Our recommendation for policymakers and health professionals is to continue providing adequate funding for kidney donations and to implement educational programs aimed at improving attitudes towards organ donation.
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