Israel's Priority System: Sign Up as a Donor, Move Up the Waitlist

When I first learned about Israel's approach to organ donation, it completely shifted how I think about policy design. In 2010, Israel implemented one of the most innovative organ donation policies in the world: a priority system that gives registered organ donors preferential placement on the transplant waiting list if they ever need an organ themselves. This isn't just an opt-out or opt-in debate — it's a fundamentally different way of thinking about fairness in the system.

The Challenge

Israel historically had one of the lowest organ donation rates in the developed world. Religious objections — particularly debates about brain death in Jewish law — contributed to high family refusal rates. Many Israelis were willing to receive organs but reluctant to register as donors, creating a significant free-rider problem. The country was heavily dependent on organ imports and transplant tourism, both of which raised ethical concerns. This is a pattern I see everywhere: the system creates a gap between what people say they believe and what they actually do. And it's always the system, not individuals, that needs to change.

"We had a situation where people wanted to receive organs but not give them. The priority system addresses that fundamental inequity." — Professor Jacob Lavee, architect of the Israeli priority system

How the Priority System Works

Under the system, when two patients have similar medical need for an organ, priority goes to the one who is a registered organ donor (or whose first-degree relative is a donor). The priority is modest — it doesn't override medical urgency — but in tiebreaker situations, it gives donors an advantage. The system also gives priority to those who have previously donated a kidney or liver lobe as living donors.

Dramatic Results

The impact was striking. Israel's organ donor card registration rate increased from roughly 10% to over 35% within a few years of implementation. Deceased organ donation rates also rose significantly. Perhaps most importantly, the policy sparked a national conversation about organ donation and shifted cultural attitudes in ways that pure opt-out legislation might not have achieved on its own. That's the part I keep thinking about — sometimes changing the default isn't enough. Sometimes you need to change the conversation too.

"The priority system didn't just increase registration — it changed the national conversation. Organ donation went from a taboo topic to a dinner table discussion." — Israeli National Transplant Center

YCOD's Take

Israel's system taught me that there are creative policy approaches beyond the binary choice of opt-in versus opt-out. While we at YCOD advocate primarily for opt-out legislation in New York through Bill A07954, I'm always looking at what other countries have tried. Israel's priority model offers powerful lessons about incentive design and cultural change. The best organ donation policy is one that fits the specific cultural context — and I believe New York's context is ready for opt-out. But I also believe we should never stop learning from innovative approaches like Israel's. When 17 people die every day waiting, we need every good idea on the table.