Transplants: The right to choose your doctor, commerce in organs and the National Transplant Institute

There is an interesting article in Haaretz.  The article touches on three different aspects of organ transplants in Israel.  The first relates to a family that needed to transplant a lobe of liver from the father to his 1 year old baby girl.

Two weeks ago, the Shaked-Hadad family from Jerusalem returned home from Belgium. The family's 1-year-old daughter, Elinor, underwent a liver-lobe transplant in Brussels last December. The donor was her father. The operation abroad followed a struggle against the Clalit health maintenance organization, under the aegis of Kav Lachayim, an association that assists seriously ill children.

When she was born, Elinor was diagnosed with severe liver failure; her father was found to be a suitable donor. The Clalit HMO wanted the operation to be performed in Israel, but the family argued that liver-lobe transplants have a higher rate of success abroad and insisted that the operation be performed at Saint-Luc University Hospital in Brussels. 
I believe that this issue is unrelated to organ transplants.  It is a case where the parents decided that they did not trust the Israeli medical system and had to go elsewhere.  I don't understand why the Clalit HMO should have to cover any more of the costs then they would have covered in Israel.  There are successful liver transplants in Israel and it requires a well trained staff and facilities to provide this service.  If you explicitly agree that patients should go elsewhere, then why maintain facilities here?

My son had a transplant here and i do not believe he could have had any better care in the US or Europe.  The staff were first rate and the care equally good.  The offer by Clalit to fly in a doctor should have been a good compromise, but clearly the parents were already convinced to go elsewhere.  I'm surprised by the choice of hospital.  If you google for "liver transplant hospital", Saint-Luc is nowhere in the top 100 hits.  In fact, the most highly regarded facilities are in the US, so why choose Belgium?

The second part of the Haaretz article relates to commerce in organs:

The distress of Israelis in need of transplants has become more acute since the enactment of the Transplantation Law in May 2008. With commerce in organs formally outlawed, the HMOs stopped funding organ transplants for Israelis in many countries. At present, transplants are financed only in countries in which it is known that such commerce does not exist. The decision on underwriting transplants abroad is made by the HMO, on the basis of the patient's condition. But in the absence of clear criteria, authorization for transplant surgery abroad rarely comes without a struggle. 
Part of the problem is that Israel has a very low donor rate and hence is unable to participate in reciprocal relationships with European countries.  As a result, the easiest available organs are from  live donors (kidney and liver).    It used to be that people purchases a kidney on the black market and performed the transplant in eastern europe.  The new law forbids the HMOs from paying for transplants in countries that allow commerce in organs.

Finally, there is an ongoing story about National Transplant Institute in Israel.

Last year, only 282 transplant operations were performed in the country. Meanwhile, the National Transplant Center has been caught in the grip of a managerial crisis since the resignation of its chairman, Prof. Gavriel Gorman, several months ago. In his resignation letter, he noted, among other points, "I did not succeed in ensuring appropriate medical representation of the center in international medical organizations." 
The transplant institute is charged with two jobs; improving the quantity of available organs and managing the priority list for those waiting for a transplant.   I have not heard or read of any complaints regarding the priority list.  On the other hand, the number of organs from cadavers has fallen significantly in the past two years.  The reason I heard on the radio is that the new law requires a specific medical test with an approved testing machine to determine brain stem death.  It seems that some of the hospitals in Israel do not have these machines and hence cannot perform the tests.   In my view, donations for these machines should be on the top of philanthropic organizations wish lists.  Its a very easy way to save a life.


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