AS SURGEON Jacob Lavee was preparing to perform a heart transplant on an ultra-Orthodox Jewish patient, they had a conversation that changed the way he thought about organ donation forever.
The patient confided in him that although he was happy to receive an organ donated by someone else - a heart that would save his life - he would never consider being an organ donor himself.
''It was five years ago in our intensive care unit, and he was on the top of the priority list for a heart transplant,'' Dr Lavee said.
''He was a very religious man and he candidly admitted to me that although he was waiting for a person to die and their family to give consent for their loved one's organs to be donated, because of his religious beliefs he would never contemplate doing the same.''
Touched by the unfairness of the deal, Dr Lavee performed the transplant, then set about revolutionising the way Israel manages its organ donation program.
Last month, it became the first country in the world to give transplant priority to patients who have agreed to donate their organs over those who have not - that is, allowing something other than medical need to be considered.
Patients are still prioritised on the severity of their condition, but if there are two people at the top of the transplant list, the one who has registered as an organ donor - or has a relative in their nuclear family who has already donated their organs - will get the transplant first.
Children, who cannot donate organs until they turn 17, are prioritised on their medical condition alone.
For Dr Lavee, the director of the Heart Transplantation Unit at Sheba Medical Centre, it has been a long process to fix what he believed was an inbuilt unfairness in the health system.
''If you do not donate something for the greater good of society, how can you then expect to get something back from that society?'' he said.
Three-and-a-half years ago he was appointed to head a multidisciplinary parliamentary committee - working with ethicists, philosophers, social workers, academics and, importantly, representatives of the Jewish and Muslim faiths - to write a new organ donation law that would be passed in the Israeli parliament.
This involved reaching agreement with Israel's influential but highly sceptical religious leaders on the definition of ''brain death'' - vital to declaring a patient dead and therefore able to donate organs.
Following agreement from a majority of rabbis, the committee moved to develop a public awareness campaign to counter the idea that Jewish scripture forbade organ donation and to promote the benefits of registering as a donor. Other religious leaders also signed on to the program.
Saving a life is one of the highest values in Judaism, Dr Lavee added: ''It should be seen as a great mitzvah [commandment] to donate your organs.''
Yet while most rabbis are no longer resistant to organ donation, there is still a vocal minority of ultra-Orthodox religious leaders who believe that a person is alive as long as their heart beats - and that means a person's organs cannot be donated.
Nonetheless, when the year-long awareness campaign came to a close on December 31, tens of thousands had responded by registering as organ donors - 70,000 in the last two months of the campaign alone, said Tamar Ashkenazi, the director of the National Transplant Centre of Israel.
''Our centre could not cope with the volume of calls, we were so overrun,'' Dr Ashkenazi said.
She conceded there had been some criticisms of the program from the ultra-Orthodox community, who believe the law discriminates against them.
''It has been very difficult … but it is a problem that they do not believe in brain death.
''When there is an issue of life and death, what we find is that the more religious the family, the less likely they are to donate.''
Countries around the world are struggling to develop ways to increase organ donation and, in turn, decrease the number of people dying on transplant lists.
Israel is well down the international rankings, with only 14 per cent of the adult population registered as donors, up from 12 per cent in 2010.
But the rates are going up, and Dr Lavee hopes that, as more people are inspired by the ''recriprocal altruism'' principle behind the new program, more lives will be saved.
Spain has long been the best-performing country on organ donation. Not only does it have an ''opt out'' system, where deceased patients are considered to be organ donors unless otherwise stated, but it also has a network of intensive care units that devote considerable resources to facilitating organ donation.
In Australia, where 31 per cent of the population are registered as organ donors, the criteria for the allocation of organs for transplant are solely clinical: clinical urgency, clinical benefit, length of time waiting and organ match, said Yael Cass, chief executive of the Organ and Tissue Authority.
Asked whether a program such as Israel's had been considered in Australia, Ms Cass said: ''The inclusion of non-clinical criteria has not been identified for consideration in the next stage of the review of waiting list eligibility criteria and allocation protocols.''
Like Spain, Australia has established a network of specialist organ and tissue donation staff - 160 in 77 hospitals across Australia - working to improve organ and tissue donation rates, Ms Cass said.
One of the priorities is to increase the donation consent rate in hospitals from donors and their families from the 2011 base of 59 per cent, she said.
In Israel the consent rate has risen from 49 per cent in 2010 to 55 per cent in 2011. But neither country is even close to Spain's consent rate of 85 per cent.