Countries are looking for ways to boost organ donation, according to the New York Times. Most recently, Israel has created a policy to give priority for organ transplants to those who sign up to be organ donors themselves.

Officials hope the incentive will increase the supply of available organs — of which there is a shortage across the world, but especially in Israel, where only one in 10 adults carries a donor card.

This is sure to be a closely watched change, as most countries have tried different measures to increase willingness to donate organs. Here’s a rundown of some of those efforts, which include (1) creating markets for organs; (2) making all citizens organ donors by default, unless they explicitly exempt themselves; and (3) investing in more health care infrastructure.

Such plans have raised a few ethical eyebrows, however:

Proposals to change the organ procurement systems in the United States and Great Britain to “presumed consent” have frequently provoked ethical objections. Critics worry that such a system would effectively coerce people into donating organs, even over the wishes of the next of kin.

Ethics aside, it’s also not clear that such programs actually produce more donations.

A sociologist comments on the quandry:

Perhaps this is because — as Kieran Healy, a sociologist at Duke University has found — “opt-out” and “opt-in” systems are really not that different in practice. In both, doctors still typically defer to the wishes of the deceased’s family, whatever the official donor status of the deceased.

In a 2006 article in the DePaul Law Review, Professor Healy argued that presumed consent laws didn’t seem to be the key to improving cadaveric organ donation rates. Rather, infrastructure investments did.

Countries that experienced the biggest donation increases in recent years, like Spain and Italy, were those that hired more transplant coordinators, started public awareness campaigns, installed 24-hour organ retrieval teams at hospitals and improved training for doctors who talk to grieving families.

He concludes:

Arguments about altruism versus self-interest and disputes over presumed and informed consent together constitute a good portion of the public discussion about organ donation. Yet neither debate helps us explain why some countries have many more organ donors than others. As best we can tell, countries with high procurement rates do not owe their success to any distinctive legal conception of consent, nor to any special way of institutionalizing exchange in human goods. Rather, more fine-grained organizational differences– specifically in logistics and process management — are responsible for their success.