ous sample studies for renal donors) for improved risk-benefit analyses by transplantation teams, donor advocates, and the potential donors themselves; a clinical commitment to the welfare of the donor as a patient before, during, and after the donation; vigorous efforts to ensure fairness and nonexploitation in the selection of donors and to ensure the prospective donor’s understanding and voluntary decision; and the increased use of independent donor advocate teams. The specific recommendations that follow are particularly important for partial liver transplantation and partial lung transplantation because of their greater medical risks and inadequate data about those risks, but they would also be valuable in the context of kidney transplantation. Indeed, these recommendations are crucial to promoting and protecting the potential donor’s voluntary and informed consent in a nonexploitative context.
In determining which potential living donors will be accepted, transplantation teams serve as ethical gatekeepers, with less societal oversight than occurs in much of transplantation. Additionally, they may have an inherent conflict of interest because they seek to obtain an organ for patients on the waiting list while assuming major responsibilities to potential and actual donors.
The development and use of an independent donor advocacy team that focuses on the donor’s needs is of paramount importance. Such a team can best protect the donor if it offers the multidisciplinary expertise needed to address the whole range of medical, ethical, social, and psychological questions and issues. Each team should include a clinician with experience in transplantation, a social worker or other mental health professional with experience in interpreting donor motivations and addressing intrafamilial conflict, and a nurse. Whether these healthcare professionals or another group of healthcare professionals are involved, the goal is to provide the expertise and skills necessary to ensure (1) that the potential donor adequately understands the risks that surround his or her donation and recognizes the uncertainties involved, especially in the absence of comprehensive data about outcomes, and (2) that the potential donor is making a voluntary decision regarding donation without undue pressure or coercion by family members or by anyone else. Focusing on the welfare and rights of the donor, the donor advocacy team can also act as a safety valve by providing a confidential way out for prospective donors who believe that they are being pressured or coerced to donate.