Organ Donation Opportunities for Action (2006) / Chapter Skim
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9 Ethical Considerations In Living Donation
9 Ethical Considerations In Living Donation
Pages 263-280
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From page 263... ...
Still other donors offer a kidney or a partial organ to patients whose stories have become known to them, perhaps through the media, whereas still others make a nondirected donation of a kidney to the transplantation system for use by any patient who needs it. Organ donation by living donors clearly saves lives, improves transplantation outcomes under some circumstances, and reduces recipients' waiting times.
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From page 264... ...
The chapter concludes by focusing on the need for further examination of this issue and on the committee's recommendations to provide independent donor advocate teams and to follow up on the health of living donors. BACKGROUND The first successful organ transplantations involved living donors.
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From page 265... ...
has collected and analyzed data regarding deceased donors, its data on the living donation process and on its effects on living donors over time are quite limited. Perhaps one reason for this imbalance is that the National Organ Transplant Act of 1984, which established the OPTN, did not address living donation.
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From page 266... ...
Hence, organ donation by living donors is not a single kind of activity because of the different organs that can be involved, the different ratios of the potential benefit to the risk, the variety of possible relationships between the donor and the recipient, and other factors. The relationship between the donor and the recipient often has a bearing on the donor's motivation for giving an organ.
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From page 267... ...
Although organ donations in such cases are usually directed donations, that is, the organ is directed to a specific patient in need, there are some cases of nondirected donation. For example, in response to the shortage of transplantable organs, a living unrelated donor may simply wish to donate an organ or part of an organ anonymously to save a life or enhance the quality of life of another person (Matas et al., 2000; Jacobs et al., 2004; Gilbert et al., 2005; Truog, 2005)
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From page 268... ...
Therefore, when this chapter uses the common formulation "risk-benefit ratio," this interpretation is operative. A complication in determining a risk-benefit ratio for living organ donation is that the donor bears almost all of the risks.
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From page 269... ...
Nevertheless, the potential donor's decision often reflects, at least in part, his or her relationship to the potential recipient. Living donors often report that they receive important psychological and social benefits from exercising their autonomy to become a living donor.
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From page 270... ...
. OTHER ETHICAL CONSIDERATIONS In addition to the ethical considerations involved in risk-benefit analyses and assessments, living organ donation raises several other ethical concerns.
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From page 271... ...
Such an individual can only be a "source" of the organs, even though sometimes such a source of organs is loosely called a "donor." Although children and some adults who are incompetent or doubtfully competent to make complex health-related decisions are sometimes involved in living donation, with the decisions made by others, such donations are difficult to justify ethically and, at a minimum, must satisfy special substantive and procedural conditions. Discussions on the issues regarding children as living organ donors continue (see, for example, Ross, 1998; Abecassis et al., 2000; Delmonico and Harmon, 2002; Holm, 2004; Jansen, 2004; Ladd, 2004; Zinner, 2004)
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From page 272... ...
A few years ago the DHHS Advisory Committee on Transplantation made several recommendations about living donation that called for the creation of a database with data on the health outcomes of all living donors (ACOT, 2005)
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From page 273... ...
Whatever the context, compensation for organs is illegal under Section 301 of the National Organ Transplant Act: "It shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration" (Public Law 98-507)
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From page 274... ...
. NEXT STEPS Although the committee believes that the whole practice of organ donation by living donors now needs a careful review and assessment on its own, in the interim the committee makes a few specific recommendations, building on ethical concerns and proposals already present within the transplantation community and drawing on the ethical perspectives that inform this report (Chapter 3)
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From page 275... ...
Independent Donor Advocate Team 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.
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From page 276... ...
As a result there is no national infrastructure for gathering information and for ensuring accountability as there is for donation by deceased individuals. Establishing registries of living donors would be a first step in developing the infrastructure needed for follow-up studies.
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From page 277... ...
:29192926. ACOT (Advisory Committee on Organ Transplantation)
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From page 278... ...
2002. Ethical incentives -- not payment -- for organ donation.
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From page 279... ...
2005. The ethics of organ donation by living donors.
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