An ethical comparison of living kidney donation and surrogacy: understanding the relational dimension

Abstract

Background The bioethical debates concerning living donation and surrogacy revolve around similar ethical questions and moral concepts. Nevertheless, the ethical discourses in both fields grew largely isolated from each other. Methods Based on a review of ethical, sociological and anthropological research this paper aims to link the ethical discourses on living kidney donation and surrogacy by providing a comparative analysis of the two practices’ relational dimension with regard to three aspects, i.e. the normative role of relational dynamics, social norms and gender roles, and reciprocity. Based on this analysis, we derive conclusions for the framing of living organ donation and surrogacy in ethical theory and practice. Results First, our analysis emphasizes the relevance of acknowledging the complex relational implications of living kidney donation and surrogacy. Underestimating this relational dimension may not only lead to individual crises but endanger existing as well as newly emerging familial relationships. Second, we point out differences in the normative assessment of social norms and gender roles in the ethical debates about living kidney donation and surrogacy. In particular, we show how different evaluations of altruism affect the understanding of autonomy in both contexts. In addition, we sensitize for biased perceptions of gender roles. Finally, we argue that challenges resulting from unresolved reciprocity are an issue in living kidney donation and surrogacy independent of whether the exchange of body parts or bodily services is framed as a gift or commercial exchange. By pointing out the limits of financial compensation, we stress the relevance of non-material, relational rewards as potential remedy.

Queering reproductive justice: Framing reproduction of gay men from a transnational perspective—Taiwan as a case

“…Also, third‐party reproduction is a process that heavily relies on women in terms of donated eggs and the gestational process (Russell, 2018). This has become a continuous debate on the ethical issues of surrogacy and on the question of whether surrogates are exploited (Armour, 2012; Beier & Wöhlke, 2019; Y. Chao, 2016; Deomampo, 2016; Gamble, 2009; Hibino, 2015; Inhorn et al., 2010; Jacobson, 2016; Pande, 2011; Rudrappa, 2016; Spar, 2006). In the ethnography on Indian surrogacy, Sharmila Rudrappa (2016, p. 174) reflected that: ‘If and when surrogate mothers are treated as full human beings, with respect for their emotional, physical, and intellectual well‐being, their sense of self, dignity, and body intact, then I am an advocate of commercial transnational surrogacy.’ Considering the disparate contexts across the globe, there still exist concerns in the transnational surrogacy industry, given the fact that many countries do not have sufficient regulations to protect the rights of surrogates and commissioning parents.…”

Commercial Surrogacy: An Overview

“… 63 64 Surrogacy is also seldom compared to donating or selling a kidney in vivo . 25 65 66 Interestingly, some argue that paid surrogacy is in no worse position than many other exploitative commercial transactions which take place against a backdrop of global inequality and constrained options, such as poorly paid and dangerous construction work. Hence, there would be no reason for special condemnation.…”

European policies on same-sex relationships, adoption and assisted reproduction

“…Surrogacy is one of the most challenging treatments, both ethically and biologically. 35 A large part of the countries worldwide does not have a specific legislation regarding surrogacy. Some countries allow surrogacy only if medically justified.…”