Donor Autonomy and Self-Sacrifice in Living Organ Donation: An Ethical Legal and Psychological Aspects of Transplantation (ELPAT) View

Abstract

Clinical teams understandably wish to minimise risks to living kidney donors undergoing surgery, but are often faced with uncertainty about the extent of risk, or donors who wish to proceed despite those risks. Here we explore how these difficult decisions may be approached and consider the conflicts between autonomy and paternalism, the place of self-sacrifice and consideration of risks and benefits. Donor autonomy should be considered as in the context of the depth and strength of feeling, understanding risk and competing influences. Discussion of risks could be improved by using absolute risk, supra-regional MDMs and including the risks to the clinical team as well as the donor. The psychological effects on the donor of poor outcomes for the untransplanted recipient should also be taken into account. There is a lack of detailed data on the risks to the donor who has significant co-morbidities.

Living Donor Kidney Transplantation in Older Individuals: An Ethical Legal and Psychological Aspects of Transplantation (ELPAT) View

“…Is it reasonable that the transplant team makes a judgment call on the value of the transplant outcome for the recipient? (30). And is there account taken of the non-physical benefits to the donor from a successful transplant for the recipient?…”

“…But this cannot provide a compelling difference here, since talk of obligation in LD is itself potentially problematic when it comes to freely given consent. Moreover, given the value of autonomy in LD, it is not obvious that obligation arising from a particular relationship should make a donation more acceptable than an autonomously motivated donation without underlying obligation (30).…”

Ethics of live uterus donor compensation

“…55 It is also considered a "unique event in healthcare" given that the donor does not gain any physical benefits from undergoing major surgery. 56 However, because vital organ donations have this lifesaving potential, the cost-to-benefit ratio might be perceived as more obviously favorable as compared with a non-life-saving uterus graft, though in another sense we might think that the "nonvital" nature of the uterus implies lower risk levels to the donor, 57 especially where post-menopausal donors who have already had children are recruited. In any case, imposing harm to donors in organ transplantation is often "justified by appeals to the value of respect for individual autonomy" and a "favorable balance of harm and benefit" for the donor as well as between the donor and the recipient.…”

Heeding the Increased Exponential Accumulation of ESRD After Living Kidney Donation

“…6,13 The public and most ethicists will accept higher risks and more autonomy for willing, well-counseled donors. 15 Kidney Disease Improving Global Outcomes proposes a hypothetical lifetime risk of 5%, 16 which is twice the lifetime risk of non-Black individuals in the general population. Increased risk thresholds will also increase the number of older acceptable candidates.…”