Have we reached the limits in altruistic kidney donation?

Abstract

Altruistic donation (unspecified donation) is an important aspect of living donor kidney transplantation. Although donation to a stranger is lawful and supported in many countries, it remains uncommon and not actively promoted. Herein, we ask the question if we have reached the limit in altruistic donation. In doing so, we examine important ethical questions that define the limits of unspecified donation, such as the appropriate balance between autonomous decision-making and paternalistic protection of the donor, the extent of outcome uncertainty and risk-benefit analyses that donors should be allowed to accept. We also consider the scrutiny and acceptance of donor motives, the potential for commercialization, donation to particular categories of recipients (including those encountered through social media) and the ethical boundaries of active promotion of unspecified kidney donation. We conclude that there is scope to increase the number of living donation kidney transplants further by optimizing existing practices to support and promote unspecified donation. A number of strategies including optimization of the assessment process, innovative approaches to reach potential donors together with reimbursement of expenses and a more specific recognition of unspecified donation are likely to lead to a meaningful increase in this type of donation.

Relinquishing Anonymity in Living Donor Kidney Transplantation: Lessons Learned From the UK Policy for Anonymous Donors

“…I have chosen not to meet the donor (famous person) as TV would be involved and I would have no control over the TV editing." Female, PPD 2 "I was curious to know who has been kind enough to donate a kidney to a stranger. I sent a thank you card, but was told there was a high possibility I wouldn't hear back so when I received a very nice card and letter, I was extremely happy.…”

“…I don't want to meet the recipient." Female, NDAD 2 "I was keen to know the outcome for him or her (hopefully positive but wanted to know even if it's not). We have exchanged emails and have spoken on the phone.…”

“…We are unaware of any empirical studies on the impact of lifting anonymity on donation rates, but as long as maintaining anonymity remains an option, donation rates are unlikely to be influenced by a possible relinquishment of anonymity after donation (5,7). This is supported by the rising number of unspecified donors in the UK (2,5) and an increased interest in directed altruistic donation which allows living kidney donors to direct their altruistic donation to a specified recipient they did not know before (often presenting themselves online or in the media). Also, the current study does not support the aforementioned concerns on removal of anonymity in the context of a well-established living donation programme.…”

“…Non-directed altruistic donors (NDADs) often donate into KEPs to initiate chains of transplants that complete with a recipient on the national transplant list. This is allowed in many countries, such as Australia, Canada, Netherlands, United Kingdom and United States (2). Within Europe, KEPs are especially well established in the Netherlands and in the United Kingdom (3).…”

Polish attitudes towards unspecified kidney donation: a cross-sectional study

“…People afraid of increasing the risk of organ trafficking will likely not approve ULKD legislative initiatives, thus it is vital that the legislation be clear that organ trafficking is a crime with serious punishment. As Poland is a predominately Catholic country (70.6% of our respondents declared to be Catholic), educational efforts should also include the Papal support for living and deceased organ donation [ 29 ]. Other potential concerns about ULKD such as donor screening and expenses, and the promotion of ULKD programs can be addressed by reflecting on best practices in high volume regions of the world [ 17 , 29 ].…”