Will you give my kidney back? Organ restitution in living-related kidney transplantation: ethical analyses

Abstract

In this article, we perform a thought experiment about living donor kidney transplantation. If a living kidney donor becomes in need of renal replacement treatment due to dysfunction of the remaining kidney after donation, can the donor ask the recipient to give back the kidney that had been donated? We call this problem organ restitution and discussed it from the ethical viewpoint. Living organ transplantation is a kind of ‘designated donation’ and subsequently has a contract-like character. First, assuming a case in which original donor (A) wishes the return of the organ which had been transplanted into B, and the original recipient (B) agrees, organ restitution will be permissible based on contract-like agreement. However, careful and detailed consideration is necessary to determine whether this leaves no room to question the authenticity of B’s consent. Second, if B offers to give back the organ to A, then B’s act is a supererogatory act, and is praiseworthy and meritorious. Such an offer is a matter of virtue, not obligation. Third, if A wishes B to return the organ, but B does not wish/allow this to happen, it is likely difficult to justify returning the organ to A by violating B’s right to bodily integrity. But B’s refusal to return the donated organ cannot be deemed praiseworthy, because B forgets the great kindness once received from A. Rather than calling this an obligation, we encourage B to consider such virtuous conduct.

The Ethical Acceptability of a Recipient’s Choice of Donor in Directed and Nondirected Transplantation: Japanese Perspective

“…This conclusion does not change even if the act could be regarded as a kind of contractual relationship, as donors are given the freedom to choose the recipient with whom they can enter such a contract. 11 Rather, it is in terms of a request for organ donation from a recipient to a donor that an ethical issue may emerge in directed living organ transplantation. Directed living organ transplantation is based on a recipient's request to a donor, whether mediated through medical professionals or family members who are not candidates, or whether understood implicitly.…”

Uterine transplantation: legal and regulatory implications in England

“…The possibility of the live donor changing her mind after retrieval and requesting the uterus back (organ restitution), perhaps even once it has served its required ‘purpose’, is one which needs consideration from a legal standpoint. The ethics surrounding the issue of organ restitution have been addressed previously 28,29 …”

“…The ethics surrounding the issue of organ restitution have been addressed previously. 28,29 For UTx, there exists the notion of whether donation of such an organ is a 'loan for use' contract. Human tissue has been recognised as being the subject of property rights by legal scholars in the UK and USA.…”