Emerging Ethical Challenges in Living Kidney Donation

Abstract

Living-donor kidney transplantation (LDKT) offers the best medical outcomes in terms of graft and patient survival for end-stage renal disease (ESRD) patients. LDKT involves a medically and psychologically suitable individual willingly agreeing to donate a kidney to a loved one or stranger. It is a unique situation in which a healthy person consents to having a medical procedure for another person’s benefit. LDKT raises numerous ethical issues, particularly with respect to voluntary consent, risks and benefits, and vulnerability. In recent years, the discovery of APOL1, a gene associated with increased risk of chronic kidney disease and ESRD in African Americans, and unique situations arising from requests to undergo living donation from persons who are not traditionally healthy or have social circumstances that may challenge influence-free, informed decision making have challenged the ethics of LDKT. In this article, we discuss the ethical issues surrounding three emerging situations in LDKT: living kidney donors with life-limiting illness, incarcerated living kidney donors, and APOL1 genotyping in the context of living donor candidate evaluation.