Living Organ Donation

Abstract

In a recent editorial, Reese et al. (1) discussed the “ethics of accepting complex living kidney donors” ( i.e. , donors at added risk). We take exception to three of their main points. (Note that our comments refer to all potential living donors, “complex” or not.) Reese et al. (1) imply that when determining donor acceptability, the risk of donor harm should be balanced against anticipated recipient benefit. We disagree. Such a standard asks physicians to change the primary focus of their loyalty in a major and, we believe, unacceptable way. More than 20 yr ago, Levinsky (2) argued cogently that “in caring for an individual patient, the doctor must act solely as that patient’s advocate.” Physicians cannot accomplish this goal if, when trying to decide whether to recommend a procedure for one patient, they are asked to balance the risks for that person against the benefits for another. Such an approach would pose a clear conflict of interest, the recognition of which has led to the sensible recommendation that potential donors and recipients be evaluated by separate physicians (3), a position that Reese et al. support (1). How then should physicians decide whether a volunteer is acceptable? We propose that, as is true of other medical situations, for a physician to support her patient as an organ donor, she must believe that there will be benefits for her patient ( i.e. , the potential donor) that are …