The living donor.

Abstract

Living donation of kidneys is increasing throughout the world in an attempt to address the shortage of cadaver organs. For the same reason, donation of part of a liver from a live donor is also increasing, although this is a much more controversial area. In this forum, the writers have addressed many of the psychologic and social attitudes that influence living donation. The forum does not pretend to be comprehensive, but it does present several thought-provoking articles related to the overall theme, which we hope our clinical readers, in particular, will find helpful. Lennerling and colleagues in the first article present an in-depth prospective evaluation of the motives and feelings of potential donors that lead them to become donors. This is followed by a qualitative analysis, by Franklin and Crombie, of the psychologic, social, and cultural attitudes of donor families after transplantation, which complements the findings of the first study. However, it does demonstrate that there are risks, beyond the known physical risks, to live donation. The donation of kidneys by members of the public to an unknown recipient has raised the issue of whether the donor should be allowed to state to whom the organ should go to, or, as is more likely, to whom it should not go to. Aaron Spital has sought the view of the US public in this regard and finds that they do not feel that the altruistic donor should be allowed to determine the recipient, other than perhaps to an unknown child. In the next article, Delmonico and Surman stress the importance of the doctor and donor relationship and rightly, inour opinion, stress that this relationship is an important responsibility for the doctor and cannot be abrogated by donor autonomy or the needs of the potential recipient. Because living liver donation is associated with a significant risk to the donor, it is interesting to see that the attitude of the public of Great Britain is supportive. This also shows that their perception of the acceptable risk of the donor dying is poorly understood, although acceptance of a high risk of dying is more likely to be accepted if the recipient is a family member. A majority of respondents felt that the donor should be compensated for the cost of donation (e.g., loss of employment), and a minority felt that the donor should be paid a fee. We then have the fascinating account of Jochum Hoyer, the German transplant surgeon, who, in 1996, donated one of his kidneys to an unknown stranger to publicize the relevant safety of live kidney donation to the German medical profession and public. Dr. Hoyer was exposed to quite incredible hostility by many colleagues, as he recounts in this article, but years later, he feels that the growth in live kidney donation in Germany was in no small part related to his act. This is followed by a fascinating scenario of emotional coercion by James Dwyer: What would your decision be? Finally, James Nelson provides an excellent commentary on the first article as well as on the scenario depicted by Dwyer, rounding off a forum on the Living Donor that we feel not only provides valuable information but will also provoke further discussion in an area of increasing importance in organ transplantation. ONLINE LINKS http://www.bts.org.uk/standards.htm–This is the British guidelines for living kidney donors PDF http://www.connect.net/ron/phenom.htlm–This is a page outlining the main directions within Phenomenology www.unos.org/Resources/bioethics.asp?index=10http://www.transplantliving.org/ Access to these interactive links are free online. Note: The views expressed on these sites are independent and do not necessarily reflect the opinions of the authors or Editors of this forum.