KidneyMatch.com: The ethics of solicited organ donations

Journal of Clinical Ethics

Volumn 19, Issue 2, 2008, Pages 141-149

  Dees, Richard H ^a   Singer, Eric A ^b  

^a UNIVERSITY OF ROCHESTER   (United States)

^b UNIVERSITY OF ROCHESTER MEDICAL CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ALTRUISM; DECISION MAKING; DIRECTED TISSUE DONATION; ETHICS; HOSPITAL ADMISSION; HUMAN; INTERNET; KIDNEY TRANSPLANTATION; LIVING DONOR; PERSONAL AUTONOMY; PERSONALITY; PSYCHOLOGICAL ASPECT; REVIEW; TRANSPLANTATION;

ALTRUISM; CHOICE BEHAVIOR; DIRECTED TISSUE DONATION; HUMANS; INTERNET; KIDNEY TRANSPLANTATION; LIVING DONORS; PERSONAL AUTONOMY; PERSONALITY; TISSUE AND ORGAN PROCUREMENT; WAITING LISTS;

EID: 50449087900     PISSN: 10467890     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (36)

1. Organ Procurement and Transplantation Network, "Current US Waiting List, Overall by Organ," www.optn.org/latestData/rptData.asp, accessed 9 June 2008.
2. R. Dinavahi and E. Akalin, "Preemptive Kidney Transplantation in Patients with Diabetes Mellitus," Endocrinology and Metabolism Clinics of North America 36 (2007): 1039-49.
3. G. Remuzzi et al., "Long-Term Outcome of Renal Transplantation from Older Donors," New England Journal of Medicine 354 (2006): 343-52.
4. See note 1 above.
5. www.MatchingDonors.com, accessed 9 June 2008.
6. We have been able to verify that 10 hospitals have performed these surgeries and that one has refused, and we have no reason to doubt claims by MatchingDonors.com.
7. American Society of Transplant Surgeons, "Statement on Solicitation of Donor Organs, January 20, 2005."
8. American Society of Transplant Surgeons, "Statement on Directed Donation and Solicitation of Organs, October 23, 2006."
9. Quoted in R. Stein, "Search for Transplant Organs Becomes a Web Free-For-All," Washington Post, September 23, 2005, p. A1.
10. See, for example, C. Robertson, "Who is Really Harmed Anyway? The Problem of Soliciting Designated Organ Donations," American Journal of Bioethics 5 no. 4 (2005): 16-7.
11. L.F. Ross notes that some forms of complicated donations can hurt people on the list - when, for example, someone donates to the next suitable person on the list to gain preference for a cadaveric organ for their intended recipient. But those complications do not affect the argument here. See "The Ethical Limitations in Living Donor Transplantations," Kennedy Institute of Ethics Journal 16 (2006): 151-72.
12. D. Steinberg, "The Allocation of Organ Donations by Altruistic Strangers," Annals of Internal Medicine 145 (2006): 197-203.
13. C. Elliott, A Philosophical Disease: Bioethics, Culture, and Identity (New York: Routledge, 1999), chap. 6.
14. In research contexts, we use a similar standard. The risks of certain experiments are simply too high to allow persons to bear them, even if they are willing to do so. For a discussion, see for example, B.A. Brody, The Ethics of Biomedical Research (New York: Oxford University Press, 1998), chaps. 2, 6.
15. R. El-Galley et al., "Donor Nephrectomy: A Comparison of Techniques and Results of Open, Hand Assisted and Full Laparoscopic Nephrectomy, " Journal of Urology 171 (2004): 40-3
16. and A. Breda et al., "Complications of Laparoscopic Living Donor Nephrectomy and Their Management: The UCLA Experience," Urology 69 (2007): 49-52.
17. I. Fehrman-Ekholm, "Living Donor Kidney Transplantation," Transplantation Proceedings 38 (2006): 2637-41.
18. The 2005 statement of the ASTS had this view. See note 7 above.
19. D. Hanto in Harvard Medical School Ethics Forum, "Soliciting Organs on the Internet," Lahey Clinic Medical Ethics (Fall 2005): 5-8.
20. What counts as the greatest need in this context is not, of course, a simple matter. It depends not only on who is most likely to die without a kidney, but also on who can survive the best and the longest with a kidney, who has been waiting the longest, and other factors that the UNOS system tries to capture.
21. M. Ignatieff, The Needs of Strangers (New York: Viking Books, 1984), 7-23.
22. G. Meilaender, "Gifts of the Body," New Atlantis 13 (2006): 25-35.
23. See N. Scheper-Huges, "The Tyranny of the Gift: Sacrificial Violence in Living Donor Transplants," American Journal of Transplantation 7 (2007): 507-11.
24. So Martin Zandt reports, based on an informal survey of his patients at the University of Rochester Medical Center.
25. This principle does not even allow the more nuanced view of Michael Gill and Robert Sade, who argue that we should allow donors to accept money, but not allow recipients to buy them. If the donors are allowed to control the process, then they should be able to get whatever money they like. See M. Gill and R. Sade, "Paying for Kidneys: The Case against Prohibition," Kennedy Institute of Ethics Journal 12 (2002): 17-45.
26. E.S. Anderson, "The Ethical Limitations of the Market," in Values in Ethics and Economics (Cambridge: Harvard University Press, 1993), 154-6.
27. World Health Organization, "Blood Transfusion Safety: Voluntary Blood Donation," www.who.int/bloodsafety/voluntary_donation/en/, accessed 9 June 2008.
28. For an extensive discussion, see K. Healy, Last Best Gifts (Chicago: University of Chicago Press, 2006), chap. 4.
29. M. Goyal et al., "Economic and Health Consequences of Selling a Kidney in India," Journal of the American Medical Association 288 (2002): 1589-93.
30. N. Scheper-Hughes, "Commodity Fetishism in Organs Trafficking," and L. Cohen, "The Other Kidney: Biopolitics Beyond Recognition," both in Commodifying Bodies, ed. N. Scheper-Hughes and L. Wacquant (London: Sage Publications, 2002), 31-62 and 9-29, respectively.
31. See D. Brock in Harvard Medical School Ethics Forum, "Soliciting Organs on the Internet," Lahey Clinic Medical Ethics (Fall 2005): 7-8.
32. Also see P. Ford and T. Nicoletti, "My Organs, My Choice," American Journal of Bioethics 5 no. 4 (2005): 30-1.
33. See, for example, R. Epstein, "Remarks to the President's Council on Bioethics, April 20, 2006," bioethics.gov/transcripts/april06/session2. html
34. and B. Hippen, "The Case for Kidney Markets," New Atlantis 14 (2006): 47-61.
35. S. Zink et al., "Examining the Potential Exploitation of UNOS Politics," American Journal of Bioethics 5 no. 4 (2005): 6-10.
36. Organ Procurement and Transplantation Network, "OPTN/UNOS Board Addresses Information Needs of Potential Living Donors, 2005," www.unos.org/news/newsDetail.asp?id=391, accessed 25 January 2008.