Donor Benefit Is the Key to Justified Living Organ Donation
AARON SPITAL a1 a1 Aaron Spital, M.D., is an academic nephrologist and
Associate Professor of Medicine at the University of Rochester School
of Medicine, Rochester, New York. He has a special interest in the
ethical issues of organ donation
Spurred by a severe shortage of cadaveric organs, there has been a
marked growth in living organ donation over the past several years.
This has stimulated renewed interest in the ethics of this practice.
The major concern has always been the possibility that a physician may
seriously harm one person while trying to improve the well-being of
another. As Carl Elliott points out, this puts the donor's
physician in a difficult predicament: when evaluating a person who
volunteers to donate an organ, “a doctor is in the position of
deciding not simply whether a subject's choice is reasonable
… but whether he [the doctor] is morally
justified in helping the subject accomplish it.”1 This
question has become even more difficult since the introduction of
living donor operations that are more risky than living kidney donation
(e.g., adult-to-adult liver donation) and the suggestion that
volunteers at added risk may sometimes be acceptable.2 So,
how can we decide when the risk is too much?