The Ethics of Organ Transplants: The Current Debate

P. J. Morris and R. A. Sells

SIR,—Allegations that renal transplantation between living unrelated donors and recipients from outside Britain, where the donor has been paid for the donation, is being done at private hospitals in London cause us grave concern. Both the international Transplantation Society and the British Transplantation Society have opposed such practice and feel strongly that steps should be taken to prevent any further such operations in the UK.

The only circumstances where a kidney may be removed ethically from a living donor is when it is a gift to the recipient. Transplants between relatives are, therefore, permissible and widely practiced. In unusual circumstances living unrelated donors might be considered where there is a special relationship between donor and recipient, as, for example, between a husband and wife. But payment is an inducement for the donor to submit to the operation. People should never be operated on under such duress or as a result of bribery; such an inducement not only destroys the very special nature of the gift made by the donor but also threatens the safeguards normally used to preserve the health of both donor and recipient. For if financial gain is the object of the donation, an organ may be removed from a donor who might be unsuitable for medical reasons, and a kidney which is less than ideal may be transplanted into a recipient. These latter objections are, we believe, verified by experience with blood transfusion in countries where blood donors are paid. For this practice has led to an increased spread of disease through the vector of a blood transfusion with a deterioration in the quality of the service and a great increase in the expense of blood as a result of obligatory screening procedures.

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