Living Organ Donation on Shaky Ethical Ground

Article excerpt

CHICAGO -- Steps must be taken to ensure that living organ donation is "ethically impeccable," since by its nature the practice violates the physician's vow to "do no harm," ethicist Arthur Caplan, Ph.D., said during the annual clinical congress of the American College of Surgeons.

Dr. Caplan, director of the Center for Bioethics at the University of Pennsylvania, Philadelphia, said he supports living organ donation, but added that "there are key ethical challenges that make this a close call." Ethical questions about living organ donation demand prompt attention, he stressed, since the practice is growing dramatically. Two years ago, more Americans received kidneys from living donors than from cadavers for the first time. Living donations of partial organs, including livers and lungs, also are becoming more common.

Newer transplant programs, anxious to build a patient base and flummoxed by organ shortages, are often turning quickly to living donations, Dr. Caplan said.

Foremost among his concerns is whether living organ donors have an opportunity to give voluntary, educated, non-coerced informed consent. "Are donors coerced?" he asked. "I think they are."

In many cases, family members, coworkers, and even church members are approached to be organ donors by people desperate for a transplant. "Someone will stand up in church and say, 'One of our members needs a kidney. It would be the Christian thing to do [to be tested for compatibility],'" he said.

Some friends and family members agree to donate organs despite significant risks to themselves, but any potential donor should receive unbiased, no-pressure counseling before they do so. In too many cases, the transplant team acting on behalf of a person who needs an organ is the same team that approaches and counsels potential donors, and that poses a profound conflict of interest, Dr. Caplan said.

Hospital social workers or other individuals who counsel donors should not have their job performance based on the number of donors they recruit, even if it helps boost the hospital's bottom line to perform more living donor transplants. …

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