Responding to offers of altruistic living unrelated kidney donation by group associations: an ethical analysis

Members of a religious community presented to our institution and offered to be altruistic unrelated living kidney donors en masse. This situation raised a number of ethical concerns related to the situation specifically and to altruistic unrelated living kidney donation in general. Based on our ethical analysis, we made the following conclusions. Altruism is a legitimate motive for living unrelated kidney donation, and altruistic acts can be based legitimately on religious beliefs. Retrieval of kidneys from living donors is generally safe, and altruistic donors may derive benefit from donating (eg, enhanced self-esteem) assuming they are autonomous and free of coercion. Separate teams should evaluate and care for potential donors and recipients to avoid compromising the donor screening process and to ensure potential donors satisfy medical and psychosocial criteria for donation. Indeed, transplant clinicians should not assume that potential unrelated living kidney donors are not susceptible to coercion. In fact, in our situation, coercion was our biggest concern. Appointing a donor's advocate can facilitate donor understanding of the risks, benefits, and alternatives to organ donation and can help discern coercion. Furthermore, an experienced social worker should assess all potential donors and discern if coercion is present; potential donors should be referred to a psychologist or psychiatrist as appropriate. Although concerns regarding allocation were not raised by our specific situation, ethical concerns regarding allocation of kidneys donated by altruistic unrelated kidney donors exist (eg, requesting that such donations be allocated to recipients with specific characteristics).