BMJ  2006;333:919 (28 October), doi:10.1136/bmj.333.7574.919

Letter

Living organ donation needs debate on harm to donors

EDITOR—Conspicuously absent from the article by Friedman et al,¹ and from the rapid responses to it that have been published to date, is a detailed account of the inevitable morbidity and risk of serious harm that is inflicted on the donor by doctors in the course of their ordinary paid employment. The short term risks include life threatening haemorrhage, pulmonaryembolism, pneumothorax, infection, transfusion transmitted hepatitis, and AIDS.^{2 3} In the longer term, there is increased risk of hypertension and renal failure.^{3 4} The long term psychological effects on the donor are not known.

In another article elsewhere,⁵ Friedman et al reported 105 episodes of serious haemorrhage; blood transfusion was needed in at least 19 cases and reoperation required in 29. Two patients died, and two patients developed renal failure. These figures were obtained by questionnaires sent to 893 transplant surgeons, only 24% of which were returned. Although such a low response provides no basis for an estimate of the rate of occurrence of these complications, it is clear that they are not rare.

Whether or not these risks are adequately explained to those asked to donate or sell one of their kidneys may, in due course, become a matter of concern to the lawyers. Of most concern to those in the medical profession who subscribe to the "first, do no harm" principle—in the belief that the laity's trust in us depends on it—should be the ever more open flouting of that principle without published protest. I submit that we continue to condone that abuse at our peril. Let us have a fully informed discussion and debate about this presently stealthy move towards a purely utilitarian basis of practice, before its potentially disastrous consequences become inevitable. It may well be that some, or even many, of those who have become involved in these practices without sufficient awareness of these considerations will welcome a frank examination of their ethical basis at this stage.

Queens' College, Cambridge CB3 9ET dwevansmd{at}tinyworld.co.uk

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Competing interests: None declared.

References

1. Friedman AL. Payment for living organ donation should be legalised. BMJ 2006;333: 746-8. (7 October.)[Free Full Text]
2. Ingelfinger JR. Risks and benefits to the living donor. New Engl J Med 2005;353: 447-9.[Free Full Text]
3. Hartmann A, Fauchald P, Westlie L, Brekke IB, Holdaas H. The risk of living kidney donation. Nephrol Dial Transplant 2003;18: 871-3.[Free Full Text]
4. Boudville N, Prasad GVR, Knoll G, Muirhead N, et al. Meta-analysis: risk for hypertension in living kidney donors. Ann Intern Med 2006;145: 185-96.[Abstract/Free Full Text]
5. Friedman AL, Peters TG, Jones KW, Boulware LE, Ratner LE. Fatal and nonfatal hemorrhagic complications of living kidney donation. Annals of Surgery 2006;243: 126-30.[CrossRef][ISI][Medline]

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Relevant Article

Payment for living organ donation should be legalised

Amy L Friedman
BMJ 2006 333: 746-748. [Full Text] [PDF]

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