BMJ  2003;327:1287 (29 November), doi:10.1136/bmj.327.7426.1287-c

Letter

Role of living liver donation

Surgery violates principles of beneficence and autonomy

EDITOR—Neuberger and Price admit that there is a significant morbidity and an up to 1% mortality among living liver donors.¹ They argue that a combination of the potential benefits to the recipient, the right of donors to make an altruistic decision to help someone else, an acceptable "societal ceiling" concerning mortality and morbidity, and an acceptable risk-benefit ratio, are sufficient for living liver donation to be morally acceptable.

However, the fundamental goals of medicine, without which medicine could not exist as a practice, are more important than either the notion of patient autonomy or a utilitarian cost-benefit analysis. The fundamental end of medicine is to help an individual sick or injured patient; from this prime goal stem the principles of non-maleficence, "Do no harm," and beneficence, "Benefit the patient."

The surgery to remove a portion of a healthy person's liver may benefit the recipient, but at considerable risk to the donor's health, with some risk to the donor's life. The surgery is not for the benefit of the donor's health; the surgery can only cause bodily harm to an individual who would have remained healthy otherwise. This violates both the ends of helping this individual patient and not harming this individual patient.

Utilitarian considerations, such as the benefit to the recipient or even the potential satisfaction of the donor should the transplant be successful with minimal complications to both parties, do not change this fact. Neither does the principle of patient autonomy, which is not an absolute right (as Neuberger and Price themselves recognise), but is valid in so far as it fits into the fundamental goal of medicine to help an individual patient in need.

Since surgery on the donor does not benefit the health of that individual patient and is potentially harmful, it violates both the principles of beneficence and autonomy, and should not be considered a morally acceptable part of the practice of medicine.

Philosophy and Religion Department, Methodist College, Fayetteville, NC 28311, USA gratiaetnatura{at}yahoo.com

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Competing interests: None declared.

References

1. Neuberger J, Price D. Role of living liver donation in the United Kingdom. BMJ 2003;327: 676-9. (20 September.)[Free Full Text]

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