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# Prisoner wants to donate his second kidney

BMJ 1999; 318 (Published 02 January 1999) Cite this as: BMJ 1999;318:7
1. Deborah Josefson,
2. San Francisco

A convicted felon's offer to donate his remaining kidney to his ailing daughter has raised difficult ethical questions in California. David Patterson, aged 38, first donated a kidney to his estranged daughter, Renada Daniel Patterson, in 1996.

Renada was born with congenital renal anomalies and received a cadaveric renal transplant at age 5. When that kidney was rejected, her father's kidney was found to match and was transplanted. But now, that kidney too is failing. David Patterson, who is serving a 13 year term for burglary and heroin possession, wants to replace Renada's failing kidney with his remaining one.

The unprecedented offer challenges conventional medical ethics and pits a family's wishes against the rule of medicine: “first do no harm.” If Patterson were to donate his remaining kidney, he too would become dependent on dialysis and a candidate for transplantation. It would essentially shorten his life and amount to trading one life for another.

Dialysis is painful, complicated, time consuming, and expensive--about $50000 ($31000) per year. If Patterson were to donate his remaining kidney, the government would pay for his dialysis as long as he was in prison. Medicaid would likely foot the bill thereafter.

Surgeons at the University of California, San Francisco (UCSF) /Stanford Health Care, where Renada is a patient, have refused to consider removing her father's remaining kidney for transplantation. The family contends that the decision is a private family and spiritual matter in which hospital officials have no right to interfere.

Vickie Daniel, Renada's mother, stated: “This is not about ethics. It's a family matter about what's best for this child. We've made a decision for our child and we want it to stand.”

The case has been referred to the hospital's ethics committee and is receiving national attention. Bob Spieldenner of the United Network for Organ Sharing (UNOS), the agency that coordinates organ transplant registries in the United States, said: “I haven't heard of such a case before, and I don't know of any surgeon who would do it. UNOS doesn't have a policy or position on it. It's a difficult decision and hasn't yet been looked at by our ethics committee, but probably will be in the near future.”

Meanwhile, the urgency of the case has abated somewhat since Renada's condition has improved considerably. Moreover, it is possible that Renada has developed antibodies to her father's kidneys, which would render him an unsuitable match.

Renada, now 16, was admitted to hospital with an acute rejection episode, marked by nausea, vomiting, and dehydration.

Dr Donald Potter, her nephrologist, described her condition as “stable” but emphasised that she has moderate to severe chronic rejection and is likely to require dialysis or a transplant within 3 to 4 months.

“The results of recent tests show that the kidney rejection episode is responding to treatment. But this is not a cure.”

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