Intended for healthcare professionals

Rapid response to:

Analysis And Comment Controversy

Payment for living organ donation should be legalised

BMJ 2006; 333 doi: (Published 05 October 2006) Cite this as: BMJ 2006;333:746

Rapid Response:

Living organ donation

EDITOR - Conspicuously absent from the article by Friedman and
colleagues(1), and from the 'Rapid responses' to it which have been
published to date, is a detailed account of the inevitable morbidity and
risk of serious harm which is inflicted upon the donor by doctors in the
course of their ordinary paid employment. The short-term risks include
life-threatening haemorrhage, pulmonary embolism, 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 upon the donor are not known.

In another article elsewhere(5), Friedman and her colleagues did
report 105 episodes of serious haemorrhage, blood transfusion being needed
in at least 19 cases and reoperation being required in 29. There were 2
deaths and 2 patients developed renal failure. These figures were obtained
by questionnaires sent to 893 transplant surgeons, only 24% of which were
returned. While such a low response provides no basis for an estimate of
the rate of occurence 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 upon 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.

1. Friedman AL. Payment for living organ donation should be
legalised. BMJ 2006;333:746-748

2. Ingelfinger JR. Risks and benefits to the living donor. New Engl J
Med 2005;353:447-449

3. Hartmann A, Fauchald P, Westlie L, Brekke IB, Holdaas H. The risk
of living kidney donation. Nephrol Dial Transplant 2003;18:871-873

4. Boudville N, Prasad GVR, Knoll G, Muirhead N, et al. Meta-analysis
: risk for hypertension in living kidney donors. Ann Intern Med

5. Friedman AL, Peters TG, Jones KW, Boulware LE, Ratner LE. Fatal
and nonfatal hemorrhagic complications of living kidney donation. Annals
of Surgery 2006;243:126-130

Competing interests:
None declared

Competing interests: No competing interests

16 October 2006
David W Evans
Retired physician
Queens' College, Cambridge, CB3 9ET