Intended for healthcare professionals

Rapid response to:

Head To Head

Is it unethical for doctors to encourage healthy adults to donate a kidney to a stranger? No

BMJ 2011; 343 doi: (Published 15 November 2011) Cite this as: BMJ 2011;343:d7140

Rapid Response:

Re: Is it unethical for doctors to encourage healthy adults to donate a kidney to a stranger? No

Antonia J. Cronin (1) claims that “Restricting the risks that autonomous adults may freely run on the basis that this is legitimate paternalism because it might conflict with a clinician’s responsibility to ‘do no harm’ is not a compelling ground for arguing that living kidney donation should be prohibited or further restricted.” Glannon does not argue for this claim; it is merely assumed. To focus on the shortage of organs and the deaths of potential organ recipients does not address the issue of potential harm to the organ donor. It is that issue that must be addressed to show that autonomy trumps beneficence in living donor donation.

A number of studies of living kidney donation have revealed complication rates ranging from 7.2% to 23.9%, including several deaths (2). The fundamental responsibility of the physician is for the health care of the individual patients whom he or she serves. That responsibility is subverted when the physician performs a procedure that cannot benefit (except perhaps psychologically) and can only physically harm the patient. Autonomy does not trump the fundamental responsibility of the physician to “first, do no harm,” if an autonomous decision can even be made in many cases of living kidney donation. Pressure from the patient desiring the transplant, from the patient’s family, and from the doctor, may de facto be coercive for a potential donor whose guilt may lead to donate a kidney. For a doctor to take advantage of guilt or other feelings is an abuse of power. Even if the potential donor makes a truly “autonomous” decision, that “does not remove or reduce the physician’s responsibility for doing harm to a patient.” (2) Harming a patient, even to do good for another patient, amounts to an abuse of medical power and a violation of the fundamental end of medicine to benefit, not harm, a patient. To try to encourage healthy patients to donate a kidney to a stranger is, therefore, a fortiori, morally wrong.


1. Cronin, AJ. Is it unethical for doctors to encourage healthy adults to donate a kidney to a stranger? No. BMJ 2011;343:d7140 doi: 10.1136/bmj.d7140 (Published 15 November).

2. Potts M., Evans DW. Is solid organ donation by living donors ethical? In: W Weimar, MA Bos, JJ Busschbach (eds.). Organ Transplantation: Ethical, Legal, and Psychosocial Aspects—Towards a Common European Policy. Lengerich: Pabst Science Publishers, 2008, 377-81.

Competing interests: No competing interests

20 November 2011
Michael Potts
Professor of Philosophy
Methodist University
5400 Ramsey St., Fayetteville, NC 28311-1498