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: https://doi.org/10.1136/bmj.d7140 (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

It is unfortunate that the framing of the question for this debate allows only two responses - Yes or No. It thereby fails to recognise reality, and artificially restricts the arguments on both sides.

In this context “encouragement” spans a wide range: from the neutral presentation of relevant facts to already interested members of the general public, via websites and the like - all the way to personally urging a previously uninterested patient in the course of consultation about another matter.

There is nothing wrong in the former: but the latter would be so highly unethical as to warrant sanction.

The relevant factors include:
1. the nature of the relationship between the recommending doctor and the potential donor. Is the doctor making the recommendation as part of his/her role as physician to the donor, or in a more general sense?

2. the setting in which information is passed and any recommendation made (website, leaflet, media appearance, personal lecture, or one-to-one clinical encounter).

3. who triggers the discussion: a potential donor who wished to further explore such donation; or a doctor raising the subject with a previously unaware patient?

Having been involved in the assessment of some 16 potential altruistic donors, leading to 6 transplants to date (all successful for donor and recipient), I have no doubt that these procedures can be of great benefit. But they are not risk-free, and they are still novel in the UK, requiring us as professionals to proceed very cautiously.

Furthermore, paternalistic though it may sound, there is a need to protect those whose wish to donate arises from mental disorder. This is recognised by the HTA in guidance which requires mental health assessment of potential altruistic donors at an early stage in the assessment process, to which neither author makes reference.

Finally the charity newly established to promote altruistic donation might wish to reconsider its title. “Give a kidney: one’s enough” combines a peremptory command with the implication that anyone walking round with two kidneys is selfish in retaining more than they need. I’m sure this isn’t the intention, and that the charity’s work is valuable: but branding matters.

Reference:

Guidance for transplant teams and Independent Assessors: Living Donor Transplantation. Human Tissue Authority

http://www.hta.gov.uk/bodyorganandtissuedonation/organdonations/independ...

Competing interests: No competing interests

20 November 2011
Stephen G Potts
Liaison Psychiatrist
Royal Infirmary of Edinburgh
Little France, Edinburgh. EH16 4SA