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

It’s a funny thing. If I were to submit an article to the BMJ about a medical treatment, I would be expected first to do a systematic review, and I would have to list all the previous publications that I had used to reach my conclusions. But when it’s an ethical issue, it’s as if no one had ever thought of the subject before. I have not done a systematic review, but I used to have a passing interest in the ethics of transplantation. Taking a quick look at my notes I find that in 1989 Evans wrote [1] that non-related donation should be welcomed “where clinically appropriate and truly voluntary”. He also stated categorically that, “The principal arguments for a ‘genetic-relative’ restriction have been shown to fail…”

Levinsky in 2000 [2] reviewed the history of unrelated donation in the USA, and took more the view of “first do no harm”. Levinsky was particularly worried about the financial interests of hospitals that did both retrieval and transplantation, although this is not relevant in the UK.

When I searched on Evans’ paper, PubMed suggested some related citations. Just by scanning the titles, some seem to me to be highly relevant to this head-to-head ethical debate [3-5]. I have not done a more detailed search, but then I am not writing an article.

Admittedly, the head-to-head in this issue of the BMJ is restricted by the precise question of whether doctors should encourage donation by strangers, but nonetheless the question is if Evans, in 1989, considered the ethical objections had failed, why did Cronin not cite him in support, and why did Glannon not specifically refute his already constructed argument?

My views are with Stephen Potts: it depends what you mean by “encourage”, but my response is emotionally not ethically based.


1. Evans M. Organ donations should not be restricted to relatives. J Med Eth 1989;15:17-20.
2. Levinsky NG. Organ donation by unrelated donors. NEJM 2000;343:430-432.
3. Peters DA. J Med Humanit Bioeth Rationale for organ donation: charity or duty? 1986;7:106-21.
4. Prottas JM. Altruism, motivation, and allocation: giving and using human organs. J Soc Issues 1993;49:137-50.
5. Spike J. What's love got to do with it? The altruistic giving of organs. J Clin Ethics. 1997;8:165-70.

Competing interests: No competing interests

23 November 2011
Neville W Goodman
Bristol, BS9 3LW, UK