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

In 2010-2011 NHS Blood and Transplant reported a reduction in the number of patients on the UK transplant list for the first time over the last decade. This has coincided with a steady increase in transplant activity over recent years.

The increase that has been seen in donor numbers contributing to this trend has been largely attributed to the growing number of live donor transplants taking place, with donor numbers in this group growing at a marked and steady rate. Deceased donor numbers however seem to have remained largely static.

Although altruistic donor numbers as mentioned contribute to a small proportion of organ transplants taking place in the UK at present, I have no doubt that its proportion will grow and become increasingly important in the future.
Whether or not doctors should actively promote this form of organ donation to their patients however remains a rather different matter altogether.

As somebody who has benefited from a live donor renal transplant I am obviously in favour of most strategies that will improve national rates of organ donation and give other patients the same opportunity as I had to regain my life.
Despite this however, while I believe that altruistic donation is an ethically valid and acceptable mode of organ donation, it is one that causes several conflicts within our moral code as healthcare professionals. Actively promoting the idea of altruistic donation to patients who have not actively initiated or expressed interest in discussing such issues would be wholly unacceptable, as we would be failing to place the best interests of the patient who sits before us as our primary concern. It would also contradict the basic ethical value of non-maleficence by introducing our patient to the idea of risk taking for the “greater good” of society.

Of course those patients who are actively seeking knowledge on the idea of donation by whatever mean should be offered counselling and balanced information giving in a professional and non-biased manner, but a definitive line needs to be drawn and the focus of the consultation kept purely patient centred.

Organ donation and transplantation remains an emotive and ethically challenging branch of medical practice where public health and frontline medicine merge. The social conscious of society on issues surrounding organ donation continue to evolve, as is evident by the recent public consultation of the Welsh Assembly Government on the issue of introducing “soft” presumed consent.

Our aim as doctors however is to remain unbiased in the face of this and make decisions on a professional basis with the health of each individual patient kept in mind, however difficult this can sometimes be.

Competing interests: No competing interests

13 February 2012
Michael D Rees
General Surgical Trainee
NP20 2UB
Royal Gwent Hospital
Cardiff Road, Newport