The ethics of liver transplantation from a living donor.
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Child↗
Biomedical subjects
M Spital
Publications and source records attributed to M Spital.
Living kidney donation. Attitudes outside the transplant center.
Many transplant centers are opposed to the use of living unrelated kidney donors and donors at added risk. To see how the public and nontransplant physicians view these issues, we surveyed samples of these groups in Rochester, NY. We found that the majority of respondents supports the use of unrelated donors and believes that donors should be allowed to accept added risk. Our findings were confirmed by a Gallup Poll of a random sample of the US adult population. It appears that many transplant centers are out of step with public opinion, as well as that of other members of the medical profession. We hope our data will induce the centers to become more attuned to public attitudes and give donors a greater voice in determining their own suitability. If this occurs, more donors will likely become available and the number of patients with end-stage renal disease receiving transplants will increase.
Adult↗
The donor's decision in renal transplantation: a cost-benefit analysis.
We previously suggested that a fully informed competent potential donor be allowed to donate his/her kidney as long as society will not suffer from the proposed transplant, even if there is added risk for the donor. To help make this sometimes difficult determination, we have constructed a benefit equation that calculates the benefit to society (either positive or negative) of any proposed living-related transplant. We believe that as long as the benefit calculated is positive, the prospective donor should generally be allowed to donate his kidney, since society will not be injured. It is emphasized that the benefit equation should be viewed as a guide to be used in difficult situations where the donor may be at added risk of renal death, and is not meant to supplant the entire complex decision-making process regarding living-related kidney donation.
Adult↗
Kidney donation: reflections.
Living related kidney donors are still the donors of choice for renal transplantation at most US transplant centers. Nevertheless, many centers are strongly paternalistic and do not allow the potential donor at added risk to determine his own medical suitability. There are several reasons for this paternalism, yet all are flawed. Therefore, we suggest that it is generally ethically justified to allow the informed competent donor at small or unknown added risk to determine his own medical suitability. We offer guidelines to help determine how much added risk a potential donor should be allowed to accept.
Attitude↗
Kidney donation: exclusion criteria.
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Humans↗
More on donor's choice or Hobson's choice.
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Cadaver↗
The living kidney donor. Alive and well.
The results of cadaveric renal transplantation have markedly improved in recent years. Concurrently, a few long-term follow-up studies of living kidney donors found an increased incidence of proteinuria and hypertension. As a result, some have argued that living donors should no longer be the preferred source of kidneys. To see if transplant centers are moving away from the use of living donors, we sent a questionnaire to all US transplant centers. The results of our survey show that rather than becoming extinct, living donors are still the preferred source of kidneys at most US transplant centers. In fact, new ways are being sought to increase the supply of living kidney donors.
Cadaver↗
The compelling case for seat belts on school buses.
The ability of seat belts to reduce injuries and fatalities in vehicular accidents has been established beyond question. Nevertheless, most school buses are not equipped with seat belts. The available evidence shows that seat belts would provide added safety for our children in school buses, just as they do in the family car. Moreover, the use of seat belts on school buses would foster a lifelong habit of seat belt use. By exerting their considerable influence in the community, physicians can contribute a great deal to the nationwide campaign to require the use of seat belts on school buses. If this campaign is successful, not only will our children ride their school buses in greater safety, but a whole generation of young Americans will learn a habit that is known to reduce drastically the number of tragic highway injuries and deaths.
Accidents, Traffic↗
Donor's choice or Hobson's choice?
During the evaluation of the living-related renal donor, medical abnormalities may be uncovered. When the added risk to the donor, resulting from such abnormalities, is greater than the chance of a successful transplant, most would agree that such individuals should be excluded from donating. However, when minor abnormalities are uncovered, adding small or unknown risk, is the donor given a choice in his own medical suitability? To answer this, a questionnaire was mailed to transplant centers around the country. The results indicate that many centers do not allow the potential donor to accept uncertain risks. In their effort to protect the donor, these centers actually practice pseudoprotectionism, since they deprive some individuals of the right to give, perhaps one of life's most meaningful experiences. We propose that under the circumstances described, the final decision regarding acceptability for donation should rest with the donor. If this attitude were adopted, perhaps the renal donor pool would increase.
Adult↗