Transplantation Looks at "The Living Donor"

Newswise — Living donation—donating a kidney or part of a liver for transplantation, usually to a family member—is a controversial but increasingly important approach to overcoming the shortage of organs from brain-dead donors. The October 27 issue of Transplantation, official journal of the Transplantation Society, presents a special Forum on "The Living Donor," exploring the psychological, emotional, and ethical issues posed by this new medical option.

The Forum includes qualitative studies, opinion surveys, and essays from leading American, British, Swedish, and German authorities. The seven papers address a wide range of critical topics, including:· Studies exploring the process of deciding to donate a kidney and the impact of that decision. The decision is easy in some situations but conflicted in others, and sometimes leads to changes in family relationships.· A U.S. opinion survey showing good public support for the concept of "nondirected" living donations—that is, donating an organ to a stranger in need, rather than a relative or other loved one. Most Americans felt that donors shouldn't be permitted to restrict their donation to recipients of a certain race or religion, but should be allowed to stipulate that the recipient be a child.· An essay affirming the importance of a traditional doctor-patient relationship between the transplant surgeon and the living donor. Transplant surgeons are urged to remember that the living donor is their patient too—just as much so as the organ recipient.· A U.K. opinion survey, which found that about three-fourths of Britons supported the relatively new concept of living liver donation—donating a part of the liver to a patient with liver failure.· A gripping personal account by Dr. Jochem Hoyer, a German transplant surgeon who donated one of his own kidneys to a stranger. Although he experienced some unexpected consequences of his decision—including intensely negative reactions by some medical colleagues—Dr. Hoyer feels he was successful in achieving his main goal: increasing nondirected organ donation.· A fictionalized composite account illustrating some of the potentially harrowing issues raised by the availability of living donation. What if your ex-wife asked you to give her part of your liver? And if you refused, what if she planned to ask your daughter?· A review considering some of the difficult ethical concerns involved in living donation.

What factors affect the decision to donate a kidney to an ailing family member? In a survey study, Swedish living donors cited several different motives, including the desire to help, a sense of self-esteem, and the "self-benefit" from an improvement in their relative's health. However, regardless of their individual motives, all donors reached a central conclusion: that donating a kidney was "the only option" to help their loved one.

This final motive was so important that information on the medical facts of living donation—including the risks to the donor—had little effect. Some donors felt pressured to donate by their family, whether directly or indirectly. The researchers warn medical staff to avoid subjecting potential donors to any coercion, even unconsciously.

A British study explored the psychological, social, and cultural issues raised by living donation. The results suggested that living kidney donors do not regret their decision, and experience a feeling of increased self-esteem afterward. For parents—especially mothers—the decision to donate was unequivocal. But for siblings, the decision became considerably more complex; in some cases, living donation led to conflicts and altered relationships within the family.

Living donation has become an increasingly important alternative to waiting for a cadaver donor organ. Living kidney donation, the most common type of living donor procedure, provides higher success rates than cadaver organ transplantation. Encouraging results have also been achieved with liver lobe donation. In the future, other types of living organ donations may become possible as well. The Editors of Transplantation hope that the articles in the Forum will promote further discussion of the psychological, emotional, and social issues affecting living donation.