Serial Living Solid Organ Donation: An Ethical Analysis

Introduction

It is possible in many countries to not only become a living solid organ donor, but to become a serial living solid organ donor, a process in which an individual subsequently donates a liver lobe after donating a kidney, or vice versa. The major ethical issues that surround uncompensated living single solid organ donation (the doctor's duties to respect autonomy, of beneficence, and of non-maleficence) have been well described, and this process is generally considered ethically permissible if the donor has sufficient health, and if their decision is voluntary, fully informed, and made in the absence of coercion. However, the landscape of ethical issues pertaining to serial living solid organ donation has so far gone unexamined.

Methods

This paper conducts an ethical analysis, using the ethical framework of Principlism, of the ethical issues that surround serial living solid organ donation.

Findings

Serial living solid organ donation not only repeats the ethical issues that pertain to single organ donation, but also compounds some of them. Respect for autonomy in serial donation is challenged by uncertainty of the long-term risks of serial donation, and serial donors potentially face an increased risk of coercion from those in need of an organ and other third parties. The removal of a second healthy organ in serial donation poses greater risk to non-maleficence than single organ donation because the enduring effects of the previous surgery increase surgical risk. The effect of serial donation on beneficence is currently unknown. Serial donation also generates the potentially novel ethical issue of the donation being motivated by pathological altruism (the act thereby being inspired by selfish concerns), which threatens autonomy, non-maleficence, and beneficence.

Discussion

Research is required to understand the long-term risks to physical health and psychological wellbeing of serial donation to promote autonomy, non-maleficence, and beneficence. Additionally, the understanding of pathological altruism as a motivating factor for living organ donation should be increased, and the psychological assessment of potential living donors should be vigilant to detect this motivation.