More attention urged for living donors

There are few data on risks and long-term effects of living organ donation, raising concerns about the ethics of performing surgery on a healthy person.

By Andis Robeznieks, AMNews staff. Nov. 10, 2003.

Saying that using living organ donors violates the honored principle of "First do no harm," a prominent bioethicist told doctors that the practice is on shaky ethical ground but is worth doing because the benefits can be so great.

"It's a very, very close call ethically," said Arthur Caplan, PhD, chair of the department of medical ethics at the University of Pennsylvania, Philadelphia, speaking at the American College of Surgeons annual meeting in Chicago. "But I think we can manage the practice. I think we should. We owe it to people on the waiting list."

Because there is no health benefit and considerable health risk to living donors, Dr. Caplan said they need to receive more focus in the organ transplant process. He called for a national registry to collect data on the risks and long-term effects of donating kidneys or parts of a lung or liver, better standards on who can donate and safeguards against coercion.

Dr. Caplan also said there is a need for a neutral donor advocate on the transplant team -- someone whose job is not evaluated by the number of potential donors who say yes.

Donors should not be paid, Dr. Caplan said, because it increases the risk that donors would not disclose their own health problems. "When you put money in the mix, safety goes out the window." But, he said, a donor's expenses for travel, time off work, baby-sitting and health care should be covered.