Efforts to increase the supply of organs available for transplant can serve the interests of individual patients and the public and are in keeping with physicians’ obligations to promote the welfare of their patients and to support access to care. Although public solicitations for directed donation—that is, for donation to a specific patient—may benefit individual patients, such solicitations have the potential to adversely affect the equitable distribution of organs among patients in need, the efficacy of the transplant system, and trust in the overall system.
Donation of needed organs to specified recipients has long been permitted in organ transplantation. However, solicitation of organs from potential donors who have no pre-existing relationship with the intended recipient remains controversial. Directed donation policies that produce a net gain of organs for transplantation and do not unreasonably disadvantage other transplant candidates are ethically acceptable.
Physicians who participate in soliciting directed donation of organs for transplantation on behalf of their patients should:
- Support ongoing collection of empirical data to monitor the effects of solicitation of directed donations on the availability of organs for transplantation.
- Support the development of evidence-based policies for solicitation of directed donation.
- Ensure that solicitations do not include potentially coercive inducements. Donors should receive no payment beyond reimbursement for travel, lodging, lost wages, and the medical care associated with donation.
- Ensure that prospective donors are fully evaluated for medical and psychosocial suitability by health care professionals who are not part of the transplant team, regardless of any relationship, or lack of relationship, between prospective donor and transplant candidate.
- Refuse to participate in any transplant that he or she believes to be ethically improper and respect the decisions of other health care professionals should they choose not to participate on ethical or moral grounds.
AMA Principles of Medical Ethics: VII, VIII, IX
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