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Organ Donors: The Ethics of Living Organ Donation

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Most living organ donors have a relationship with the person who needs a transplant. They are family, friends, or members of the same community. Some, however, are strangers. They volunteer to donate for altruistic reasons. When the first such “stranger donors” volunteered to give a kidney to someone they didn’t know, doctors were suspicious. They referred these altruists to psychiatrists, assuming that they must be crazy. Most, it turned out, were not.

Over the last few decades, the number of “stranger donors” has steadily increased. Many transplant centers now encourage kidney patients who need a transplant to expand their donor search to the general community. They note that donation is considered low risk, especially if potential donors are carefully screened for potential medical and psychological problems. But even as transplant centers are increasingly embracing altruistic donors, they have enacted policies and procedures that make it very difficult to donate. This book is about the journey of one such “stranger donor.” 

This book is about the journey of one such “stranger donor.” 

In Kidney to Share, Martha Gershun tells the story of her decision to donate a kidney to a woman she read about in the newspaper. The book takes readers through the arduous vetting process that Gershun went through so doctors could be satisfied she was physically and psychologically fit to undergo major surgery and continue a healthy life with only one kidney. The process was frustrating, expensive, and intrusive. The transplant center requested records from her therapist. They worried Gershun had substance abuse problems because she disclosed occasionally smoking recreational pot (in a state where it was legal). They required multiple trips from her home town to the transplant center, six hours away. 

Despite these barriers Gershun persisted, ultimately donating a kidney that saved the life of her recipient. It was one of the most meaningful experiences of her life. She wondered why it had to be so hard.

Despite these barriers Gershun persisted, ultimately donating a kidney that saved the life of her recipient. 

Lantos, a physician and bioethicist, places Gershun’s story in the larger context of the history of kidney transplantation and the ethical controversies that surround living donors. He outlines the discoveries that made transplantation relatively safe and effective as well as the legal, ethical, and economic policies that make it feasible. He explores the steps involved in recovering and allocating organs and analyzes the differences that arise depending on whether the organ comes from a living donor or one who has died.

Kidney to Share provides an account of organ donation that is both personal and analytical. The combination of perspectives leads to a profound and compelling exploration of a largely opaque practice. Gershun and Lantos make important recommendations to ease the barriers facing living organ donors. In the process they ask us to consider just how far society should go in using one person’s healthy body parts in order to save another person.

We need more organ donors. There are nearly 100,000 people in the United States on the waiting list for a kidney transplant. Every day, thirteen of these patients will die waiting. Their best hope is for a living donor to step up to donate a kidney.

Every day, thirteen of these patients will die waiting. Their best hope is for a living donor to step up to donate a kidney.

In the face of this compelling need, we would expect the medical community to openly embrace the altruism of prospective organ donors and make it as easy as possible for them to offer this ultimate gift of life. As this book shows, that is not the case. On the contrary, transplant centers have policies and procedures that create medical, financial, and psychosocial barriers that delay—or derail—the efforts of prospective donors to save the lives of family members, friends, and strangers.

Gershun and Lantos offer policy recommendations that could help eliminate these barriers—saving lives and allowing more people the great gift of becoming altruistic organ donors.

Featured photo: Painting of hands. Credit: Tim Mossholder.

Cover image of Kidney to Share.
Read more about this book.

Martha Gershun is the former Executive Director of Jackson County CASA (Court Appointed Special Advocates). She is author of Care & Custody, and her work has appeared in The Kansas City StarThe New York Times MagazineKveller, and The Radcliffe Quarterly. Follow her on Twitter @mgershun.

John D. Lantos, MD, is Director of the Bioethics Center at Children’s Mercy Hospital and Professor of Pediatrics at the University of Missouri Kansas City School of Medicine. His books include Do We Still Need DoctorsNeonatal Bioethics, and Controversial Bodies. He is Associate Editor of American Journal of BioethicsPerspectives in Biology and Medicine, and Current Problems in Pediatrics and Adolescent Health Care. Follow him on Twitter @johnlantos.

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