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Informed Consent Living Donor Research Living Donor Risks

Living Donor Death – Acceptable Risk

I just read a recent research study entitled “Understanding Risk in Living Donor Nephrectomy” by Maples, et al. Cutting through all the academic language, what this really amounts to is – how great of a risk of death will a potential living donor assume for their recipient and does that degree vary depending on the relationship with the recipient and/or the severity of the recipient’s prognosis.

Naturally the biggest limitation of a study like this is that it deals with hypotheticals. Asking a group of living kidney donors if, in hindsight, they would accept a risk of death is, by all accounts, meaningless because they’ve already survived the experience. They can’t donate another kidney, so what’s the point? While making the same inquiry of a group of people who are not in line to be living donors may be more meaningful in that they might, some day, find themselves in that predicament, the odds are, probably not. There is a vast world of difference between pondering a situation and actually facing it head-on.

The results are not surprising, that prospective living donors will assume a ‘greater’ risk of death for a closer relative, or a recipient who is nearer death. What I find notable is that the way the risk was presented also made a significant difference in how it was perceived as acceptable or not by the research subjects.

For example: Risk of Death
Versus: Chance of Survival

39% accepted a ‘risk of death’ greater than 1 in 20
71% accepted a ‘chance of survival’ of 95%

See, words do matter.

The other day I had the national news on the background when they were discussing the prospects of offshore, domestic drilling. A member of the Sierra Club said that statistically, there is one major oil spill per year, which causes who knows how much damage to the environment.

What if, instead of the above scenario (or the transplant center’s favorite ploy – We’ve never lost a donor), prospective living donors and would-be recipients were told the truth – Statistically, one to two living donors die every year.

Would recipients allow their loved one to assume that risk? Would the public demand greater responsibility on the part of the transplant industry?

I say we find out.

Maple NH, Hadjianastassiou V, Jones R, & Mamode N (2010). Understanding risk in living donor nephrectomy. Journal of medical ethics, 36 (3), 142-7 PMID: 20211992

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