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Ethical Considerations Liver Donor

Living Donor Faux Pas

Recently, a post appeared on a message board from a prospective liver donor whose recipient died before the donor evaluation process could take place. Naturally, what followed were words of condolescence, sympathy and concern.

Then an unrelated kidney donor (meaning, someone who donated a kidney to an individual not emotionally tied to them) posted the following (in part):

You might want to give some thought in the future of possibly donating a kidney… There are SO many people that you have never even heard of whose quality of life could be improved by such a gift. But better to let your emotions settle down a bit before making such a decision.

If you’re not already disturbed, and I hope you are, I’ll explain why this was a wholly inappropriate thing to say.

On a broad level, one simply shouldn’t respond to expressions of vulnerability with suggestions. Women generally accuse men of this – trying to ‘fix’ a problem when a solution was neither wanted or required. Sometimes this occurs because a person simply doesn’t know how to respond to someone else’s emotionality. Other times it’s just an inability to get out of one’s own way.

Remember: anything important enough to be felt as a loss cannot be replaced. One would not tell a new widow, “I’m sorry for your loss. When you’re done grieving, call me because I have someone I’d like to set you up with”. Neither should one think that recipients are interchangable, especially when the original is a relative (uncle) and the alternate is a total stranger.

Here’s where we become situation specific. The overwhelming majority of living donors are blood relatives of their recipients, and the next biggest percentage are emotionally tied (spouse, friend, etc). The smallest chunk are the so-called Altruistic, Stranger, or Anonymous Donors. While the behavior of donating an organ might be the same across both groups, the motivations of Emotionally/Blood Related and Unrelated Donors are quite different.

Related Donors are invested in the well-being of their loved one. Their decision to donate is inextricably tied to that specific person. They are not interested in living donation in theory, or as an exercise, but only as a means of helping the person they care about. An Unrelated Donor, otoh, is attached to the greater concept of ‘saving a life’ via living donation. The act of donating is its own end. Consequently, the recipient of the Unrelated Donor’s organ is relatively (as it pertains to the overall experience) insignificant*.

Consequently, telling a prospective Related Donor that a stranger is as worthy of their beneficence as their loved one has the potential to be incredibly insulting. Unfortunately, if the person offering the suggestion is an Unrelated Donor, it’s quite possible they won’t understand why that’s so.

Which is exactly what happened in this case. When the gaff was pointed out, the Unrelated Donor emphasized the sympathetic portion of their sentiment while refusing to acknowledge the inappropriateness of their (in their mind) well-intentioned suggestion. In fact, they accused the person who brought it up as being anti-living donation. The Unrelated Donor in question should know better on both counts, the original remark and the defensive smear – after all, s/he’s a member of the clergy.

*Some Unrelated Donors will disagree with me on this, but think about it – what’s the difference between one stranger and another? If it’s not one particular single mother profiled in the newspaper, it’s another equally anonymous one on a website. In fact, it’s exactly what Steve Jobs and the proponents of the CA living donor registry are banking on.

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