Ethical Considerations Living Kidney Donor OPTN

Living Kidney Donor Twist Equals Bioethics Nightmare

Headline: Twist helps kidney donor save dad, husband.


Here’s the summary:

Woman’s husband needs a kidney.

Woman isn’t a match for her husband.

So woman offers to donate anonymously to a stranger on the wait list (whom she does match) so her husband will move to the top of the list.

But before she can donate, her father’s kidneys fail.

Woman wants to give her kidney to her father.

The hospital (University of Maryland) tells the woman she HAS to give to the wait list stranger because her husband had already undergone his kidney transplant.

So she does. But wait – ha ha – the ‘wait list stranger’ turns out to be her father.


Gosh aren’t those transplant folks at the University of Maryland a hoot?


Put yourself in this woman’s place for a minute. Imagine how much anxiety she must’ve felt at the prospect of losing her life partner (and perhaps the father of her children). Think of how much worse it felt when she realized she couldn’t help him.

Is it any wonder she agreed to give her kidney to a stranger? Under those circumstances most people would agree to do any number things, especially if it meant saving* their spouse.


Imagine being this woman again, only now your husband is recovering from his kidney transplant and doing reasonably well. Not out of the proverbial woods by any means, but certainly in better condition than before. But now your father’s kidneys fail. And worse, your dad has a rare blood type that will condemn him to a indefinite wait, meaning that he will most likely die before a kidney is found.

But  – you have the same blood type. And you’ve already been evaluated so you know you can donate. Problem solved, right?

Forget it, says the hospital. You promised US your kidney, and we’ll give it to whomever we want.


So what do you do?

– Tell the hospital to go screw and give the kidney to your father?

– Allow the hospital to give your kidney to a stranger, even if it means your father might die?


Viewed from that perspective, this situation is the opposite of ‘feel good’.


Among other things, Final Rule 2000 required the establishment of committees within OPTN to examine the specific facets of transplant and develop transplant-related policy. According to an individual who served on OPTN in the early 2000s, there once existed a ad-hoc “Solicitation for Organs” committee. When its members wanted to explore the reasons why people solicit for organs (one of which being a ‘distrust in the current system’), transplant surgeon Frank Delmonico and then-UNOS Executive Director Walter Graham eliminated the committee entirely. Not much later, the Northeast Organ Bank, including Delmonico and his transplant center, began utilizing kidney swaps, including the wait list exchange.

The transplant industry concocted this delayed-wait-list-swap situation so that folks on the wait list, any and all folks on the wait list, would have access to more transplants (and not coincidentally, transplant centers would benefit from performing more surgeries). Because the transplant system was designed completely around the needs of the recipient, there was no thought as to how it would affect the people used as the would-be recipients’ treatment. It forgot (again) that living donors are people, and not just medical supply.


University of Maryland held this woman’s kidney (and her autonomy) hostage. They would argue this characterization, of course, citing the original swap obligation. But living donation is supposed to be “free from coercion”. This woman’s husband was dying (or she certainly felt like he might). Such a degree of duress can compromise a person’s decision-making abilities, especially when the decision includes a trade-off for a loved one’s health and well-being. What really happened here is that the transplant center forced this woman to choose between honoring an as-of-yet untested, quasi-legal agreement and saving her father’s life*.

That the scenario played out like a Hollywood script doesn’t negate the ethical quagmire. In fact, that no one at the University of Maryland Medical Center recognized these problems and sent the narrative to the press as promotion for kidney paired donation only makes it worse.

This is not a twist.

This is 50 kinds of awful.





*Kidney transplants in themselves are not lifesaving, because other treatments are available for end-stage renal disease. My use of the phrase is in keeping with this woman’s point of view, and the precariousness of her father’s described condition.

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