Between a rock and a hard place: the incommensurate ethics of emotionally-related living organ donation

At the end of 2007, over 71,000 candidates in the United States were awaiting a kidney transplant. That same year, 16,622 kidney transplants took place [1]. The growing shortage of organs in the face of escalating need has placed pressure on transplant centers to accept organs from voluntary living donors. Emotionally- related living organ donation (ERLOD) is becoming increasingly common. In ERLOD, donors and recipients are genetically unrelated but linked by close emotional ties. In the case of kidney transplants, ERLOD achieved over 90% success rates after only one year [2]. However, the significant need and efficacy of this practice are not sufficient for its justification; this program must also be ethically acceptable [3]. Living organ donation in general raises concerns regarding the acceptable standards of medical practice and ERLOD in particular poses unique challenges. This article examines, within a clinical care framework, the ethical concerns surrounding ERLOD and why these concerns may be difficult to reconcile from this perspective alone. Discussion may benefit from using the ethical framework of clinical research in adjunction with the clinical care framework to offer a more flexible scope of analysis