Yesterday on bmj.com two professionals debate whether doctors should encourage their patients to donate a kidney for the benefit of a stranger. Each day in the UK three individuals on the kidney transplant list die. Even though living kidney donation is relatively safe, Associate Professor Walter Glannon from the University of Calgary stresses "this does not imply that doctors should encourage healthy adults who are their patients to donate a kidney to a stranger."
"Doctors have an obligation of non-maleficence to their patients. It is one thing for a doctor to expose a patient to some risk in order to treat a disease; it is quite another to encourage a patient to put his or her own physical health at risk in order to benefit another.
There is nothing ethically objectionable about a competent adult initiating this process. But it is ethically objectionable when a doctor initiates it."
According to Glannon, if a patient inquires about living kidney donation to their doctor, "then the doctor should do no more than provide information about the process in an impartial and unbiased way." However, Glannon warns that "encouraging these patients to be living kidney donors violates their obligation not to expose or incline them to a risk of harm."
Although, according to Antonia Cronin, a Consultant Nephrologist from the MRC Center for Transplantation at King's College, London, it is legitimate to encourage altruistic donation. Cronin explains that: "living donor kidney transplantation must remain an integral part of the NHS strategy to save lives."
Cronin states that living donor kidney transplantation has an excellent record and that 3% of the total UK living donor kidney transplant activity comes from donation to strangers. Living donors have a good long term survival rate and express high levels of retrospective satisfaction regarding their decision to donate a kidney.
Although Cronin acknowledges that doctors do not have a moral obligation to encourage their patients to donate to a stranger, she stresses that:
"Encouraging healthy competent adults to voluntarily donate one of their kidneys for the benefit of another by providing them with adequate information about the process involved and recognizing the value of their donation is consistent with the ethos of the NHS, which exists for the common good."
Cronin concludes that the key point is:
"If something is not only not wrong to do but actually a good thing to do, then it cannot be wrong to encourage the doing of it."
Written by Grace Rattue