Search Results

This chapter considers the special case in which a prisoner seeks to serve as a living donor and what lessons can be learned from human subjects protections for research participants given that both activities are done with the primary goal to benefit third parties. In the federal regulations that codify human subjects protections in the US (45 CFR 46), there are additional protections enumerated for research on prisoners. Current Department of Justice Federal Bureau of Prisons policy allows prisoners to serve as living donors but only for first-degree relatives. This chapter describes what special considerations should be assessed for prisoners to ethically serve as potential living donors using a vulnerabilities approach adapted from the human research subjects protection literature. The donor transplant team (living donor advocacy team) needs both a living donor advocate and a prisoner liaison to ensure that the potential prisoner-donor satisfactorily addresses the vulnerabilities faced by prisoners.

In 1957, three years after the first successful kidney transplant between identical twin brothers, the Supreme Judicial Court in Massachusetts authorized kidney transplantation between three sets of identical twin minors and approved another two dozen living donor transplants involving minor donors over the next twenty years. Today, minors rarely serve as living solid organ donors, and donation by minors is prohibited in much of the world. In this chapter arguments are made to restrict children from serving as living donors except as a last resort. It is also argued that if one embraces the concept of the living donor as patient, then one would not make an exception for living donation by a minor to his or her identical twin sibling.

Acute liver failure (ALF), or fulminant hepatic failure, affects approximately two to three thousand patients (adults and children) annually in the United States and accounts for approximately eight percent of all liver transplants. Liver transplant for ALF is complicated by the fact that many patients who present with ALF spontaneously recover; however, the severe time constraints that ALF poses means that patients with ALF are usually listed for deceased donor liver transplant, and potential living donors begin donor evaluations even before it is known whether a transplant will be necessary. ALF was initially a contraindication to living donor liver transplantation (LDLT) both because of poor outcomes and because of concerns that the living donors did not have adequate time to give an informed and voluntary consent. Results have improved and ALF in now an accepted indication for LDLT. This chapter examines the ethical issues raised by LDLT in the setting of ALF.

This chapter explores whether living donor liver transplant (LDLT) is morally permissible when the candidate is ineligible for a deceased donor liver transplant (DDLT). Two cases are evaluated: a woman with metastatic colorectal cancer (CRC) and a young female liver transplant recipient with a history of multiple suicide attempts who is in acute liver failure due to another intentional drug overdose. Although both women could benefit (gain life years) from liver transplant, neither is deemed eligible for DDLT by their transplant teams because of a short post-transplant life expectancy in the first case and expected poor organ stewardship in the second case. This chapter argues that LDLT is morally permissible in candidates ineligible for DDLT if the living donor provides a voluntary informed consent, knows he or she can withdraw at any time, and understands that the recipient candidate will not be listed for a DDLT should the LDLT fail.

Given the gap between demand and supply, living donation is not going away any time soon. This chapter explores the book’s initial premise that the field of living donor organ transplantation is ethical, even if some specific applications are not, eg pre-mortem organ procurement of an imminently dying patient. Concerns regarding the appropriate moral limits to living solid organ donation by both eminent transplant physicians (Joseph Murray, Felix Rapaport) and the social scientists (Renée Fox, Judith Swazey) embedded in evaluating the practice are explored. This chapter reiterates the book’s primary position: only if living organ donors are regarded as patients in their own right can the moral limits of living solid organ donation be realized and living donors be given the full respect that they deserve.