With three people on the kidney transplant list dying in the UK every day, should doctors encourage their patients to put themselves at risk for the benefit of others? Two experts debate the issue on bmj.com today.
Associate Professor Walter Glannon from the University of Calgary argues that, although living kidney donation is relatively safe, "this does not imply that doctors should encourage healthy adults who are their patients to donate a kidney to a stranger."
He points out that "doctors have an obligation of non-maleficence to their patients" and says: "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."
He adds: "There is nothing ethically objectionable about a competent adult initiating this process. But it is ethically objectionable when a doctor initiates it.
Glannon believes that if a patient asks a doctor about living kidney donation, "then the doctor should do no more than provide information about the process in an impartial and unbiased way." But he warns that "encouraging these patients to be living kidney donors violates their obligation not to expose or incline them to a risk of harm."
But Consultant Nephrologist, Antonia Cronin from the MRC Centre for Transplantation at King's College, London believes that encouraging altruistic donation is legitimate and that "living donor kidney transplantation must remain an integral part of the NHS strategy to save lives."
Living donor kidney transplantation has an outstanding record, she writes, and donation to strangers now contributes 3% of the total UK living donor kidney transplant activity. The long term survival of living donors is good, and living donors express high levels of retrospective satisfaction with their decision to donate, she adds.
She acknowledges that doctors do not have a moral obligation to encourage stranger kidney donations, but argues 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 recognising the value of their donation is consistent with the ethos of the NHS, which exists for the common good."
The key point, she concludes, is that "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."