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Between Friends: Living Donors

It's a trend that's changing transplant medicine. More and more people are willing to donate a kidney or part of a liver - while they're still alive.

The New World of Transplant Medicine continued...

The human liver is an atlas of tiny blood vessels and vital arteries that must be severed and sealed off or the donor can bleed to death. Marcos likens the surgery to a plumber fixing a leak without turning off the water. The donor must give up at least half of his or her liver, which means surgery can last up to 14 hours. And while the liver apparently fully regenerates in about two weeks, there are other risks. Donors face a 20% chance of a complication. Typically, these will be minor, such as developing an infection or catching a cold while in the hospital. However, 4% may face a serious complication requiring a second surgery, such as hemorrhage or the development of an abscess.

Therefore, there's no question that the surgery could potentially "do harm" to a healthy donor. Do the donors and doctors have the right to agree to take the risk? In today's world -- where medicine promises so much if only organs are available -- bioethicists increasingly say yes.

"There are trade-offs, and people should have the right to weigh the trade-offs," says Arthur Caplan, PhD, a medical ethicist and director for the Center for Bioethics at the University of Pennsylvania. "As long as the donor 'gets it,' they should be allowed to participate in risky things. Doctors are not doing evil by doing small harm."

The bigger question, says Caplan, is whether transplant centers require enough psychological counseling to make sure the donors truly understand the full risks. In his experience, many don't, and on that point, many doctors agree. In the August 10, 2000, issue of The New England Journal of Medicine, editors warned that while a donor may receive the "altruistic satisfaction of having assumed a risk in order to help another person," strict rules are needed to ensure that people aren't pressured into becoming donors and are fully informed of the risks.

Doing a Favor for a Friend

Although Steven accepted Michael's offer before hanging up the phone that fateful day, he worried that his friend didn't fully understand the pain and risks he faced by donating half his liver. He also worried that once Michael understood the risks, he would change his mind. "I didn't want him to say 'I want to do this' and change his mind a month later when we were down to the wire," Steven recalled after the operation.

But Michael knew what he was getting into. His friend, Ken, had given a half of his liver to a woman Ken saw in a TV news report. "I thought, man, that was a damn noble thing to do," Michael says. "I wondered if I would have the courage to do something like that."

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