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When a Gift From the Heart Is a Kidney

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"It's a gray area, but I think if you look at it both from an ethics perspective, and perhaps from a basic science perspective, it's not a surprise, and it's something that people have been thinking and talking about for a long time," bioethicist Mary Faith Marshall, PhD, tells WebMD. "I actually have seen it as something inevitable and I don't see it as a bad thing. From a moral perspective I see nothing wrong with [nondirected donation] as long as there are procedural safeguards in place, and especially psychological ones, for the people who are involved." Marshall is director of the Program in Bioethics at Medical University of South Carolina in Charleston.

Levinsky concedes that some would-be donors may indeed have altruistic motives, just as bystanders sometimes rescue complete strangers from perilous situations, and that unrelated donors may not be subject to the same pressures, overt or implicit, that a relative of a critically ill patient might be subject to. But he also points out that the rate of death from an operation to remove a kidney is low. "If 10,000 unrelated kidney donors were recruited each year, three might die, and as many as 1,000 might have various complications."

To prevent solicitation of donations by the medical community, Levinsky suggests applying the same rules that currently govern organ procurement and distribution from people who've died to the harvesting and distribution of nondirected donations. If organs were distributed according to a nationally agreed-upon formula, medical personnel at the institution where the donor surgery is performed would not necessarily expect the donated organ to go to a recipient on their own list. That could eliminate any motives, no matter how unconscious or unintended, for putting the volunteer under pressure to give up a body part.

As controversial as the idea of nondirected donation may be at present, advances that hold promise for the ability to grow new organs in the body or replace them with artificial substitutes, may in the not too distant future make ethical concerns about organ donation obsolete, Marshall tells WebMD.

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