Mueller Paul S, Case Ellen J, Hook C Christopher
Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Transplant Rev (Orlando). 2008 Jul;22(3):200-5. doi: 10.1016/j.trre.2008.04.003. Epub 2008 May 13.
Members of a religious community presented to our institution and offered to be altruistic unrelated living kidney donors en masse. This situation raised a number of ethical concerns related to the situation specifically and to altruistic unrelated living kidney donation in general. Based on our ethical analysis, we made the following conclusions. Altruism is a legitimate motive for living unrelated kidney donation, and altruistic acts can be based legitimately on religious beliefs. Retrieval of kidneys from living donors is generally safe, and altruistic donors may derive benefit from donating (eg, enhanced self-esteem) assuming they are autonomous and free of coercion. Separate teams should evaluate and care for potential donors and recipients to avoid compromising the donor screening process and to ensure potential donors satisfy medical and psychosocial criteria for donation. Indeed, transplant clinicians should not assume that potential unrelated living kidney donors are not susceptible to coercion. In fact, in our situation, coercion was our biggest concern. Appointing a donor's advocate can facilitate donor understanding of the risks, benefits, and alternatives to organ donation and can help discern coercion. Furthermore, an experienced social worker should assess all potential donors and discern if coercion is present; potential donors should be referred to a psychologist or psychiatrist as appropriate. Although concerns regarding allocation were not raised by our specific situation, ethical concerns regarding allocation of kidneys donated by altruistic unrelated kidney donors exist (eg, requesting that such donations be allocated to recipients with specific characteristics).
一个宗教团体的成员来到我们机构，表示愿意集体成为利他性非亲属活体肾捐赠者。这种情况引发了一些与该具体情形以及一般意义上的利他性非亲属活体肾捐赠相关的伦理问题。基于我们的伦理分析，我们得出了以下结论。利他主义是进行非亲属活体肾捐赠的合理动机，利他行为可以合理地基于宗教信仰。从活体捐赠者获取肾脏总体上是安全的，假设利他性捐赠者具有自主性且不受胁迫，他们可能会从捐赠中受益（例如，增强自尊）。应该由不同的团队对潜在捐赠者和受赠者进行评估和护理，以避免损害捐赠者筛查过程，并确保潜在捐赠者符合捐赠的医学和社会心理标准。实际上，移植临床医生不应假定潜在的非亲属活体肾捐赠者不会受到胁迫。事实上，在我们的情形中，胁迫是我们最担心的问题。指定一名捐赠者倡导者有助于捐赠者理解器官捐赠的风险、益处和替代方案，并有助于识别胁迫行为。此外，一名经验丰富的社会工作者应该对所有潜在捐赠者进行评估，识别是否存在胁迫；如有需要，应将潜在捐赠者转介给心理学家或精神科医生。尽管我们的具体情况未引发关于分配的担忧，但对于利他性非亲属肾捐赠者所捐肾脏的分配存在伦理问题（例如，要求将此类捐赠分配给具有特定特征的受赠者）。
