Solid organ transplantation represents one of the most important achievements in history of medicine. Over the last decades, the increasing number of transplants has not been of the same extent of the number of patients in the waiting lists. Live donation has been implemented in order to reduce the gap between supply and demand. From an ethical standpoint, the donation process from a live donor seems to violate the traditional first rule of medicine—primum non nocere because inevitably exposes healthy persons to a risk in order to benefit another person. In the chapter will be presented the crucial role of ethics and specific ethical issues in the different forms of live donation, such as financial incentives for living donation, reimbursement in unrelated live donation, minor sibling-to-sibling organ donation. The ethical aspects of live donor organ transplantation are continuously evolving; in order to make this strategy more beneficial and lifesaving, everyone involved in the process should make every possible effort with in mind the best interests of the patients.
TopLive Donation: Ethical Standpoint
Since its inception in the clinical practice more than 60 years ago, live donation has raised a wide range of complex ethical issues for all health professionals involved in the process. This chapter summarizes key ethical principles; a detailed description of the theoretical and philosophical background to the subject can be found in several reviews in the literature (Price, 2009; Price, 2000a; plant et al., 2002; Ross et al., 2002; Kahn & Matas, 2002; Truog, 2005). Organ donation by living donors starts as an amazing act of altruism and presents a unique ethical dilemma, in that physicians must pose at risk a healthy person to save or improve the life of a patient. From the donor perspective, the donation process from a live donor seems to violate the traditional first rule of medicine—primum non nocere (above all, do no harm)—because inevitably exposes healthy persons to a risk during the removal of an organ or part of it in order to benefit another person. From the recipient perspective, not only patient survival is markedly prolonged, but also the quality and productivity of life is considerably improved, with decreased cost of health care for the society. For example, the expected survival of a patient with end-stage renal disease treated with kidney transplantation, at 1, 5, 10 years is 20–40% higher than treatment withdialysis. Also, the cost of dialysis is 3 times the cost of kidney transplantation over a 5-year period (Keown, 2001; Eggers, 1998; Hunsicker, 1999; Caplan & Coehlo, 1998). For the above-mentioned reasons, the live donation process has to follow ethically accepted rules and guidelines. The ethical principals include respect for the donor's autonomy, donor selection and full, voluntary, informed consent (Pruett et al., 2006).