Abstract
This paper will present and discuss our conclusions about the ethics of living donation for liver transplant (LDLT) after 8 year of collaboration between our clinical ethics consultation service and liver transplant teams, in the course of which we met with all donor-candidates. We will focus on the results of a follow-up study that was conducted in order to evaluate the long-term consequences for potential donors and to interview them on the ethical aspects of the screening process. This study was conducted from April 2007 to November 2009 and consisted of interviews with donor-candidates, regardless of whether they underwent harvest surgery, at least 1 year after the recipient’s transplant. We explored their views about their own and the recipients’ physical and psychological condition, changes in family and career dynamics, their experience as potential or real donors, and their views about LDLT process in general. Results shed new light on the ethical grounds of LDLT and allow us to envisage new ways of improving the ethical soundness of current procedures and practices. In particular, we argue that the purpose of an ethics committee should be to provide follow-up support for the donors rather than merely to check the freedom of donors’ consent. We also suggest that the recipient’s consent deserves more attention than it currently receives.
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Notes
Kelly (1999) Action research has two basic characteristics: it is “simultaneous” and “integrated”. Action and research proceed together and are integrated insofar as the collected data can enhance the comprehension of the people involved in the decision-making process itself.
One year was considered the minimum amount of time necessary for a subject to gain enough perspective to formulate a clear and untroubled judgment about the procedure.
This is another example of how well candidate donors know what to say in order to be perceived as “good donors.”
They often complained about the burden of traveling to Paris for a hospital stay lasting several weeks, and mentioned having had to buy new pajamas and bathrobes.
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Acknowledgments
Our follow-up study on donors 1 year after transplant, the results of which are reported in this paper, was supported by a grant from the Agence de la Biomedicine. We thank all the members of the transplant teams with whom we collaborated over the years: Olivier Soubrane and Olivier Scatton, of the Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, and Emmanuel Jacquemin, Sophie Branchereau, and Florence Plainguet, of the Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris.
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Fournier, V., Foureur, N. & Rari, E. The ethics of living donation for liver transplant: beyond donor autonomy. Med Health Care and Philos 16, 45–54 (2013). https://doi.org/10.1007/s11019-012-9430-8
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DOI: https://doi.org/10.1007/s11019-012-9430-8