Related and unrelated living donor transplantation
KeywordsLiving Donor Transplantation Donor Transplantation Living Donor Kidney Living Donor Kidney Transplantation Related Living Donor
Living donor transplantation has been performed for 50 years. There is nearly unanimous consent that related living donor transplantation is ethical provided that the donation is based on a free decision of the donor and that no somatic or psychosocial harm is done to the donor. It is of note however that the percentage of related living donor transplantation varies between countries. Whereas more than 50% of renal transplantation in children in the US is based on related living donation the respective percentage in Europe is below 25%. This difference may reflect a difference in information but also in ethical standards and acceptance in the various societies.
Unrelated living donor kidney transplantation was one of the main topics at the last Annual Meeting of the European Society of Pediatric Nephrology. In this issue, four articles are published on related and unrelated living donor transplantation in children [1, 2, 3, 4]. The articles cover a wide spectrum of aspects from responsible psychosocial care for the donor to the question of commercial transplantation in desperate situations. It becomes clear that “legal” is not congruent with “ethical” and also that ethical standards vary widely from one place to another. Commercial interest as a primary incentive to perform transplantations is condemned everywhere. On the other hand ethical regulations of living donor transplantation cannot be transferred from one society to another without adjustment. As Dr. Hoyer  pointed out, a written regulation for living donor transplantation is the prerequisite for a respectful discussion inside and outside the individual societies. Ethical agreements and standards are not invariable because the ethical consensus may change with time. In Israel for instance, unrelated transplantation with compensation for the donor is not allowed. There is however, an ongoing discussion whether this law and ethical standard should be changed .
The publication of the four contributions does not aim to provide the readership with ethical or practical solutions but to provide information on different ethical viewpoints and practical handlings of this complex problem.