Advertisement

Theoretical Medicine and Bioethics

, Volume 22, Issue 4, pp 351–368 | Cite as

Who shall be Allowed to Give? Living Organ Donors and the Concept of Autonomy

  • Nikola Biller-Andorno
  • George J. Agich
  • Karen Doepkens
  • Henning Schauenburg
Article

Abstract

Free and informed consent is generally acknowledged as the legal andethical basis for living organ donation, but assessments of livingdonors are not always an easy matter. Sometimes it is necessary toinvolve psychosomatics or ethics consultation to evaluate a prospectivedonor to make certain that the requirements for a voluntary andautonomous decision are met. The paper focuses on the conceptualquestions underlying this evaluation process. In order to illustrate howdifferent views of autonomy influence the decision if a donor's offer isethically acceptable, three cases are presented – from Germany, theUnited States, and India. Each case features a person with questionabledecision-making capacity who offered to donate a kidney for a siblingwith severe renal insufficiency. Although the normative framework issimilar in the three countries, different or sometimes even contraryarguments for and against accepting the offer were brought forward. Thesubsequent analysis offers two explanations for the differences inargumentation and outcome in spite of the shared reference to autonomyas the guiding principle: (1) Decisions on the acceptability of a livingdonor cannot simply be deducted from the principle of autonomy but needto integrate contextual information; (2) understandings of the wayautonomy should be contextualized have an important influence on theevaluation of individual cases. Conclusion: Analyzing the conceptualassumptions about autonomy and its relationship to contextual factorscan help in working towards more transparent and better justifieddecisions in the assessment of living organ donors.

autonomy clinical ethics decision-making capacity informed consent living organ donation vulnerable donors 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. 1.
    Nicholson ML and Bradley JA. Renal transplantation from living donors. BMJ 1999; 318: 409–410.Google Scholar
  2. 2.
    Daar AS. Use of renal transplants from living donors. BMJ 1999; 318: 1553.Google Scholar
  3. 3.
    Singer PA, Siegler M, Whitington PF, Lantos JD, Emond JC, Thistlethwaite JR and Broelsch CE. Ethics of liver transplantation with living donors. N Engl J Med 1989; 321(9): 620–622.Google Scholar
  4. 4.
    Spital A. Unrelated Living Kidney Donors: An Update of Attitudes and Use among U.S. Transplant Centers. Transplantation 1994; 57(12): 1722–1726.Google Scholar
  5. 5.
    Starkman B. Inter vivos transplantation: The child and dependent adult as donors. Transplantation Proc 1985; 17(6), Suppl. 4: 40–46.Google Scholar
  6. 6.
    Mudur G. Doctors take kidney from patient incapaéle of giving consent. BMJ 1999; 318: 753.Google Scholar
  7. 7.
    Safjan M and Safjan D. Transplantation from living donors who are unaéle to give consent for organ harvesting. Transplantation Proc 1996; 28(6): 3609–3611.Google Scholar
  8. 8.
    Jacoés C, Johnson E, Anderson K, Gillingham K and Matas A. Kidney transplants from living donors: How donation affects family dynamics. Adv Ren Replace Ther 1998; 5(5): 89–97.Google Scholar
  9. 9.
    Johnson EM, Anderson JK, Jacoés C, Suh G, Humar A, Suhr BD, Kerr SR and Matas AJ. Longterm follow-up of living kidney donors: quality of life after donation. Transplantation 1999; 67(5): 717–721.Google Scholar
  10. 10.
    Westlie L, Fauchald P, Talseth T, Jakoésen A and Flatmark A. Quality of life in Norwegian kidney donors. Nephrol Dial Transplant 1993; 8(10): 1146–1150.Google Scholar
  11. 11.
    Bernstein DM and Simmons RG. The adolescent kidney donor: The right to give. Am J Psychiatry 1974; 131: 1338–1342.Google Scholar
  12. 12.
    Gilligan C. In A Different Voice: Psychological Theory and Women's Development. Caméridge, MA: Harvard University Press, 1982.Google Scholar
  13. 13.
    Kittay EF and Meyers DT, eds Women and Moral Theory. Totowa, NJ: Rowan & Littlefield, 1987.Google Scholar
  14. 14.
    Appeléaum PS. Assessing patients’ capacities to consent to treatment. N Engl J Med 1988; 319(25): 1635–1638.Google Scholar
  15. 15.
    Meisel A, Roth LH and Lidz CW. Toward a Model of the Legal Doctrine of Informed Consent. In: Appeléaum PS, Lidz CW and Meisel A, eds. Informed Consent – Legal Theory and Clinical Practice. New York & Oxford: Oxford University Press, 1987, 192–200.Google Scholar
  16. 16.
    Grisso T and Appeléaum PS. Comparison of standards for assessing patients’ capacities to make treatment decisions. Am J Psychiatry 1995; 152(7): 1033–1037.Google Scholar
  17. 17.
    Appeléaum PS and Grisso T. The MacArthur treatment competence Study I: mental illness and consent to treatment. Law Hum Behav 1995; 19(5): 105–126.Google Scholar
  18. 18.
    Grisso T, Appeléaum PS, Mulvey EP and Fletcher K. The MacArthur treatment competence Study II: measures of aéilities to consent to psychiatric and medical treatments. Law Hum Behav 1995; 19(5): 127–148.Google Scholar
  19. 19.
    Grisso T and Appeléaum PS. The MacArthur treatment competence Study III: aéilities of patients to consent to psychiatric and medical treatments. Law Hum Behav 1995; 19(5): 149–174.Google Scholar
  20. 20.
    Faden R and Beauchamp T. A History and Theory of Informed Consent. New York: Oxford University Press, 1986.Google Scholar
  21. 21.
    Roth LH, Meisel A and Lidz CW. Tests of competency to consent to treatment. Am J Psychiatry 1977; 134: 279–284.Google Scholar
  22. 22.
    Siléerfeld M and Checkland D. Faulty judgment, expert opinion, and decision-making capacity. Theor Med Bioethics 1999; 20: 377–393.Google Scholar
  23. 23.
    White BC. Competence to Consent. Washington, DC: Georgetown University Press, 1994.Google Scholar
  24. 24.
    Alderson P and Goodey C. Theories of consent. BMJ 1998; 317: 1313–1315.Google Scholar
  25. 25.
    Agich GJ. Can the patient make treatment decisions? Evaluating decisional capacity. Cleveland Clinic Journal of Medicine 1997; 64(9): 461–464.Google Scholar
  26. 26.
    Drane JF. Competence to Give an Informed Consent. JAMA 1984; 252(7): 925–927.Google Scholar
  27. 27.
    Spike J. What's love got to do with it? The altruistic giving of organs. J Clin Eth 1997; 8(2): 165–170.Google Scholar
  28. 28.
    Mackenzie C and Stoljar N, eds Relational Autonomy. New York & Oxford: Oxford University Press, 2000.Google Scholar
  29. 29.
    Charland LC. Appreciation and emotion: theoretical reflections on the MacArthur treatment study. Kennedy Inst Eth J 1998; 8(4): 359–376.Google Scholar
  30. 30.
    Appeléaum PS. Ought we to require emotional capacity as part of decisional competence? Kennedy Inst Eth J 1998; 8(4): 377–387.Google Scholar
  31. 31.
    Silverman H. The role of emotions in decisional competence, standards of competency and altruistic acts. J Clin Eth 1997; 8(2): 171–175.Google Scholar
  32. 32.
    Rhodes R, Burrows L and Reisman L. Mt. St. Anonymous – The Adolescent Living-Related Donor. HEC Forum 1992; 4(5): 314–323.Google Scholar
  33. 33.
    Klepper H. Incompetent Organ Donors. J Social Philosophy 1994; 25th Anniversary Special Issue: 241–255.Google Scholar
  34. 34.
    Agich GJ. Autonomy and Long Term Care. New York & Oxford: Oxford University Press, 1993: 76–113.Google Scholar
  35. 35.
    Elliott C. Doing harm: living organ donors, clinical research and The Tenth Man. J Med Eth 1995; 21: 91–96.Google Scholar
  36. 36.
    Lamanna MA. Giving and getting: altruism and exchange in transplantation. J Med Human 1997; 18(3): 169–192.Google Scholar
  37. 37.
    Reiter-Theil S. Altruismus mit ethischen Komplikatonen? Zeitschrift für Medizinische Ethik 1999; 45: 139–148.Google Scholar

Copyright information

© Kluwer Academic Publishers 2001

Authors and Affiliations

  • Nikola Biller-Andorno
    • 1
  • George J. Agich
    • 1
  • Karen Doepkens
    • 1
  • Henning Schauenburg
    • 1
  1. 1.Department of Medical Ethics and History of MedicineUniversity of GoettingenGoettingenGermany E-mail

Personalised recommendations