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Ethical Issues in Living Donor Transplantation

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The inadequate supply of organs is a public health crisis. This research will explore the ethical and policy issues raised by transplantation with living donors. The broad objectives of the project are: 1) to examine the trend from replenishable organs (blood and bone marrow) to one of a paired organ (kidney) to parts of organs (liver, lung and pancreas) and what this means in terms of risk;2) to examine the expanding role of living solid organ donors from genetically related family members to spouses, friends, and now strangers and whether and how this should impact risk-benefit calculations;3) to examine the practice of permitting medically less ideal candidates to serve as living organ donors;4) to examine the evolving demographics of transplant recipients from living donors;5) to examine the evolving role of vulnerable populations as living donors;6) to explore the risks and benefits of immune tolerance research performed on live donor transplants;and 7) to propose policy recommendations that achieve a moral balance between protecting living donors and respecting their autonomy.

The main outcome of the research will be a book that offers a critical ethical analysis of current policies and practices regarding the participation of living persons as organ sources. The book will be entitled: Ethical Issues in Living Donor Transplantation. In part I, I provide a history of organ procurement issues from deceased and living donors and describe the philosophical principles that provide a moral foundation for a critical analysis of specific case studies and classic problems and for affirming current guidelines or recommending revisions. Part II is entitled "Donor Autonomy" and focuses on organ exchanges, strangers as organ donors and when, if ever, should donor autonomy be restricted. I specifically argue against a market for organs from living sources. Part III is entitled "Living Donor Allocation Policies and Practices". It focuses on whether there are or ought to be policies that restrict to whom the potential donor may donate. Part IV is entitled "The Moral Agency of the Transplant Team". I consider issues related to privacy and confidentiality including what should be done when unintended discoveries are made and what explanations should be offered when a donor reneges. I also examine the dual role of the transplant team as physicians and scientists. Specifically, I discuss whether immune tolerance research should focus on transplants with deceased or living donors. Part V is entitled "Vulnerable Populations" and examines the role of race, gender and age in living donor demographics and whether and when prisoners, children and adults who lack decision making capacity should serve as living donors. Part VI provides a methodological consideration of the numerous policy recommendations and revisions that are offered throughout the book to promote the ethical participation of living persons as organ sources.

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