All Donations Should Not Be Treated Equally: A Response to Jeffrey Kahn's Commentary

Kahn J. “Making the Most of Strangers' Altruism,” Journal of Law Medicine & Ethics, 30, no. 3 (2002): 446–447.

Ross L.F. , “Should All Living Donors Be Treated Equally?,” Transplantation, 74 (2002): 418–21.

See the transplant services of the Fairview-University Medical Center website, at <http://www.fairviewtransplant.org/livertx.htm> (last visited September 12, 2002).

Hardwig J. , “Should Women Think in Terms of Rights?,” Ethics, 94 (1984): 441–55, at 445–46.

See also Elliott C. , “Doing Harm: Living Organ Donors, Clinical Research and the Tenth Man,” Journal of Medical Ethics, 21 (1995): 91–96.

Ross L.F. “Solid Organ Donation Between Strangers,” Journal of Law, Medicine, & Ethics, 30, no. 3 (2002): 440–445.

Kahn , supra note 1, at 447.

Glannon W. Ross L.F. , “Do Genetic Relationships Create Moral Obligations?,” Cambridge Quarterly of Health Care Ethics, 11 (2002): 153–59, at 155.

Hingorani S. Watkins S.L. , “Dialysis for End-Stage Renal Disease,” Current Opinion in Pediatrics, 12 (2000): 140–45.

Glannon Ross , supra note 8, at 155.

Ross , supra note 2, at 419.

Glannon Ross , supra note 8, at 155–56.

Id. at 156–57.

Kahn , supra note 1, at 447.

Matas A.J. , “Nondirected Donation of Kidneys from Living Donors,” N. Engl. J. Med., 343 (2000): 433–36, at 435.

Kahn , supra note 1, at 447.

Id.

see id. at 303–04 and 388–411.

It may be that we should question this policy for cadaveric organs as well, but I will limit my comments to living donors. I would like to thank Carol Stocking, Ph.D., for pushing me on this issue and Glannon Walter , Ph.D., for helping me to critically examine the ethics raised by this issue.

Kant I. , Groundwork of the Metaphysic of Morals, trans. Paton H.J. (New York: Harper & Row, 1964): at 89;

and The Doctrine of Virtue, trans. Gregor M. (New York: Harper & Row, 1964): at 54.

I thank Goldblatt Ann Dudley J.D.L.L.M. , for suggesting this analogy to me.

See, for example, Ackerman T. , “Donation Dilemmas: Schools Need Cash but Some Cringe at Strings,” The Houston Chronicle, April 2, 1995, at A33;.

Golden T. , “Donations to Universities Sometimes Carry a Price,” The New York Times, Dec. 9, 1996,): at A1; Associated Press.

“Yale Refuses Gay Endowment Offer: AIDS Activist Alleges Homophobia,” St. Louis Post-Dispatch, July 10, 1997, at 02A.

See Veatch , supra note 18, at 388–401.

I write that the obstacle was or should have been understood to be physiologic and not moral, because this was not the case at all transplant centers. Elsewhere, my colleagues and I explore the basis for this policy, which was twofold. First was the belief that the improved transplant survival that was seen with living donors was due to a degree of genetic similarity between the donor and recipient (i.e., matching for minor as well as major histocompatibility antigens) that was not possible with unrelated donors. This was found to be less important than the fact that the organ was from a living person. Second, many transplant programs were also of the belief that only biological family members were properly motivated. The exclusion of all nongenetic relatives failed to distinguish between the emotionally related nongenetic relative (e.g., spouse or close personal friend) and the non-emotionally related stranger, and “suggests a misguided valuation of genetic relationships instead of on relationships grounded in intimacy.”

See Ross L.F. , supra note 2, at 419.

Kahn , supra note 1, at 447.

Id.