Transparent Vessels?: What Organ Donors Should Be Allowed to Know about Their Recipients

In my example, the donor is female and the recipient is male, and for clarity, I will refer to the generic donor as female and the generic recipient as male. While the points of the paper obviously apply to donors and recipients of either gender, my choice is not random: about 60 percent of live donors are female, and about 60 percent of recipients of live donations are male. See Organ Procurement and Transplant Network (OPTN), OPTN/SRTR Annual Report 2010, at Tables 2.9, 5.4d available at <http://srtr.transplant.hrsa.gov/> (last visited February 22, 2013).

Live Organ Donors Consensus Group, “Consensus Statement on the Live Organ Donor,” JAMA 284, no. 22 (2000): 2919–2926, at 2920.

Segev D. L. Muzaale A. D. Abimereki D. Caffo B. S. Mehta S. H. Singer A. L. Taranto A. S. E. McBride M. A. , and Montgomery R. A. , “Perioperative Mortality and Long-term Survival Following Live Kidney Donation,” JAMA 303, no.10 (2010): 959–966, at 965.

Ibrahim H. N. Foley R. Tan L. P. Rogers T. Bailey R. F. Guo H. Gross C. R. , and Matas A. J. , “Long Term Consequences of Kidney Donation,” New England Journal of Medicine 360, no. 5 (2009): 459–469; and Morgan B. R. and Ibrahim H. N. , “Long-Term Outcomes of Kidney Donations,” Current Opinion in Nephrology and Hypertension 20, no. 6 (2011): 605–609; Lentine K. L. and Patel A. , “Risks and Outcomes of Living Donations,” Advances in Chronic Kidney Disease 19, no. 4 (2012): 220–228.

For simplicity's sake, I will limit the discussion to kidney donations. Most of the discussion will apply to other live donations as well. However, the risks involved in other donations are often higher. So, for example, the risk of death for liver donors is 17 per 10,000. See Muzaale A. D. Dagher N. N. Montgomery R. A. Taranto S. E. McBride M. A. , and Segev D. L. , “Estimates of Early Death, Acute Liver Failure, and Long-term Mortality among Live Liver Donors,” Gastroenterology 142, no. 2 (2012): 273–280.

See Live Organ Group, supra note 2.

Ad Hoc Clinical Practice Guidelines Subcommittee of the Patient Care and Education Committee of the American Society of Transplant Physicians, “The Evaluation of Living Renal Transplant Donors: Clinical Practice Guidelines,” Journal of the American Society of Nephrology 7, no. 11 (1996): 2288–2313, at 2305–2306 and 2302–2303. See also Organ Procurement and Transplant Network, “Proposal to Establish Requirements for the Medical Evaluation of Living Kidney Donors,” available at <http://optn.transplant.hrsa.gov/PublicComment/pubcommentPropSub_295.pdf> (last visited February 23, 2013).

Dew M. A. Jacobs C. L. Jowsey S. G. Hanto R. Miller C. , and Delmonico F. L. , “Guidelines for the Psychosocial Evaluation of Living Unrelated Kidney Donors in the United States,” American Journal of Transplantation 7, no. 5 (2007): 1047–1054; Lentine K. L. Schnitzler M. A. Xiao H. Axelrod D. Davis C. L. McCabe M. Brennan D. C. Leander S. Garg A. X. , and Waterman A. D. , “Depression Diagnoses after Living Kidney Donation: Linking U.S. Registry Data and Administrative Claims,” Transplantation 94, no. 1 (2012): 77–83.

Ross L. F. Glannon W. Josephson M. A. , and Thistlethwaite J. R. Jr. , “Should All Living Donors Be Treated Equally?” Transplantation 74, no. 3 (2002): 418–426.

See OPTN, supra note 1, at Tables 5.8cd, 5.10cd.

See Live Organ Donors, supra note 2; Steinman T. Becker B. Frost A. Olthoff K. Smart F. Suki W. , and Wilkinson A. , “Guidelines for the Referral and Management of Patients Eligible for Solid Organ Transplantation,” Transplantation 71, no. 9 (2001): 1189–1204.

These examples are all relatively clear, but many more are not. However, we might think that some quality of life issues may be important. So, we might be inclined to transplant a parent of young children, even though that parent is likely to live only two years, on the grounds that the time spent with his children will be greatly valuable both to himself and to his children.

In addition, some of the issues here demonstrate the real disparities between the poor and the rich in the transplant system. Many of the disadvantaged have a history of poor medical compliance because they lack the resources – both financial and social – to follow a complicated regimen. Indeed, the most disadvantaged may have few friends or relations who can help see them through the transplant process, and for that reason, they may be unlikely to do well with a transplant.

See Steinman , supra note 10 at 1193.

Formica R. Asch W. Wagner K. , and Kulkarni S. , “Kidney Transplantation and HIV: Does Recipient Privacy Outweigh the Donor's Right to Information?” Clinical Journal of the American Society of Nephrology 5, no. 5 (2010): 924–928; Bright P. D. and Nutt J. , “The Ethics Surrounding HIV, Kidney Donation, and Patient Confidentiality,” Journal of Medical Ethics 35, no. 4 (2009): 270–271.

Dunn T. B. Browne B. J. Gillingham K. J. Kandaswamy T. Human A. Payne W. D. Sutherland D. E. R. , and Matas A. J. , “Selective Retransplant after Graft Loss to Nonadherence: Success with a Second Chance,” American Journal of Transplantation 9, no. 6 (2009): 1337–1346.

See Ad Hoc Subcommittee, supra note 6, at 2302–2303 and 2298; OPTN, supra note 6.

See Elliott C. , “What's Wrong with Living Heart Transplantation?” in A Philosophical Disease (New York: Routledge, 1999): 103–120, at 105–106.

Magee J. C. Barr M. L. Bassadonna G. P. Johnson M. R. Mahadevan S. McBride M. A. Schaubel D. E. , and Leichtman A. B. , “Repeat Organ Transplantation in the United States, 1996–2005” American Journal of Transplantation 7, no. s1 (2007): 1424–1433; and Rao P. S. and Ojo A. , “Organ Retransplantation in the United States: Trends and Implications,” Clinical Transplants (2008): 57–67. But see Barocci S. Valenta U. Fontan Tagliamacco A. Santori G. Mossa M. Ferrari E. Trovatello G. Centore C. Lorenzi S. Rolla D. , and Nocera A. , “Long-Term Outcome on Kidney Retransplantation: A Review of 100 Cases from a Single Center,” Transplantation Proceedings 41, no. 4 (2009): 1156–1158.

See OPTN, supra note 1, at Table 5.10d.

See Live Organ Group, supra note 2, at 2920.

Id., at 2925 (emphasis added).

The percentage of potential recipients who thought donors should have this information is, in every case, higher than those of potential donors. For HIV status, 58 percent of potential donors and 67 percent of potential recipients thought the donor should be told. For loss of organ due to noncompliance, 75 percent of potential donors and 84 percent of potential recipients thought the donor should know. Rodrigue J. R. Ladin K. Pavlakis M. , and Mandelbrot D. A. , “Disclosing Recipient Information to Potential Living Donors: Preferences of Donors and Recipients, Before and After Surgery,” American Journal of Transplantation 11, no. 6 (2011): 1270–1278, at 1274.

An average of about 21 people die each year in skydiving accidents in the U.S., 6.7 deaths for every 10,000 skydivers, while an average of less than two people died each year from kidney donations, 3.1 deaths for every 10,000 donations. See United States Parachute Association, “Skydiving Safety,” available at <http://www.uspa.org/AboutSkydiving/SkydivingSafety/tabid/526/Default.aspx> (last visited February 22, 2013) and Segev , supra note 3, at 965.

Scheper-Hughes N. , “The Tyranny of the Gift: Sacrificial Violence in Living Donor Transplants,” American Journal of Transplantation 7, no. 3 (2007): 507–11.

See Dew , supra note 7; Levy N. B. , “Psychological Aspects of Renal Transplantation,” Psychosomatics 35, no. 5 (1994): 427–433.

See Elliott , supra note 15, at 118–1119.

See Magee , supra note 16; Rao and Ojo , supra note 16; Barocci , supra note 16.

Stock P. G. Barin B. Murphy B. Hanto D. Diego J. M. Light J. Davis C. Blumberg E. Simon D. Subramanian A. Millis J. M. Lyon G. M. Brayman K. Slakey D. Shapiro R. Melancon J. Jacobson J. M. Stosor V. Olson J. L. Stablein D. M. , and Roland M. E. , “Outcomes of Kidney Transplantation in HIV-Infected Patients,” New England Journal of Medicine 363, no. 21 (2010): 2004–2014, at 2008; and Locke J. E. Montgomery R. A. Warren D. S. Subramanian A. , and Segev D. L. , “Renal Transplants in HIV-Positive Patients: Long-Term Outcomes and Risk Factors for Graft Loss,” Archives of Surgery 144, no. 1 (2009): 83–86.

See Stock , supra note 26, at 2012; Locke , supra note 26.

See Rodrigue , supra note 20, at 1274.

See Bright and Nott , supra note 13, at 271.

The Washington Post/Kaiser Family Foundation, 2012 Survey of Americans on HIV/AIDS, available at <http://www.kff.org/kaiserpolls/upload/8334-T.pdf> (last visited February 22, 2013).

See Dunn , supra note 13, at 1345. An unfortunate truth is that many cases of non-adherence are related to problems that the recipients have paying for the immunosuppressant drugs and to the difficulties they have in maintaining such a regimen. See Evans R. W. Applegate W. H. Briscoe D. M. Cohen D. J. Rorick C. C. Murphy B. T. , and Madse J. C. , “Cost-Related Immunosuppressive Medication Nonadherence among Kidney Transplant Recipients,” Clinical Journal of the American Society of Nephrology 5, no. 12 (2010): 2323–2328); Dobbels F. Van Damme-Lombaert R. Vanhaecke J. , and De Geest S. , “Growing Pains: Non-adherence with the Immunosuppressive Regimen in Adolescent Transplant Patients,” Pediatric Transplantation 9, no. 3 (2005): 381–390. Such problems point to another significant disparity between rich and poor in the transplant system. However, the data available are not detailed enough to determine if such patients are more or less likely to lose a second transplant than other non-adherent recipients.

See Dunn , supra note 13, at 1341.

Id., at 1345.

See Rodrigue , supra note 20, at 1274.