by George Taniwaki

Am I sane enough to donate a kidney? What are the indications that a person should not be allowed to donate? I ask this because I have a psychiatrist consult scheduled for Wednesday (see Feb 2010 blog post).

Recently, I was watching a repeat episode of Law and Order: Criminal Intent in which the suspect is revealed to be a compulsive donor who gave his kidney to a woman who runs a charity. When she later stops working for the charity he becomes angry and shoots her in the head (leaving her brain-dead) so that the kidney can be harvested and given to a more deserving recipient. I believe that type of person should not be allowed to donate a kidney. I want to state categorically that I would never do this. In fact, I can’t imagine this, or even how the screenwriter imagined it.

LawAndOrderCI

The episode entitled Ex Stasis was broadcast in Season 4, Episode 16. Image from NBC

More seriously, the UWMC transplant team wants to ensure that donors are making a rational, informed decision. (I’m all for that. Helping people make good decisions is the goal of the Real Numeracy blog.) All living donors are carefully screened.

But it appears that nondirected donors (also called altruistic donors) are often given tougher screening than related donors, if they are allowed to donate at all. Fewer than half of transplant centers in the U.S. allow nondirected donations. Outside the U.S, nondirected donations are virtually unheard of and heavily discouraged. Some of the stated reasons are the risk that stranger donors are more likely to be coerced into a donation or receive compensation (which is illegal), are more likely to have unrealistic expectations of a positive donation experience, and are more likely to encounter psychological complications after surgery. For instance see Nephr. Transpl.Dialy. 2001.

It’s not clear to me how a donor knowing the recipient reduces the chance of psychological complications. Family members could be coerced by parents or siblings into donating a kidney to save another. They may receive explicit or implicit promises of compensation. And since presumably related donors will continue to have contact with their recipients after surgery, they may feel resentment, depression, or guilt, especially if the kidney fails.

This is not to say that live kidney donations are likely to produce psychological problems for donors. But one shouldn’t assume related or acquaintance donors are less likely to have problems than nondirected donors. For an early description of the possible ethical problems with live organ donations, see this NIH research paper, 1992.

Since nondirected donations are so rare, there are few studies that compare social and psychological outcomes for nondirected donors to directed donors. The only study I found was a survey of 42 stranger donors (stranger donors are still directed) described in Amer. J. Transpl. Jul 2005 (subscription required). It shows stranger donors were more willing to incur the risk of medical complications than related donors, and both groups were more willing than a control group of nondonors. Stranger donors did not differ from related donors in other attitudes, depression, or anxiety.

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