Thursday, March 1, 2018

A liver for a kidney?

One consequence of the growth of kidney exchange is that there is more discussion of novel modes of exchange. Here's an article forthcoming in the American Journal of Transplantation that cautiously discusses the ethical issues that would be involved in a kidney-liver exchange.  I found the most interesting of the issues discussed to be those surrounding the excuse that medical teams give to prospective donors who don't really want to donate: they say e.g. that the kidney isn't suitable, or that the donor's kidney function isn't sufficient to allow him/her to donate. So the article discusses how this might pressure a reluctant donor if the question "but how about his/her liver"? could be asked...

The main case being discussed of course is one in which two lives could be saved by an exchange of donors, as in kidney exchange (or liver exchange, as has been employed a bit in Asia...).

(Incidentally, the article is written in the future hypothetical, but I wouldn't be shocked to hear that somewhere in the U.S. one such exchange has already taken place.)

New in the AJT:

A Liver for a kidney: Ethics of trans-organ paired exchange


  • Accepted manuscript online: 
  • DOI: 10.1111/ajt.14690
  • American Journal of Transplantation (forthcoming)
  • Abstract
  • Living donation provides important access to organ transplantation, which is the optimal therapy for patients with end-stage liver or kidney failure. Paired exchanges have facilitated thousands of kidney transplants and enable transplantation when the donor and recipient are incompatible. However, frequently willing and otherwise healthy donors have contraindications to donation of the organ that their recipient needs. Trans-organ paired exchanges would enable a donor associated with a kidney recipient to donate a lobe of liver and a donor associated with a liver recipient to donate a kidney. This paper explores some of the ethical concerns that trans-organ exchange might encounter including unbalanced donor risks, the validity of informed consent, and effects on deceased organ donation.

No comments: