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Compensated Living Kidney Donation: A Plea for Pragmatism
Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
Uppsala University.
Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
2010 (English)In: HEALTH CARE ANALYSIS, ISSN 1065-3058, Vol. 18, no 1, 85-101 p.Article in journal (Refereed) Published
Abstract [en]

Kidney transplantation is the most efficacious and cost-effective treatment for end-stage renal disease. However, the treatments accessibility is limited by a chronic shortage of transplantable kidneys, resulting in the death of numerous patients worldwide as they wait for a kidney to become available. Despite the implementation of various measures the disparity between supply and needs continues to grow. This paper begins with a look at the current treatment options, including various sources of transplantable kidneys, for end-stage renal disease. We propose, in accordance with others, the introduction of compensated kidney donation as a means of addressing the current shortage. We briefly outline some of the advantages of this proposal, and then turn to examine several of the ethical arguments usually marshaled against it in a bid to demonstrate that this proposal indeed passes the ethics test. Using available data of public opinions on compensated donation, we illustrate that public support for such a program would be adequate enough that we can realistically eliminate the transplant waiting list if compensation is introduced. We urge a pragmatic approach going forward; altruism in living kidney donation is important, but altruism only is an unsuccessful doctrine.

Place, publisher, year, edition, pages
2010. Vol. 18, no 1, 85-101 p.
Keyword [en]
End-stage renal disease, Dialysis, Transplantation, Compensated donation, Ethics, Cost-effectiveness, Public opinions
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-54072DOI: 10.1007/s10728-008-0110-zISI: 000274334600005OAI: diva2:298297
Available from: 2010-02-22 Created: 2010-02-22 Last updated: 2011-10-11
In thesis
1. Just Waiting: Ethical Challenges in Priority Setting Posed by Organ Scarcity in Kidney Transplantation
Open this publication in new window or tab >>Just Waiting: Ethical Challenges in Priority Setting Posed by Organ Scarcity in Kidney Transplantation
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Over the last few decades kidney transplantation has transformed from an experimental treatment to the treatment of choice for end-stage renal disease. Unfortunately, however, the established organ donation models in many countries, relying chiefly on altruism, fail to motivate a sufficient number of donors. As a consequence, many lives which could be saved are lost, and others which can be improved are left to deteriorate.

Dealing with the challenge of scarcity in kidney transplantation requires a dual approach. In the immediate term, we must ensure the fair distribution of kidney transplantation as a scarce medical resource. In the long term, we must find a policy level solution to mitigate the root issue of scarcity. The policy approach promoted in this thesis is the introduction of incentive based organ donation. Fair resource allocation, and incentive based donation are two themes which raise interesting normative questions, and ethical challenges. Each theme corresponds to two paperswhich form the basis for the thesis.

Papers I &II, evaluate fairness in the priority setting processes underpinning access to kidney transplantation; this is done both within Sweden's four transplant centers and the Toronto General Hospital in Canada. The criteria, values, and procedures used in clinical decision-making are analyzed to identify barriers to fairness and how such barriers can be removed.

Papers III and IV, propose incentive based living kidney donation and incentive based deceased donation, respectively, as policy solutions to the organ scarcity. The most frequently raised ethical objections against incentive based models are discussed in a bid to demonstrate the moral permissibility of incentive based organ donation.

The discussion about fairness, and incentive based models, highlights that the ethical challenges raised by kidney scarcity are inherently difficult. While we may not find infallible solutions we certainly can work towards better solutions. We can create clinical priority setting processes, that while not perfect, move us closer towards increased fairness by removing clear obstacles to just distribution. We can create organ donation policies while not free of ethical challenges; do not shy away from all risk, or from asking the difficult questions.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2011. 87 p.
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 544Linköping Dissertations on Health and Society, ISSN 1651-1646 ; 20
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
urn:nbn:se:liu:diva-71197 (URN)978-91-7393-068-0 (ISBN)
Public defence
2011-09-29, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Available from: 2011-10-11 Created: 2011-10-05 Last updated: 2012-10-18Bibliographically approved

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