Ethical challenges in live organ donation

Purpose of review: The supply of deceased donor organs continues to fall significantly short of demand. This imbalance has resulted in lengthy waiting times, morbidity, and even death to the patient on the waiting list. In response to this, living donation has become an accepted practice. Recent findings: Among individuals hoping to reduce their waiting times, a variety of approaches have emerged to solicit live, and even deceased, donor organs. Many of these approaches present significant ethical challenges for the transplant community. Use of the media or Internet to solicit directed organ donation increases societal awareness about donation and transplantation; however, the practice is ethically problematic. Summary: The solicitation for the directed donation of deceased donor organs is unethical. With regard to live donor organs, (1) the solicitation for a directed donation of an emotionally unrelated living donor's organ is ethically problematic; (2) the most appropriate approach to living unrelated organ donation is the allocation of these organs to the general pool of patients awaiting transplant, rather than to specific individuals. In this way, conflict of interest is reduced, and altruism is maximized, because the donated organs go to patients who clinically and logistically match at the top of the waiting list.