Considering Tangible Benefit for Interdependent Donors: Extending a Risk–Benefit Framework in Donor Selection

Abstract

From its infancy, live donor transplantation has operated within a framework of acceptable risk to donors. Such a framework presumes that risks of living donation are experienced by the donor while all benefits are realized by the recipient, creating an inequitable distribution that demands minimization of donor risk. We suggest that this risk-tolerance framework ignores tangible benefits to donor. A previously proposed framework more fully considers potential benefits to the donor and argues that risks and benefits must be balanced. We expand on this approach, and posit that donors sharing a household with and/or caring for a potential transplant patient may realize tangible benefits that are absent in a more distantly related donation (e.g. cousin, non-directed). We term these donors, whose wellbeing is closely tied to their recipient, “interdependent donors.” A flexible risk-benefit model that combines risk assessment with benefits to interdependent donors will contribute to donor evaluation and selection that more accurately reflects what is at stake for donors. In so doing, a risk-benefit framework may allow some donors to accept greater risk in donation decisions.

Offspring living kidney donors should not be ruled out

“…These "interdependent donors" experience tangible benefits from donation because of the improvement in quality of life and well-being of their recipient following transplantation. 5 We continue to strongly recommend that offspring not be ruled out as donors because of their relationship with their recipient. For the fortunate transplant candidate with one or more potential living kidney donors, we suggest continued individualized counseling with the use of LKDPI to compare potential donors and consideration of benefits for the donor as well.…”

Helping More Patients Receive a Living Donor Kidney Transplant

“…She may not understand that many donors benefit from the donation process. For example, her children may take on care responsibilities were she to begin dialysis treatments, which would be relieved were she to receive a transplant (15). In a systematic review of 51 studies describing 5139 donors who were assessed on average 4 years after donation, most donors reported no change or an improved relationship with their recipient, spouse, family members, and nonrecipient children, and some experienced an increase in self-esteem (16).…”

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

“…This can be the case because of the possible benefits donors can derive from helping a loved one to have a better quality of life and because of the interest donors have in limiting the risks of losing someone they care about. 37 Kidney failure is typically marked by a waitlist mortality of 6%-8% per year, with a significantly reduced quality of life. 15,38 This is, in fact, not dissimilar to the liver waitlist mortality and reduction in quality of life, for the patients with a moderate Model for End-Stage Liver Disease (MELD) of 12-17.…”