Assignment
Your ethics committee is convened to determine the best course of action for Kim, a healthy woman volunteering to donate a kidney to an unrelated but known recipient. (LURD*) Of ethical concern is the issue of consent to organ donation, noting that donor-informed consent must be "Uncoerced, not paid, fully understands the procedure, is in good health"
*LURD=Living, unrelated renal donor.
Kim is a 31 year-old woman who has expressed a wish to donate a kidney to John, a 30 year-old male patient who has end-stage renal disease from a congenital condition and is now requiring regular dialysis.
Her own health status is good. She has been tissue-typed and found to be a compatible match. She says she is a church acquaintance/friend of John. They have known each other for a while, though she does not describe their relationship as close.
Kim describes herself as a devout Pentecostal Christian. She presents as self-assured, competent, intelligent and compassionate. She states that she firmly believes that donation to John is an idea implanted in her mind by God. She learned of John's medical situation via their pastor's announcements from the pulpit and requests for prayer on John's behalf. She claims that no one asked for donation, that she never before had entertained such a thought, that she does not know anyone who donated an organ and that she had not seen a recent news documentary of LURD between church associates.
According to Kim, when she first approached John he expressed skeptical hesitation but he agreed to evaluation because she said that her reason to donate "is really from God." Kim says that John's family is thrilled. Others in the congregation know about her wish to donate, saying she's "Kim, the one with John's kidney." When asked that the notoriety and recognition may make it more difficult subsequently to say no to kidney donation, Kim understood the issue, but did not anticipate changing her decision.
Kim is divorced and believes that John is about her own age and single also. She has some support from friends from work, but is distanced from her own family. She admits, when asked, to possible romantic aspirations motivating her volunteerism, but maintains that "the idea came clearly from God, not from me." Her expectation after the transplant is that "there would be some bonding, some special relationship" even when understanding that there may be post-transplant recipient-response uncertainty (due to feelings of obligation, guilt, etc.)
Kim is somewhat apprehensive of surgery, but dismisses risks associated with donor nephrectomy (kidney removal): impact on future pregnancy or surgical mortality or morbidity (lingering effects). She has a family history of diabetes. She maintains that whatever happens is "the will of God".
In speaking with John, he is not eager for a close relationship with the donor. He appreciates her offer on the premise that the idea was "of God" but he wants her to know there was nothing he could give in return.
Your committee is convened to consider the best recommendation for Kim regarding her volunteering to be a LURD. Use the attached document to clarify the issues of the case (fill in the box) and come up with your best recommendation.
I. List what further questions you have, ie what information do you still need? Is an expert consultant needed to clarify the issue(s). (eg a legal expert, a community expert
II. Summarize the ethical dilemma(s) to resolve?
III. Describe what various ethical principles (autonomy, beneficence, non-maleficence, justice, and/or dignity) could be used to guide the recommendation to resolve the ethical dilemma(s)
IV. What recommendation options COULD your committee give to resolve the case? Provide details. (these options should be different from what you ultimately decide to recommend-question 5)
V. What IS your committee's recommendation to resolve the case, and why? Provide detalls.
VI. List any remaining concerns for those involved in the case?