Pay it forward and kidney donation chains

Pay it forward and kidney donation chains

Altruism is, of course, a good thing, but altruism tends to have its limits. For instance, some transplant programmes will accept an altruistic kidney donation from a stranger for a stranger, while others will not. We are quite familiar with the “usual” case where a family member, loved one, or even a friend offers a kidney to someone he or she knows and cares for. This type of donation raises its own ethical issues – what for instance would it mean for such a decision to donate to be “free” or uncoerced? But generally we agree that it is a “normal” even desirable thing to do to want to help a family member or friend. These gifts are generous, altruistic and loving, but within the context of family and friendship they are understood. The family ought to be the home of loving, caring and altruistic feelings.

(I can’t just let this piece go at the moment so let’s keep exploring it. I wonder if there are shared expectations here, or if we each have our own, completely idiosyncratic views. Would we (would I) expect a spouse to wish to donate to a spouse? A parent to a child, or a child to a parent? One adult sibling to another, to a cousin – or to my best friend? To what extent would other factors be relevant – the health of the donor, the “worthiness” of the recipient and so on. If you knew that an acquaintance or friend had decided not to donate to his or her spouse – or child, would that change your opinion of the person? If we relate these questions to the health care professional who is counselling or advising someone contemplating donation to what extent do our own values and expectations play a role as we enter that discussion?)

But what about the donation by one stranger to another? How do we understand the offer of a kidney by one human being to another, based purely on the other’s need? As we said at the outset, some programmes would accept that offer, others would not. Why wouldn’t some programmes accept that offer? It is difficult to get programmes to be specific about this issue but I think the reasoning goes something like this. That altruistic gift is just too much. There are risks involved and consequences for the donor. Those risks and consequences make sense in the context of a family where some self-sacrifice might be expected, but they just do not make sense outside of that context. So, either the donor doesn’t really understand what is involved, or there is somehow something “wrong” with wanting to make that offer. (It should, of course be pointed out that there is a strong religious, Christian, tradition of self sacrifice that itself might provide a context for wanting to make the donation. But outside of those religious traditions how do we understand that great a desire to do good for others? And, should those of us who do not feel compelled to offer a kidney to help a stranger feel somehow morally guilty or inadequate?)

So, back to the really neat move that capitalizes on the desire to help the ones we know and love to benefit a broader range of people we do not know. There are a number of transplant centres that are organizing kidney donation chains. The donation chain works from the fact that in some, perhaps many, cases a person in need of a transplant has a willing, but unmatched donor. What would happen if you were ensured that your partner, in need of the kidney, would receive one from a third party if you donated yours to someone else with whom you are matched? So, you give to a stranger, whose donor friend gives to another stranger, whose donor friend gives to another stranger, whose donor friend ultimately donates to your partner. The outcome is that many more kidneys are made available for transplant. It is an elegant and practical method for capitalizing on “ordinary” altruism to reach extraordinary results.

Bravo to all involved.