Linda Fox of Brooklyn, New York, donated a lobe of her liver to save her husband, whose own liver had failed. The transplant took, and Fox said although recovery from the surgery was no picnic, she would willingly do it again.
Will Maloney, also of Brooklyn, donated a kidney to his brother, who was struggling to survive with the aid of dialysis. The operation was anything but simple, and Maloney suffered significant complications. Worse yet, the transplanted organ quickly failed, and his brother was again in need of a donated kidney, which he eventually received from a deceased donor.
In 2004 and 2005, the number of organ donations from living donors surpassed those from dead donors. And although dead donors are once again more common, many people risk surgery and the loss of an organ to save the lives of people they love - and increasingly of strangers, as well.
In addition to a kidney and lobe of a liver, living donors can give the lobe of a lung and bone marrow. Almost half of all kidney donors in the US are living donors, a total of 6,434 last year. Living donors last year also provided lobes of the liver to 288 recipients and lobes of a lung to five recipients. Transplants between unrelated donors are now highly successful, thanks to improved methods of immune suppression that reduce the need for close tissue matching to prevent rejection.
But many problems can complicate transplants from live donors. It is important that potential donors know about them and take the time to resolve them before deciding whether to go ahead with a donation, which carries the potential for serious physical and emotional risks.
ETHICAL CONCERNS
Robert Truog, professor of medical ethics and anesthesia at the Harvard Medical School, lists three categories of living organ donation: directed donation, to a loved one or friend; non-directed donation, in which the organ goes to the general pool to be transplanted into the recipient at the top of the waiting list; and directed donation to a stranger, in which a donor gives to a specific person with whom there is no emotional connection.
And, Truog added in an essay in The New England Journal of Medicine in August 2005, "each type of donation prompts distinct ethical concerns."
When, as with Fox and Maloney, the donated organ is destined for a loved one or friend, there is the possibility of coercion - intense pressure on the potential donor to risk the surgery, as well as the chance that the transplant will not succeed. For those who do not want to go forward with a living organ donation and say so to the doctors involved, transplant teams are typically willing to provide a reasonable medical excuse to enable the person to bow out gracefully.
But, Truog noted, there are "situations in which people feel compelled to donate regardless of the consequences to themselves." He told of a case in which a child was dying of respiratory failure. Both parents "insisted on donating lobes of their lungs in a desperate but unsuccessful attempt to save her life."
He maintains that in such cases it is not enough to obtain informed consent from the potential donor. Rather, he said, "physicians are obligated to prevent people from making potentially life-threatening sacrifices, unless the chance of success is proportionately large."
In non-directed donations to the general transplant pool, it is important to explore what has motivated the person to make such a sacrifice for an anonymous recipient.
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