Ethical dimensions of living donation: experience with living liver donation.
Whereas distributive justice is the most important principle in most aspects of transplantation and the allocation of scarce resources, it is far less of a central principle in directed living liver donation. For living donation, the ethical principals include (1) respect for the donor's autonomy through full, voluntary, informed consent; (2) beneficence; and (3) nonmaleficence. But how do we put these principles into practice? Practical decision making in living liver donation involves 3 fundamental ethical dimensions: (1) need, (2) probability of donor safety, and (3) the chance for good short- and long-term recipient outcomes. These same dimensions exist everywhere, but the size and shape of the "triangle" can vary greatly depending on societal beliefs. Ultimately, the proper balance of ethical equipoise is affected by the dynamics of these 3 dimensions.
Miller
Charles M
CM
Liver Transplantation, Department of General Surgery, The Cleveland Clinic, Cleveland, OH 44195, USA. millerc8@ccf.org
D001208:Asia; D001656:Biliary Atresia / Q000601:surgery; D001675:Bioethics; D002648:Child; D003657:Decision Making; D017408:Guidelines as Topic; D006801:Humans; D007258:Informed Consent; D016031:Liver Transplantation; D019520:Living Donors; D010348:Patient Care Team; D018579:Patient Selection; D026684:Personal Autonomy; D014019:Tissue Donors / Q000600:supply & distribution; D009927:Tissue and Organ Procurement / Q000941:ethics*