Children as living organ donors: current views and practice in the United States.
OBJECTIVE
To summarize recent practices and views regarding children as living organ donors in the USA.


RESULTS
Living donors have become an increasingly important source of organs for transplantation. Concern for the rights of donors has resulted in reconsideration of the use of minors as living organ donors. Most commentators have voiced concerns that minors deserve extraordinary protection, but are unwilling to ban the practice of living donation by minors outright. Instead, factors to be considered in individual situations have been enumerated, and safeguards recommended. These same safeguards have also been recommended to be extended to adults, as attainment of legal age does not in itself confer immunity from exploitation. Developmental factors of importance include brain maturation affecting decision making, executive function and impulse control; the dependent status of minors, usually on the persons who may most want them to be donors; youthful idealism and sense of invulnerability; and incomplete identity formation.


CONCLUSIONS
Fewer children in the USA have become living donors in the past decade. Preadolescent children in particular should probably be considered as potential donors only in extraordinary circumstances. Safeguards protect not only children, but transplant physicians, programs and the image of the transplant endeavor.
Olbrisch
Mary E
ME
Departments of Psychiatry and Surgery, Virginia Commonwealth University, Richmond, Virginia 23298-0268, USA. molbrisch@mcvh-vcu.edu
Levenson
James L
JL
Newman
Joel D
JD
D000293:Adolescent; D000367:Age Factors; D000533:Altruism; D001291:Attitude of Health Personnel; D002648:Child; D002651:Child Advocacy / Q000941:ethics / Q000331:legislation & jurisprudence; D032882:Comprehension; D037921:Gift Giving; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007258:Informed Consent; D019520:Living Donors / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology / Q000600:supply & distribution*; D033242:Minors / Q000331:legislation & jurisprudence / Q000523:psychology; D016377:Organ Transplantation / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology; D017410:Practice Guidelines as Topic; D000297:Psychology, Adolescent; D002666:Psychology, Child; D011639:Public Opinion; D014481:United States