title: Seriously ill patients as living unspecified kidney donors: rationale and justification.
abstract: BACKGROUND
  Between 2000 and December 2013, 106 live donor nephrectomies from anonymous living-donors were performed at the Erasmus MC Rotterdam; five of the donors (5.4%) had a life-threatening disease. The aim of the present report is to give the rational and justification for this procedure.
  
  
  METHODS
  All five donors underwent the national standard living-donor screening procedure. Additionally, motivation to donate and psychologic stability were assessed by a psychologist using in-depth interview techniques and a psychologic complaints questionnaire. Post-donor nephrectomy follow-up consisted of standard questionnaires and clinical check-ups.
  
  
  RESULTS
  One patient had cerebral and caudal ependymomas, one had severe and progressive emphysema, two had Huntington's disease and one had a grade 2 oligodendroglioma. The psychologic screening revealed genuine motivation, adequate risk perception, and normal sense of reality. No contraindications for donation were found. The five donor nephrectomies made nine kidney transplantations possible. All donors were satisfied with the donation procedure. Three donors died during follow-up (0.6-4.9 years) as a result of their disease.
  
  
  CONCLUSIONS
  In the absence of apparent additional health risks, medical, and psychologic contraindications, we consider it ethically justified to accept an offer from a cognitively competent patient with a life-threatening disease in view of their self-reported satisfaction during follow-up. Although based on a limited number of patients, we conclude that a stricter psychologic screening for seriously ill donors compared to healthy unspecified anonymous donors to unspecified patients is not necessary.
authors.affiliation: 1 Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. 2 Department of Medical Ethics and Philosophy, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. 3 Department of Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. 4 Department of Surgery, division of Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
authors.forename: Yannick S
authors.initials: YS
authors.lastname: Rakké
authors.forename: Willij C
authors.initials: WC
authors.lastname: Zuidema
authors.forename: Medard T
authors.initials: MT
authors.lastname: Hilhorst
authors.forename: Ruud A M
authors.initials: RA
authors.lastname: Erdman
authors.forename: Emma K
authors.initials: EK
authors.lastname: Massey
authors.forename: Michiel G H
authors.initials: MG
authors.lastname: Betjes
authors.forename: Frank J M F
authors.initials: FJ
authors.lastname: Dor
authors.forename: Jan N M
authors.initials: JN
authors.lastname: IJzermans
authors.forename: Willem
authors.initials: W
authors.lastname: Weimar
mesh_terms: D000533:Altruism; D002423:Cause of Death; D003071:Cognition; D046148:Donor Selection / Q000941:ethics; D005260:Female; D037921:Gift Giving; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016030:Kidney Transplantation / Q000941:ethics / Q000379:methods*; D019520:Living Donors / Q000941:ethics / Q000523:psychology / Q000600:supply & distribution*; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009392:Nephrectomy / Q000009:adverse effects / Q000941:ethics; D009426:Netherlands; D011594:Psychometrics; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014836:Volition