title: The Ethics of Promoting Living Kidney Donation Using Nonargumentative Influence: Applications, Concerns, and Future Directions.
abstract: Recommendations from the 2014 Consensus Conference on Best Practices in Living Kidney Donation reflect increasing attention to overcoming barriers to donation as a means of expanding access to living donor kidney transplantation. "High priority" initiatives include empowering transplant candidates and their loved ones in their search for a living kidney donor. Transplant programs are assuming an unprecedented role as facilitators of patients' solicitation for donors, and nonprofits are promoting living kidney donation (LKD) in the community. New strategies to promote LKD incorporate "nonargumentative" forms of influence (i.e. approaches to shaping behavior that do not attempt to persuade through reason) such as appeals to emotion, messenger effects and social norms. These approaches have raised ethical concerns in other settings but have received little attention in the transplantation literature despite their increasing relevance. Previous work on using nonargumentative influence to shape patient behavior has highlighted implications for (1) the relationship between influencer and influenced and (2) patient autonomy. We argue that using nonargumentative influence to promote LKD is a promising strategy that can be compatible with ethical standards. We also outline potential concerns and solutions to be implemented in practice.
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: M B
authors.initials: MB
authors.lastname: Allen
authors.affiliation: Renal Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA.|Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA.|Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA.
authors.forename: P P
authors.initials: PP
authors.lastname: Reese
mesh_terms: D032921:Consensus; D006801:Humans; D016030:Kidney Transplantation / Q000941:ethics*; D019520:Living Donors; D009392:Nephrectomy; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic / Q000592:standards*; D020858:Tissue and Organ Harvesting / Q000941:ethics*
keywords: clinical decision-making; donors and donation: living; editorial/personal viewpoint; ethics; ethics and public policy; kidney transplantation/nephrology; kidney transplantation: living donor; media and social media; social sciences