title: Should gratitude be a requirement for access to live organ donation?
abstract: Gratitude is both expected and problematic in live organ donation. Are there grounds to require it, and to forbid access to live donor transplantation to a recipient who fails to signal that he feels any form of gratitude? Recipient gratitude is not currently required for organ donation, but it is expected and may be a moral requirement. Despite this, we argue that making it a condition for live organ transplantation would be unjustified. It would constitute a problematic and disproportionate punishment for perceived immoral behaviour on the part of the recipient. It would also bar the donor from positive aspects of organ donation that remain even in the absence of recipient gratitude. A potential recipient's lack of gratitude should be explored as a possible symptom of other morally problematic issues and integrated into the information provided to the potential donor. Recognition of the donor's gift and gratitude for it may also need to be expressed in part by others. This last aspect is relevant even in cases where the recipient feels and expresses gratitude.
authors.affiliation: Clinical Ethics Council, Geneva University Hospitals, Geneva, Switzerland.|Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Monica
authors.initials: M
authors.lastname: Escher
authors.affiliation: Clinical Ethics Council, Geneva University Hospitals, Geneva, Switzerland.|Gynecology and obstetrics department, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Monique
authors.initials: M
authors.lastname: Lamuela-Naulin
authors.affiliation: Clinical Ethics Council, Geneva University Hospitals, Geneva, Switzerland.|Direction of care, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Catherine
authors.initials: C
authors.lastname: Bollondi
authors.affiliation: Clinical Ethics Council, Geneva University Hospitals, Geneva, Switzerland.|External affairs directorate, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Paola
authors.initials: P
authors.lastname: Flores Menendez
authors.affiliation: Clinical Ethics Council, Geneva University Hospitals, Geneva, Switzerland.|Institute for Ethics, History, and the Humanities, Geneva University Medical School, Switzerland.
authors.forename: Samia A
authors.initials: SA
authors.lastname: Hurst
mesh_terms: D003142:Communication; D004644:Emotions / Q000941:ethics*; D037921:Gift Giving; D006801:Humans; D007258:Informed Consent; D016030:Kidney Transplantation / Q000941:ethics / Q000523:psychology*; D019520:Living Donors; D028681:Moral Obligations; D009927:Tissue and Organ Procurement / Q000941:ethics*; D066027:Transplant Recipients / Q000523:psychology
keywords: Clinical Ethics; Donation/Procurement of Organs/Tissues; Informed Consent; Kidneys; Transplantation