THE ETHICIST : Life Preserver

THE ETHICIST : Life Preserver

By ARIEL KAMINER
Published: June 24, 2011

A few months ago, I signed up to be a living kidney donor to help someone in need who was not related to me. Recently I was told that I was a match for a local 16-year-old. But if I were to enroll in the national kidney registry, my donation could facilitate a donor chain, potentially benefiting 5 or 10 patients. Should I help one person now or several people in the future? It’s hard to say no to a child, yet does the good of the many outweigh the good of the one in this case? BALA AMBATI, SALT LAKE CITY

For those unfamiliar with the term, a bit about donor chains. Imagine your sister needs a kidney transplant; you wish to help her, but tests reveal that you are not a good biological match. Elsewhere, another pair of siblings — or friends, or neighbors — has a similar problem: one needs a kidney, and the other would like to donate but isn’t a good fit. In a donor chain, pairs like this can be linked up in a series. You could give your organ to a stranger, but in the process position your loved one to get a new kidney from some other person along the chain, as soon as a suitable donor is found.

By facilitating these kinds of indirect transfers, the chain can greatly increase the number of people who receive the lifesaving intervention they need.

So it’s true that helping to keep a donor chain going can potentially save many lives. And all things being equal, many is better than one.

But in this case, we are talking about offering up a piece of your body — a piece you are currently using, though it’s part of a matched set — to a stranger. You’re not even doing it to indirectly help a loved one; you’re just doing it because you can. That’s an act of such extraordinary generosity that reducing it to simple arithmetic doesn’t seem to do it justice. For one thing, it doesn’t account for the emotional rewards you might get from watching the 16-year-old grow up.

It’s not merely selfish to consider those rewards. Given how few people donate kidneys and how many people need them, anything — well, almost anything — that makes the process more palatable, for you or anyone else, is probably a good thing. At the same time, you only have one kidney to give. It makes sense that you would want to maximize its impact.

That impact is not so easy to calculate, however. Dr. Bryan Becker, the past president of the National Kidney Foundation, says a transplant would probably extend the life of an otherwise healthy 16-year-old longer than it would an older patient in a donor chain. As to the multiplier effect you’re looking for, there are no guarantees. Between now and the time you donate, a link in that donor chain could break. Insurers could for whatever unpredictable reason decline to participate. With all due respect, you could be run over by a bus.

This is an occasion to follow your heart. Helping several strangers is wonderful, but saving the life of a single child can’t be anything less than ethical.

UPDATE: Ambati gave his kidney to the 16-year-old boy; the donor and recipient are each doing great.

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http://www.nytimes.com/2011/06/26/magazine/the-ethicist-life-preserver.html