The Ethicist: Kidney Punch

The Ethicist
Kidney Punch
By RANDY COHEN
Published: December 3, 2010

My father-in-law suffers from chronic kidney disease and expects to need a transplant in the not-too-distant future. He does not wish either of his adult children or me to donate a kidney, on the grounds that even in our late 30s, we are too young and might need our other kidney at some point down the road. Instead, he plans to add his name to the recipient list and wait his turn. May we ignore his wishes and anonymously donate a kidney when the time comes? R.B., DENVER

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I admire your determination to help your father-in-law in so profound and self-sacrificing a way, but not your willingness to defy his wishes. He is entitled to handle this as he thinks best. You may discuss the transplant with him using all your powers of persuasion — take acting lessons, hire musicians to accompany your entreaty — but the decision must be his. It would be a terrible thing for him, feeling as he does, if he one day discovered that his improved health came at the expense of one of his children’s or yours.

In the United States, the wait for a donor kidney can be a daunting three years, an understandable spur to your proposed generosity. It is also true that many people live long and healthy lives after donating a kidney. These are potent facts to present to your father-in-law, but not so potent as to justify robbing him of his autonomy.

Incidentally, while directed donation — giving an organ to a particular person — is legal in the United States, you can’t simply put your kidney in a beer cooler, leave it on your father-in-law’s back porch, ring his doorbell and run away. (Nor can you legitimately order one online from those parts of the world where people with money are able to buy organs from people without.) The testing to determine a match, as well as the transplantation itself and follow-up care for donor and recipient, will very likely require the participation of your father-in-law’s doctors, who, like all physicians, are bound by the doctrine of informed consent. Your father-in-law’s doctors would violate medical ethics to so flagrantly disregard a patient’s wishes or abet those who, however altruistically, try to do so.

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