Readers Respond
Previously, a reader expressed concerns about a family member who might be coerced into kidney donation. This reader mentioned:
A 22-year-old in my family is going through evaluations to become a living kidney donor for a man he doesn’t know well (a colleague of his stepfather). It seems the stepfather suggested him as the donor, and things moved pretty quickly after that. This young person is kind-hearted but also a bit vulnerable and eager to please. He sees this as a “selfless act,” but I worry that this mindset, along with familial pressure, might be clouding his ability to make an independent decision. Plus, his father, who isn’t well, has told him to “save” the kidney for him — adding another layer of pressure. This situation feels more like him being pulled by various agendas rather than making a free choice. Is there a way to step in responsibly? Or should I just accept this? — Name Withheld
The Ethicist replied:
Transplant programs usually assign an independent advocate to living donors, who also go through a psychosocial evaluation. The fact that this young man is feeling pressured both by his stepfather to donate to a friend and by his father to “save” the kidney for him is something the advocate and evaluators need to be aware of. While it doesn’t mean he can’t consent freely, your concerns aren’t unfounded. Your role isn’t to argue for or against the donation. If you get a chance to talk to him, see if he’s discussed these pressures with the advocate and evaluators. Make sure he knows he can withdraw from the process at any time, and he doesn’t owe anyone an explanation for it.
(Read the full question and answer here.)
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Immediate intervention seems necessary. Talk to the young man, present your perspective, and perhaps accompany him to meet with the donor advocate if he struggles to express his situation. He clearly seems confused and conflicted. Regarding his biological father’s suggestion to “save” the kidney, his father may be aware of his son’s vulnerability and could be using it to counteract the stepfather’s pressure. This might just give the young man a way to refuse the stepfather without further conflict. While I support organ donation, asking a 22-year-old to make such a significant life decision feels premature — especially for the benefit of someone he barely knows. — Mary Jane
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If the potential donor isn’t completely comfortable with the idea of donation, the transplant team can inform everyone that he wasn’t a suitable match. The actual reason — his discomfort — would remain confidential between him and the team. They recognize that potential donors face intense pressure, making it hard to simply say “No, I won’t donate.” — Ann
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Just wanted to relate a personal experience from my family. While most donors do fine with one kidney, this wasn’t the case for my sister, who gave one to a colleague. Due to an undiagnosed condition, her remaining kidney didn’t compensate, and now she’s in kidney failure. Although she underwent extensive testing beforehand, it didn’t uncover the issue, which is rare but important for potential donors to consider. Nobody should feel obligated to donate a kidney. — Dominique
