An ethical analysis of online sharing to prompt tissue donation.
Our research will identify and explore issues that arise from establishing an on-line relationship of sufficient trust and empathy to result in an ‘altruistic’ living kidney donation. It will suggest and discuss the principles that should govern this practice. It will then relate these to other possible avenues for on-line sharing, including the forming of on-line relationships for the purpose of tissue donation in other contexts.
Organs may be donated by living as well as deceased donors. Most living donors are family members of the recipient, or friends of longstanding. Occasionally people donate to strangers. Typically such donors donate into the general donor pool. The gifted organs – usually only kidneys – are allocated according to the same principles as deceased donation. It is rare for the donor and recipient to learn the identity of the other.
Clinicians increasingly have been asked to perform transplants from donors whom recipients have met on-line, on sites set up – sometimes on a commercial basis – for the purpose of matching willing donors to those in need of a transplant. Trade in organs is illegal in the UK. Here regulations permit transplants to proceed only where the two parties have met on a strictly not-for-profit site. Nonetheless, such ‘on-line pairings’ challenge the understanding of altruism traditionally used in transplantation.
Such arrangements disrupt existing allocations models, which are supposed to ensure that organs are distributed effectively and fairly. But then so too do other forms of living donation – like that which takes place between family members. So perhaps the pertinent issue is whether they extend what it means to be ‘in a relationship’ in ways that are unsettling given the risks associated with live donation.
Programme of work
This will include, but will not be limited to, the ways in which this kind of on-line sharing:
- Improves our understanding of the relationship between trust and sharing on-line, and the ethics of on-line sharing. For instance, where do we draw the line between reasonable expectations about what needs to be shared to motivate donors to give to specific individuals and gratuitous or exploitative demands for over-sharing? Is mutual trust sufficient to protect both sides?
- Impacts on existing allocation models. Do opportunities for on-line sharing dangerously undermine impartial but ‘top down’ forms of allocation, or do they represent a ‘bottom up’ response to scarcity that empowers potential donors and recipients and engenders resilience. Would officially sanctioned and maintained on-line sharing sites work for or against individual resilience?
- May erode trust and supportive on- and off-line sharing relationships between individuals waiting for transplantation. Using empathy on-line to attract potential donors introduces direct competition between potential recipients. This may result in distrust and the formations of an ‘underclass’ of potential recipients. It may disadvantage:
- stigmatised groups;
- those who do not have the resources (widely conceived e.g. not limited to access to on-line facilities but for instance dependent children or other characteristics that may attract a potential donor);
- anyone who is unwilling to share private information.
To what extent should considerations such as these affect our attitudes to and public policy about donation pairing on-line? How can emotion be understood as a form of currency to be fairly allocated?
- Can be extended to other forms of tissue donation and other forms sharing being explored by our partners.