Dear Etty, 

A friend from college called about getting together.  We have not been in touch for over twenty years.  When our families met for dinner, he surprised me by asking that I consider donating a kidney to him.  He explained that he is asking everyone he knows to undergo compatibility screening.  In making this decision, how do I take into account our ethical culture belief that our commitment is to the worth and dignity of the individual and to treating each human being to bring out the best in her or him? 

Contemplating Request 

Dear CR, 

I am sure you would have preferred having your old college friend tell you about his situation when he first contacted you.  If you believe that your friend acted less than ethically toward you, does that relieve you of responsibility to act ethically toward him?  Ethical action does not have an ‘on and off switch’ dependent on another person’s behavior.  Rather, your friend’s behavior raises issues involving honesty and trust.  However, your question asks about an ethical approach for making your decision about whether to contribute a kidney. 

Most transplant websites explain that when considering whether to become an organ donor, the only right decision is the one that makes the donor feel comfortable.  These sites also make clear that while complications involving kidney transplants are low, infection from the operation and future injury to your remaining kidney is possible.  There are also financial considerations, such as the cost of the operation, the possible affect on your life insurance and health insurance, and lost wages while you are recovering.   Despite these inhibitions, many people donate organs because they can’t bear to see someone about whom they care deeply suffer.  Other people seem to act from sheer altruism by donating an organ to a stranger.

I believe an ethical approach in deciding whether to donate a kidney would be based on (1) your feelings, and (2) what needs would be satisfied (or be dissatisfied) by donating a kidney.  For example, donating a kidney may meet your needs for interdependence (nurturing, love, and empathy) and integrity (self-worth, meaning, and authenticity), but leave you discontented regarding your need for safety (security and comfort).  Specifically, would your friend’s death due to his inability to locate a kidney be devastating to you?  Would donating a kidney satisfy your need to feel close to your friend, or, in other ways provide meaning to your life?  Conversely, would you be worried about your future health or be upset by believing that you shortchanged your family? Attributing worth and dignity to others does not require sacrificing ourselves.  It does require asking tough questions that consider other peoples’ needs and examine our motives. 

Etty