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The cost of autonomy: estimates from recent advances in living donor kidney transplantation
  1. Phedias Diamandis1,2
  1. 1Program in Developmental and Stem Cell Biology, The Hospital for Sick Children and University of Toronto, Canada
  2. 2MD/PhD Program, Medical Sciences, University of Toronto, Toronto, Canada
  1. Correspondence to Dr Phedias Diamandis, MD/PhD Program, Medical Sciences Building, Room 7205, University of Toronto, Toronto, Ontario, Canada M5S 1A8; p.diamandis{at}


Autonomy, an individual's right to make personal decisions regarding his/her own health, represents one of the major ethical principles of medicine. While there are many examples citing the benefits this right provides for the individual, the impact that personal healthcare decisions have on others is often neglected. Here, evidence from end-stage renal disease is reviewed to hypothesise the creation of a universal kidney donation programme that although provides unparalleled benefits to its citizens, relies on the participation of a large proportion of the society. Given that this essay also addresses the public's major concerns regarding kidney donation, one of the only remaining implementation barriers is the individuals' right not to participate. Therefore, irrespective of the humane and complex emotionally laden reasons for not enrolling in such programmes, this essay provides some estimates of the significant resource and quality of life costs associated with autonomy. Assuming humans are competent to make informed personal healthcare choices, similar to recent efforts to increase awareness about the negative impact of certain lifestyle choices on global warming, citizens should also be better informed about the medical costs their autonomy has on society.

  • Informed consent
  • autonomy
  • kidney transplant
  • living donors
  • health policy
  • end stage renal failure
  • applied and professional ethics
  • quality of healthcare
  • moral and religious aspects
  • kidneys

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  • Dedicated to the memory of my grandmother, Polyxeni Diamandis, who died from ESRD in 2003.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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