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Developing an ethics framework for living donor transplantation
  1. Lainie F Ross1,2,3,
  2. J Richard Thistlethwaite2,3
  1. 1Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
  2. 2Department of Surgery, University of Chicago, Chicago, Illinois, USA
  3. 3MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Lainie F Ross, Departments of Pediatrics, Surgery, and the MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL 60615, USA; lross{at}


Both living donor transplantation and human subjects research expose one set of individuals to clinical risks for the clinical benefits of others. In the Belmont Report, the National Commission for the Protection of Human Subjects of Biomedical and Behavior Research (National Commission) articulated three principles to serve as the basis for a research ethics framework: respect for persons, beneficence and justice. In contrast, living donor transplantation lacks a framework. In this manuscript, we adapt the three principles articulated in the Belmont Report to serve as the foundation for an ethics framework for living donor transplantation which we supplement with the principles of vulnerability and responsibility. The National Commission supported additional protections for vulnerable groups of potential research participants. In 2001, Kenneth Kipnis effectively argued that the concept of vulnerable groups failed to explore in what ways particular groups of people were vulnerable, thereby risking unnecessary protections for some and inadequate protections for others. He proposed a taxonomy that explored different types of vulnerabilities that all research participants may experience to provide a more robust framework for human subjects protections, which we adapt to living donors. Robert Goodin claims that health professionals, who stand in special relationship with patients, are responsible for promoting and protecting their well-being. In living donor transplantation, the donor transplant team is responsible for empowering prospective donors to address their vulnerabilities and/or for protecting those who cannot by disqualifying them from donation.

  • transplantation
  • research ethics
  • donation/procurement of organs/tissues
  • decision-making

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  • Contributors LFR: developed the framework, wrote the first draft and rewrote many subsequent drafts. JRT: provided critical insights into the development of the framework and added critical comments and revisions to multiple drafts.

  • Funding LFR and JRT received funding from the Robert Wood Johnson Investigator Award in Health Policy.

  • Competing interests None declared.

  • Patient consent Not required.

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

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