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Will you give my kidney back? Organ restitution in living-related kidney transplantation: ethical analyses
  1. Eisuke Nakazawa1,
  2. Keiichiro Yamamoto1,
  3. Aru Akabayashi1,
  4. Margie H Shaw2,
  5. Richard A Demme2,
  6. Akira Akabayashi1,3
  1. 1Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
  2. 2Division of Medical Humanities and Bioethics, University of Rochester Medical Center, Rochester, New York, USA
  3. 3Division of Medical Ethics, New York University School of Medicine, New York, New York, USA
  1. Correspondence to Dr Eisuke Nakazawa, Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo Graduate School of Medicine, Bunkyo, Tokyo 113-0033, Japan; nakazawaeisuke-tky{at}umin.ac.jp

Abstract

In this article, we perform a thought experiment about living donor kidney transplantation. If a living kidney donor becomes in need of renal replacement treatment due to dysfunction of the remaining kidney after donation, can the donor ask the recipient to give back the kidney that had been donated? We call this problem organ restitution and discussed it from the ethical viewpoint. Living organ transplantation is a kind of ‘designated donation’ and subsequently has a contract-like character. First, assuming a case in which original donor (A) wishes the return of the organ which had been transplanted into B, and the original recipient (B) agrees, organ restitution will be permissible based on contract-like agreement. However, careful and detailed consideration is necessary to determine whether this leaves no room to question the authenticity of B’s consent. Second, if B offers to give back the organ to A, then B’s act is a supererogatory act, and is praiseworthy and meritorious. Such an offer is a matter of virtue, not obligation. Third, if A wishes B to return the organ, but B does not wish/allow this to happen, it is likely difficult to justify returning the organ to A by violating B’s right to bodily integrity. But B’s refusal to return the donated organ cannot be deemed praiseworthy, because B forgets the great kindness once received from A. Rather than calling this an obligation, we encourage B to consider such virtuous conduct.

  • living donor kidney transplantation organ restitution ethics

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Footnotes

  • Contributors EN participated in conducting the research in legal and ethical aspects, manuscript writing and revision, and final manuscript approval. KY participated in conducting the research in ethical aspects, manuscript writing and revision, and

    final manuscript approval. ArA participated in conducting the research, collecting references, manuscript revision and final manuscript approval. MHS participated in conducting the research in legal and ethical aspects, manuscript revision and final manuscript approval. RAD participated in conducting the research in ethical aspects, manuscript revision and final manuscript approval. AkA participated in research design, manuscript writing and editing, and final manuscript approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer Although AkA is president of the Japan Association for Bioethics (JAB), this letter represents our personal academic analyses and opinions. It does not represent JAB’s official position on this issue.

  • Patient consent for publication Not required.

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

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