Paired Kidney Donations in Light of the National Organ Transplant Act: A Bioethical Analysis Open Access

Ginsberg, Jessica (Fall 2017)

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One phenomenon that has emerged out of the practice of live kidney donation is paired kidney exchanges. Paired kidney exchanges provide a transplant option for candidates who have a living donor who is medically able, but cannot donate a kidney to the intended candidate due to an incompatible blood type, HLA crossmatch, or both. In the exchange, an arrangement occurs between two incompatible donor pairs whereby the donor from each pair gives a kidney to a donor recipient from the other pair. For example, suppose A wants to donate to his brother, B, and suppose C wants to donate to her sister, D. A is not a match for B, but is a match for D. Similarly, C is not a match for D, but is a match for B. The four parties enter into a paired kidney exchange agreement whereby A agrees to donate to D and C agrees to donate to B.

Most astonishing about the paired kidney exchange model is the lack of protection afforded to exchange participants. That is, in the United States, no law, policy, or safeguards are in place to deter bad actors from falsely inducing one party to donate a kidney and later reneging on their promise to reciprocate. As such, this thesis will analyze the bioethical issues that must be addressed if the paired kidney exchange model will serve as a strategy for overcoming barriers to patients suffering from end stage renal disease.

Table of Contents

Introduction -1

Part I: Present Day Trends – 9

Part II: Laws, Regulations, and Policies that Govern Organ Donation – 15

Part III: Legal Concerns – 20

Part IV: Ethical Concerns – 23

Part V: Potential Solutions to the Current Paired Kidney Exchange System - 64

Part VI: Conclusion – 83

Appendix- 90

Bibliography - 102

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