[Ethical issues in living renal transplantation]

The paper by EA Friedman and AL Friedman, recently published in Kidney International, advocating legislation to govern and regulate kidney sales, stimulated a heated discussion on the Mailing List of the Italian Society of Nephrology (ML-SIN). The aim of this article is to review the main elements of the issue raised by the authors and summarize the messages on this topic. It is known that the steady increase in the number of patients with end-stage renal disease treated by dialysis outpaces the available kidney donors: the approach proposed by EA and AL Friedman to expand the pool of kidney donors is to legalize payment of a fair market price to donors. According to the authors, the case for legalizing kidney trade hinges on the right of individuals to control their body parts. The participants in the discussion on the ML-SIN generally took a critical stance against this proposal, even if they expressed their opinions more or less clearly and used different arguments. The most widely held view among the nephrologists of the ML-SIN is that trade of organs for transplant is unethical and that it is impractical to propose the legislative hypothesis suggested by Friedman in Italy because of the characteristics of its social, cultural and healthcare systems, and because it would necessitate review of all related current laws.