Ethical dimensions of living donation: experience with living liver donation

Whereas distributive justice is the most important principle in most aspects of transplantation and the allocation of scarce resources, it is far less of a central principle in directed living liver donation. For living donation, the ethical principals include (1) respect for the donor's autonomy through full, voluntary, informed consent; (2) beneficence; and (3) nonmaleficence. But how do we put these principles into practice? Practical decision making in living liver donation involves 3 fundamental ethical dimensions: (1) need, (2) probability of donor safety, and (3) the chance for good short- and long-term recipient outcomes. These same dimensions exist everywhere, but the size and shape of the "triangle" can vary greatly depending on societal beliefs. Ultimately, the proper balance of ethical equipoise is affected by the dynamics of these 3 dimensions.