What the medical excuse teaches us about the potential living donor as patient

Since the inception of living donor kidney transplantation, physicians have expressed concern about the voluntariness of the donors and their ability to recuse themselves. The literature from the late 1960s and early 1970s reveals the practice of offering a false medical excuse, although more recent comments seem to focus more on a 'general statement of lack of suitability' or 'a blameless explanation'. Simmerling et al. argue that the provision of a medical excuse rests on deception, which is wrong on deontological grounds (that physicians should hold to a principle of veracity) and on consequential grounds (deception threatens to damage trust and the doctor-patient relationship and deception may have adverse impact on the donor's relationship with his family). In this paper I examine and reject these objections. I argue that a false medical excuse is morally unjustifiable, but the medical excuse understood as a 'general statement of lack of suitability' is morally permissible because it promotes donor autonomy (the donor's right to decide whether or not to donate), and protects and preserves the donor's rights to privacy and confidentiality (by affirming the donor as an independent patient).