Organ transplantation from marginal and non-standard risk donors: ethical requisites for consent from recipients

In order to close the gap between available organs and patients needing transplants, the selection criteria for donors have gradually become more relaxed and many countries have defined expanded criteria for donor variables. However, the use of organs from marginal and non-standard risk donors poses considerable ethical issues. The acceptability of the risk/benefit ratio depends primarily on a clinical assessment, and information given to the recipient and his/her eventual consent are crucial. Some of the requisites concerning information and consent are mandatory. Once these requisites have been defined in binding regulations, adequate margins must be allowed for their personalisation and to account for the unique nature of each physician/patient relationship. Each decision should be specific for a particular person, and it must be accepted that similar clinical situations may give rise to differing solutions that are nonetheless agreed by the physician and the patient.