Consent in the dark: Can living kidney donation proceed amid marital infidelity?

Living kidney donation requires rigorous medical, psychosocial, and ethical evaluation to safeguard donor welfare, ensure valid informed consent, and prevent wrongful exploitation. In Singapore, the Human Organ Transplant Act mandates review by a transplant ethics committee (TEC) for all living-donor transplants. However, ethical judgment is not reducible to TEC approval or procedural compliance; transplant programs themselves carry a broader responsibility to evaluate relational dynamics that may affect voluntariness and authenticity of consent. This paper examines three cases involving concealed marital infidelity history in either kidney donor or recipient candidates or ongoing extramarital relationships in potential kidney donors and recipients that raised ethical concerns. Key issues include the materiality of information for informed consent, risks of psychosocial harm, integrity of caregiving arrangements, and potential institutional complicity in ongoing deception. While personal moral discomfort alone does not justify rejection, undisclosed relational complexities may warrant conditional deferral to protect donor welfare, program credibility, and public trust. In certain contexts, proceeding without disclosure may be ethically permissible when consent remains autonomous, donor privacy is respected, and anticipated harm is minimal. Transplant programs must balance substantial clinical benefit with ethical stewardship to preserve public confidence and the moral credibility of living donation.