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Should children ever donate kidneys? Views of U.S. transplant centers
1University of Rochester School of Medicine, New York 14607, USA.
Insights
Most US transplant centers oppose living kidney donation by minors. However, ethical considerations suggest that in rare cases, with appropriate consent, children may be acceptable donors when no other options exist.
Area of Science:
- Nephrology
- Pediatric Transplantation
- Medical Ethics
Background:
- Living related donors offer superior outcomes for pediatric renal transplantation.
- Parents are the most common living donors, with siblings considered when parental donation is not feasible.
- The ethical implications of child-to-child kidney donation warrant examination.
Purpose of the Study:
- To investigate current policies in US renal transplant centers regarding kidney donation by minors (under 18 years old).
- To understand the practices and ethical considerations surrounding pediatric living kidney donors.
Main Methods:
- A survey was distributed to all US renal transplant centers.
- The survey inquired about institutional policies on kidney donation by minors.
Main Results:
- 81% of responding centers prefer living related donors for pediatric recipients.
- Only 33% permit minor twins to donate to their siblings, and 21% allow non-twin minors to donate to siblings.
- 68% of centers require living donors to be at least 18 years old, with only two documented cases of child donors in the preceding year.
Conclusions:
- Most US transplant centers are hesitant to accept child living kidney donors.
- A complete prohibition may be unwarranted; consenting, mature minors could be ethically acceptable in specific circumstances.
- The ethical debate surrounding kidney donation by children requires ongoing reevaluation, especially when no alternative donors are available.
Background:
Living donors provide the best outcome for children undergoing renal transplantation. Most of these donors are parents. When parents are unable to donate, siblings are often considered. But what if the siblings are also children? Should they be permitted to donate?
Methods:
To see how this difficult ethical question is currently handled, a survey was mailed to all U.S. renal transplant centers asking for their policies regarding kidney donation by minors (< 18 years old).
Results:
Among the 117 responding centers that offer pediatric transplantation, the vast majority (81%) prefer living related donors for pediatric recipients. Yet, only 33% of responding centers would allow a monozygotic twin minor to donate a kidney to his or her twin, and even fewer (21%) would allow a nontwin minor to donate to a sibling. In the year before the survey, only two of these centers had actually used a child as a kidney donor. Furthermore, the great majority of responding centers (68%) require living donors to be at least 18 years old.
Conclusions:
These data indicate that most U.S. transplant centers are opposed to using children as living kidney donors. On the other hand, a careful analysis of this issue suggests that although donation by a minor should be uncommon, a complete ban of this practice may be unwarranted. In unusual circumstances in which no other suitable donor is available, consenting mature minors, and even rare immature minors who are highly likely to benefit from donating, may be ethically acceptable. Although there are probably no absolute wrong or right answers, the question of kidney donation by children should be readdressed.