Making it Real

Here is an article written by a director of Medical Ethics and professor of medicine from Harvard Medical School published in the medical journal  Health Affairs.    David Steinberg changed his mind about altruistic organ donation after researching Sue's motivations for her willingness to donate her kidney to a stranger in 2001.  

 

Kidneys And The Kindness Of Strangers

 

David Steinberg

 

A medical ethicist changes his mind about altruistic donors.

 

One day a patient of ours with end-stage kidney failure asked, if he found a stranger willing to give him a kidney, would our surgeons retrieve and transplant the organ? The man posing the question required dialysis and could anticipate a wait of several years before receiving a kidney transplant. The question was then presented by our kidney transplant team to the medical ethics group that I head at a hospital in a small town thirteen miles northwest of Boston.

 

The patient’s request was unusual; it was made after the patient read about a thirty-six-year-old woman from Texas who through the Internet found a stranger willing to give her a kidney. Would honoring this request be morally appropriate, the transplant team wanted to know? Thus began my own search into the implications of kidney donation by altruistic strangers.

 

 

Clarifying Motives

 

I found Susan by chance when searching for “altruistic donors” on Google. Her note said that she wanted to give one of her kidneys free to someone who needed one. I wrote to her because I was curious about her motives. It seemed bizarre to me to submit to the risks and discomforts of surgery in order to help a total stranger. And, as a medical ethicist, I knew that not every altruistic act is necessarily a “good” act. Donating a kidney is not risk-free. If a donor dies, the morality of such a donation could be called into doubt.

 

Through e-mail conversations with Susan, I probed and questioned to unearth the personality or cognitive defect that I assumed would explain her reckless altruism. I ended up, however, wondering whether, of the two of us, she was the more rational. Part of our e-mail dialogue, edited for clarity, went like this.

 

Me:     “I am interested in learning why someone would donate a kidney to a stranger.”

 

Susan:      “I believe I should try to help people. This seems to be a perfect opportunity to help someone in a big way with minimal inconvenience to myself. You may think ‘minimal’ is a strange word to use regarding a kidney transplant. However, I understand the laparoscopic surgery is very good and I should recover in about a month. Do you need a kidney?”

 

Me:     “No, I don’t. Are you aware that there is a small but real possibility of death—perhaps one in 2,500—if you donate your kidney?”

 

 

Susan:     “When I first thought about giving a kidney I was a bit freaked out thinking about the worst-case scenario—death or rejection by the other person of my kidney. I guess that’s where my faith in God comes into it. I believe God wants me to use my life to help other people, and the rewards will be a much deeper happiness and a sense of real fulfillment in my life. Many people are willing to KILL for what they believe in; why not allow people who are willing to take personal risks do what they believe in to SAVE a life? Anyway, a one in 2,500 chance of death is a pretty slim one. Part of the skepticism people feel about my decision is that the subject of live organ transplants is relatively new and still controversial. People need time to think through the issues and get over their initial reaction, which is usually based on ignorance and fear.”

 

At first my conversations with Susan were impersonal; gradually I learned a few things about her. At the end of one note she signed her full name, Susan Gianstefani. She told me that she was an Australian citizen living in London with her husband and that she stayed at home to tutor her seven-year-old son.

 

 

 

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