As the gap between organ donors and patients on the recipient waiting list grows, residents of the United States who are in need of kidney transplantation occasionally contract with living donors from outside the United States. Those donors then travel to the United States to undergo living donor kidney donation at US transplant centers. This practice is not limited to the United States and occurs with some regularity around the world. However, there is very little written about this practice from the perspective of the US transplant system, and there is little in the way of guidance (either legal or ethical) to assist centers that accommodate it in distinguishing between ethically permissible travel for transplant and what could potentially be human trafficking for organ removal. This article will present an ethical analysis of travel for organ donation with particular attention to lessons that can be drawn from living donor donation in other countries. This inquiry is particularly germane because Organ Procurement and Transplantation Network has promulgated guidelines with respect to obligations owed to living donors, but those guidelines appear to assume that the donor is a US resident. The critical question then is whether or to what extent those guidelines are applicable to the instant scenario in which the living donor is a nonresident. In addition, this article addresses several critical ethical concerns implicated by the often vulnerable populations from which donors are drawn. Finally, this article proposes that focused inquiry by transplant centers is necessary when donors are nonresidents.
1 Department of Clinical Medical Ethics, Indiana University Health, Indianapolis, IN.
2 Indiana University Center for Bioethics, Indiana University, Indianapolis, IN.
3 Medical Humanities & Health Studies Program, School of Liberal Arts, Indiana University Purdue University, Indianapolis, IN.
4 Indiana University School of Medicine, Department of Medicine, Division of Hematology/Oncology, Indianapolis, IN.
Received 23 May 2018. Revision received 17 June 2019.
Accepted 20 June 2019.
The authors wish to thank the Richard M. Fairbanks Foundation (Indianapolis, IN) and the Methodist Health Foundation (Indianapolis, IN) for funding of the Charles Warren Fairbanks Center for Medical Ethics. This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.
Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).
Correspondence: Jane A. Hartsock, JD, MA, Department of Clinical Medical Ethics, Indiana University Health, 1800 N Capitol, Noyes Pavilion, Suite E644, Indianapolis, IN 46202. (email@example.com).