Can we turn down autonomous wishes to donate anonymously?

[Clark]

http://onlinelibrary.wiley.com/doi/10.1111/j.1432-2277.2011.01333.x/abstract

Can we turn down autonomous wishes to donate anonymously?
Medard Hilhorst1, Henri Wijsbek2, Ruud Erdman3, Herold Metselaar4, Gert van Dijk5, Willij Zuidema6, Willem Weimar6
Article first published online: 13 SEP 2011
DOI: 10.1111/j.1432-2277.2011.01333.x
Transplant International
Early View (Online Version of Record published before inclusion in an issue)

Conflicts of Interest No conflicts of interests.
An earlier draft of this article ‘One donor, two Samaritan transplantations’, was presented and discussed at the Rotterdam ELPAT-conference on ethical, legal and psychological aspects of transplantation, 17–20 April 2010, published in the conference proceedings by Pabst Science Publishers, Germany in 2011.

Summary
Imagine a Samaritan living kidney donor, who some time ago has anonymously donated one of his kidneys to a patient on top of the waiting list. He now contacts the transplantation centre once again, to donate part of his liver. The Centre, startled by this idea, refers him to the regular screening procedure for all Samaritan donations. It turns out that his wish is well-informed, voluntarily made and that he is competent to decide. We acknowledge that a donor’s wish should not be followed in all cases, even though this wish is a clear expression of his own free will. However, a refusal must be based on sound moral reasons and it is less clear what reasons these might be. We outline the most common arguments for refusal, assess these arguments in terms of strengths and weaknesses, and show which arguments, if any at all, are most promising. We conclude, firstly, that we should only assess risks (which include motivations), not judge relationships, and secondly, that it is not a transplant centre’s mission to carry out a donor’s life project.