Development of a Donor-Centered Approach to Risk Assessment: Rebalancing Non-mal

[Clark]

http://onlinelibrary.wiley.com/doi/10.1111/ajt.13272/abstract

Development of a Donor-Centered Approach to Risk Assessment: Rebalancing Non-maleficence and Autonomy
C. Thiessen1, E. J. Gordon2, P. P. Reese3 andS. Kulkarni1,*
Article first published online: 13 APR 2015
DOI: 10.1111/ajt.13272
American Journal of Transplantation
Early View (Online Version of Record published before inclusion in an issue)

Abstract

Living kidney donors are often excluded from the shared decision making and patient-centered models that are advocated in medical practice. Thresholds for acceptable risk vary between transplant centers, and between clinicians and donors. Although donor selection committees commonly focus on medical risks, potential donors also consider nonmedical risks and burdens, which may alter their assessment of an acceptable level of medical risk. Thus, transplant centers may encounter ethical tensions between nonmaleficence and respect for donor autonomy. A donor-centered model of risk assessment and risk reconciliation would integrate the donor's values and preferences in a shared decision about their eligibility to donate. This paper argues for shifting to a donor-centered model of risk assessment, and presents a research agenda to facilitate the greater participation of donors in their own evaluation and approval processes.