Kidney donation: the question of coercion

[Clark]

http://marketdesigner.blogspot.com/2011/08/kidney-donation-question-of-coercion.html

Kidney donation: the question of coercion

One of the things that makes selling kidneys repugnant to many is the intuition that, if kidneys could be sold, poor people might feel coerced to sell.

Of course, removing money from the transaction doesn't necessarily remove coercion. When a transplant center evaluates a living donor, one of the things it tries to determine is if the donor is really willing. Families, of course, can exert coercion.  Here's a recent advice column from the Washington Post...Family plays 'please pass the kidney'

"DEAR AMY:
One of my in-laws needs a new kidney. She will be undergoing the transplant process soon. Her family wanted me to give her one of my kidneys. My family said no to this, and so I did not get tested beyond the blood test (we are the same blood group). Now my in-laws are angry and have stopped talking to me.

"I would like to know how my sick relative is doing, but I don’t know what to say when I call, or whether I should call.

"In the past they have said horrible things to me because I did not donate my kidney; it seems now that our long friendship is meaningless.

"I still care for her and her family, but how do I let them know that I am thinking about them? I know if I try to call, the woman who is getting the transplant will say nasty things to me. What should I do? --

Upset"
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Amy's reply seems sensible enough under the circumstances:

"DEAR UPSET: If donating an organ is what it takes to get in good with your in-laws, then their standards are a tad unreasonable.

"I assume there are other dynamics at play which created this pressure on you, but if you are eager to reach this in-law but don’t want to risk the verbal backlash, then the best way to do so is through a greeting card.

"When you send a message through the mail, you lessen the opportunity for back talk."
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[sherri]

Issues involving informed consent and freedom from coercion are issues that are not so easy when facing family donation. I don't know if there can ever be "free choice" regarding family donation. Transplant teams need to explore the issue especially when describing donation surgery to potential recipients. I wonder how the doctors described donation surgery to this in law relative. Did it go along the lines of "minimally invasive surgery, 2 days in the hospital, no cost to the donor, you only need one kidney to live". If so, it is no wonder they are angry. Perhaps if the surgery is described the way they describe it to non related donors with the appropriate level of risk it would be understood better by both parties. There are some hospitals that have a mandatory waiting period for non related (or what they call altruistic donors) but not for family donors. The assumption is that family wants to do this but a non related donor must be a little off balance and needs protection or an advocate. More education for families as a unit needs to happen with a lot more services dedicated to the emotional and psychological needs of the family. Non directed donors can walk away, family donors will always be connected for better or for worse. Makes family gatherings awkward sometimes. The hospitals protect themselves by giving the "medical out" for donors but these people all go home together to learn how to work out all the details.