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Living Kidney Donation pp 327–348Cite as

Ethical and Policy Considerations in Living Kidney Donor Evaluation and Care

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Abstract

Living donor kidney transplantation (LDKT) is an important strategy for treating end-stage kidney disease, alongside dialysis and deceased donor transplantation. LDKT can benefit recipients and other patients waiting for a donated kidney. The relationships among transplant programs, donor candidates, and LDKT recipients, however, do not neatly map onto the traditional model of clinician-patient relations. Hence, the responsible management of LDKT demands a distinct ethical framework.

This chapter identifies a set of public and professional values and principles bearing on LDKT. Among them are bodily autonomy, professional beneficence and integrity, patient safety, and procedural fairness. Transplant programs can operationalize these ideals through mechanisms for establishing informed consent, ascertaining that anticipated benefits outweigh potential harms, defining acceptable risk, and ensuring that all patients receive due attention. The chapter then examines three activities that are current points of debate in the organization of LDKT. Namely, these are compatible donor-recipient pairs’ participation in paired exchange and chain donation, the use of predictive genetics as exemplified by APOL1 testing, and the public solicitation of living donors for individual recipients. Without purporting to resolve every aspect of these challenges definitively, the chapter “call[s] out” relevant ethical considerations and proposes ways of appropriately balancing them.

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Authors and Affiliations

  1. Bioethics Program, University Health Network, Toronto, ON, Canada

    Jed Adam Gross

  2. Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada

    Jed Adam Gross & Marie-Chantal Fortin

  3. Centre de recherche du CHUM, Montreal, Canada

    Marie-Chantal Fortin

  4. Deparatment of Medicine, Université de Montréal, Montreal, Canada

    Marie-Chantal Fortin

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  1. Jed Adam Gross
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  2. Marie-Chantal Fortin
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Correspondence to Jed Adam Gross .

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Editors and Affiliations

  1. Center for Abdominal Transplantation, Division of Nephrology, Saint Louis University School of Medicine, St. Louis, MO, USA

    Krista L. Lentine

  2. Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    Beatrice P. Concepcion

  3. Section of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA

    Edgar V. Lerma

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Gross, J.A., Fortin, MC. (2021). Ethical and Policy Considerations in Living Kidney Donor Evaluation and Care. In: Lentine, K.L., Concepcion, B.P., Lerma, E.V. (eds) Living Kidney Donation. Springer, Cham. https://doi.org/10.1007/978-3-030-53618-3_15

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  • DOI: https://doi.org/10.1007/978-3-030-53618-3_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-53617-6

  • Online ISBN: 978-3-030-53618-3

  • eBook Packages: MedicineMedicine (R0)

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