Online kidney donor matching raises ethical concerns

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Online kidney donor matching raises ethical concerns

Web sites that match kidney donors with recipients may facilitate social worth judgements, researchers say, raising concerns of socio-economic discrimination.

According to a new study published in the journal Clinical Transplantation, online donor/recipient matching may put less emphasis on information relevant to transplant outcome, and more emphasis on the persuasiveness of the appeal.

Clinical and health psychologist James R. Rodrigue of the University of Florida examined the socio-demographic characteristics and profiles of 224 potential kidney transplant recipients who registered on ‘the largest recipient/donor matching Web site in the U.S.’.

The findings show that the proportion of patients registered online who are white or employed is higher than among the general waiting list population.

Other than blood type, region and gender, ‘surprisingly few’ socio-demographic and medical details were posted with most solicitation profiles, Rodrigue found.

He expects that patients may omit certain personal or medical characteristics in their online profiles for a variety of different reasons. Some patients may question the relevancy of certain characteristics, such as marital status, while others may be concerned about how certain features -- such as age, race, and transplant waiting time -- may contribute to bias among potential donors.

“It is not surprising that patients will present themselves in the most favourable light while omitting characteristics that they perceive as undesirable, as to do otherwise might reduce their success in attracting a suitable living donor,” Rodrigue said.

“However, the transplant community has worked diligently for years to ensure that social worth and bias are removed or otherwise minimised from patient selection decisions, yet we passively accept such social worth judgments by Good Samaritan donors in the context of public solicitation.”

Living donor kidney transplantation is the preferred treatment option for patients with end stage renal disease. 38 percent of all kidney transplants in the U.S. are now performed using living donors.

Most living donor kidney transplant patients receive donor kidneys from within their family or social networks. However, some patients do not have access living donors who are both willing and medically eligible to give them a kidney, and may thus publicly solicit donations via Web sites that attempt them with so-called ‘Good Samaritan’ donors.

In the U.S., there are more than 75,000 individuals awaiting kidney transplantation. However, Good Samaritan donors are rare -- numbering 71 in 2005 and 68 in 2006 -- so many patients continue to experience long waiting times and high morbidity and mortality while waiting.

“If one accepts that, as the waiting list grows, more and more patients will consider the public solicitation of living donors via websites like the one we reviewed, it is imperative that the transplant community begin to ask – and answer – some key questions,” Rodrigue said in a statement to the media.

The practice of soliciting donors online may impair public trust in the organ allocation system, and thus indirectly reduce the total number of living and deceased kidneys donated, he noted.
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