PHIL103: Moral and Political Philosophy

This includes information and understanding about possible emotional and psychological consequences of making a decision one way or the other, for the potential recipient, the potential donor, the relationship between these two people, and for other family members. These questions can only be answered within the context of understanding a particular family and/or the particular individuals involved whatever the outcome, certain issues may take some time to resolve.

Tissue typing and other medical checks may identify only one suitable donor in a family, which can lead to great pressure being put on that person. There may be more than one suitable donor and in these cases there can be complex pressures again as a choice is made between these people. As examples of such pressures, focus may fall on one of the suitable people for various reasons, perhaps without sufficient thought. In other cases there may be one person who is extremely eager to donate and so perhaps too willing to overlook possible difficulties that may be encountered. Often, such very willing people may need even more careful counseling to ensure that their decision is sound.

Living donation offers the recipient immediate hope. Because the results are generally favorable, the mood of the recipient, family and donor are usually optimistic. Against this background, other issues need to be considered:

Chances of survival of recipient:

It is argued by some that it is preferable to donate to recipients who are not critically ill, because choosing recipients with higher chances of survival better balances the risk to the donor. In addition, when such recipients are chosen, there is less need to make a decision under pressure and the additional time allows thorough medical and psychological evaluation of the proposed donor.

Changes in donor/recipient relationship:

The exceptional nature of what has happened and what both the donor and recipient have shared may be mutually enhancing. After a donation, there is often increased contact between a donor and the recipient where they are known to each other. Our experience suggests that reaction to being identified as a donor is very positive.

Feeling if the transplant fails:

If the donation does fail, the donor may have feelings of guilt or inadequacy or feelings of anger, sadness, or that the donated organs or tissues have been wasted, and that the discomforts he or she has suffered have been made for nothing.

Feelings of 'ownership' towards the recipient:

Living donors can feel closer to recipients and have expressed attitudes of ownership about the state of health and activities of the recipient. They may feel that they have a right to ensure that the recipient is taking good care of his or her health and therefore of the donated organ or tissue. Conversely, the recipient may identify with the donor and feel that part of the donor is living in them. Ultimately such feelings may not be in the best interest of either party.

Recipient feelings of guilt if the donation has harmful effects on the donor:

A recipient may feel guilty and responsible if the donor suffers from his or her donation.

Consequences of not donating:

A decision not to donate can have a major impact on relationships within a family. The recipient's illness is often life-threatening and death may occur before or after transplantation. It is therefore important that the family, including prospective donors, do not have unrealistic expectations for the recipient nor underestimate the difficulties for the donor. A decision not to donate might be entirely appropriate for the individual, but still have profound effects on family relationships if the proposed recipient dies. It is very important to consider whether such factors amount to undue pressure on a potential donor