Children as Renal Donors

With the exception of identical twins, preadolescent children have been excluded as renal donors. The justification for this policy appears to be based on a notion that renal donation is an altruistic act, primarily for the benefit of another, and that stringent standards of informed consent must be followed. This paper challenges the present policy on two grounds: consent from adults who donate kidneys is generally not informed, and therefore it is inconsistent to use the consent requirement as a justification for excluding children; and renal donation by adults can be seen as a procedure done for the benefit of the donor (as well as the recipient), and the appropriate rules for using children as donors should therefore be those pertaining to beneficial intrusions on non-consenting subjects. (N Engl J Med 296:363–367, 1977) The suggestion of forced altruism is abhorrent to most Americans. In contrast to some European countries, our laws do not require us to come to the aid of a person in peril.¹ Similarly, in the field of kidney transplantation, the idea of removing a kidney from a person, without his consent, for the benefit of another has generally been unacceptable. The objection is greater when the potential donor is a child, lacking the verbal, physical or political power to resist or protest. Opposition to the use of minor donors is not absolute, however, for identical-twin minors have been used for.