Development of a Donor-Centered Approach to Risk Assessment: Rebalancing Nonmaleficence and Autonomy

Am J Transplant. 2015 Sep;15(9):2314-23. doi: 10.1111/ajt.13272. Epub 2015 Apr 13.


Living kidney donors are often excluded from the shared decision making and patient-centered models that are advocated in medical practice. Thresholds for acceptable risk vary between transplant centers, and between clinicians and donors. Although donor selection committees commonly focus on medical risks, potential donors also consider nonmedical risks and burdens, which may alter their assessment of an acceptable level of medical risk. Thus, transplant centers may encounter ethical tensions between nonmaleficence and respect for donor autonomy. A donor-centered model of risk assessment and risk reconciliation would integrate the donor's values and preferences in a shared decision about their eligibility to donate. This paper argues for shifting to a donor-centered model of risk assessment, and presents a research agenda to facilitate the greater participation of donors in their own evaluation and approval processes.

Keywords: Donors and donation: donor evaluation; donors and donation: living; editorial/personal viewpoint; ethics; ethics and public policy; kidney transplantation/nephrology; kidney transplantation: living donor; risk assessment/risk stratification.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Decision Making*
  • Donor Selection
  • Ethics, Medical
  • Humans
  • Informed Consent / ethics*
  • Living Donors / ethics*
  • Patient Selection
  • Personal Autonomy*
  • Risk Assessment / ethics*
  • Tissue and Organ Procurement / ethics*