Case narrative

Mrs. Alberta “Allie” Truistic, a married mother of a 10-year-old and a 12-year-old, offered to donate a kidney to any patient with end-stage kidney disease who could benefit from transplantation. Having been refused by three transplant programs, she presented to a fourth in 1996. A thoughtful transplant surgeon in our university program asked me, a nephrologist and clinical ethicist, what he should do. I recommended he undertake a study of altruistic, nondirected, unrelated renal transplant donation and consult the institutional review board (i.e., the human subjects research committee). He preferred to consult with the medical ethics committee of which I was vice chairman. The committee of 15 physicians, 8 nurses, 5 hospital administrators, 4 community representatives, 3 social workers, 3 bioethicists, and 2 attorneys performed ethics consultation either with a small team of four individuals or with the committee as a whole, as in this case.

The transplant surgeon told the committee that Allie Truistic had been motivated to donate ever since the death of her grandmother from polycystic kidney disease. She was told her grandmother, who had been on dialysis for several years, would have lived had she received a kidney transplant. Mrs. Truistic attended a meeting of our ethics committee and informed us that her husband and children supported her wish to donate. Concerned that detailed questioning by the 28 members of our committee might be intimidating, the transplant surgeon and two committee members (including the author) interviewed the patient. She was committed to donate and had a thorough understanding of the risks.