Attempting to balance the needs and interests of minors with the
obligation to protect them from their own potentially harmful decisions
poses an ethical challenge for the physician. This problem is further
exacerbated when the context is not medical treatment but organ
donation. That is, medical treatment scenarios generally involve
decisions likely to result in objective improvements to the
minor's health status. Consent to organ donation, however, raises
several vexing problems. First, how should the provider measure both
the cognitive ability and competence to consent of the minor to ensure
that the minor comprehends the risks and benefits of donation and that
no coercion is involved? Second, given that improvement of one's
health is an unlikely scenario, is there a way to measure subjective
determinations of satisfaction and altruism enjoyed by a minor
following organ donation? If so, should the physician regard these
values in a manner analogous to physical improvement? Finally, are
parents the appropriate decisionmakers for their children when a
sibling-to-sibling donation occurs? Is it possible for parents to
always act in the best interests of both children in this event?