Howard Fischer
Uppsala, Sweden

 

Operating theatre. Photo by Piotr Bodzek. Via Wikimedia. CC BY-SA 3.0.

“Life’s most persistent and urgent question is ‘What are you doing for others?’”
— Martin Luther King, Jr.

 

Kidney transplantation is the preferred form of treatment for chronic, permanent renal failure. Transplanted patients have better long-term survival than patients receiving repeated hemodialysis. There is, unfortunately, a shortage of usable kidneys worldwide. In the US in 2021, 97,000 people were waiting for a kidney. Kidneys taken from cadavers are insufficient to meet the demand. Kidneys from living donors produce better results than cadaveric kidneys. The nephrectomy that a living donor undergoes is major surgery, but “the vast majority [of donors] have excellent long-term survival, at least as good as that of the general population.”¹ A working group in Germany investigated the ethical, legal, psychological, and medical aspects of living organ donation. They found no reason to exclude “genetically unrelated living donors.”²

In 1996, Dr. Jochem Hoyer, a well-known German surgeon and head of a transplantation unit at a university hospital was told by a colleague, “It is easy for you as a transplant surgeon to praise living donors as long as it is NOT you who has to donate, but someone else.”³ Hoyer then voluntarily donated a kidney to an unknown recipient on the Munich waiting list⁴ with the idea that this would make a “very strong statement.”⁵

His action led to proposals in Germany for nondirected donation. However, the German Transplantation Act of 1997 prohibited nondirected transplants from living donors.⁶ Opponents of nondirected transplants feared that this would produce a market in which donors would expect financial compensation. Some surgeons did think that if organs from living donors were to go to someone to whom the donor felt connected, donations might increase.⁷

One change that might be attributed to Dr. Hoyer’s donation was a substantial increase in the percent of living kidney donations in Germany, jumping from 4% to 20% of all renal transplants.⁸ The 1997 Transplantation Act was legally challenged, but the German Constitutional Court upheld it.⁹ In 2012, regulations permitted only first- and second-degree relatives, spouses, and registered life partners to receive a kidney from a living donor. No nondirected donations were allowed.¹⁰ This was reaffirmed in 2018: “Altruistic or anonymous [kidney] donation is legally not allowed.”¹¹

Dr. Hoyer stated that it is “…incomprehensible that legislation…disapproves of a consistently lived Christian charity by refusal of an altruistic nondirected donation.”¹² Dr. Hoyer was fired from the institution in which he had worked for thirty years.

 

References

1. Reginald Gohh, Paul Morrissey, et al. “Controversies in organ donation: The altruistic living donor,” Nephrol Dial Transplant, 16, 2001.
2. Abdallah Daar, Walter Land, et al. “Living donor renal transplantation: Evidence-based justification for an ethical option,” Transplantation review, 11, 1997.
3. Jochem Hoyer. “A nondirected kidney donation and its consequences: personal experience of a transplant surgeon,” Transplantation, 76(8), 2003.
4. Nadey Hakim, Ruben Conelo, et al. Living Related Transplantation, London: Imperial College Press, 2010.
5. Hoyer, “Nondirected.”
6. Hoyer, “Nondirected.”
7. Hakim, “Living Related.”
8. Hoyer, “Nondirected.”
9. Hoyer, “Nondirected.”
10. NA. Deutsches Referenzzentrum für Ethik in der Biowissenschaften. Organ Transplants. Legal Aspects, 2022.
11. Mariel Nöhre, Iris Pullmann, et al. “Partnership satisfaction in living kidney donors,” Front Psychiatry, 9, 2018.
12. Hoyer, “Nondirected.”

 

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HOWARD FISCHER, M.D., was a professor of pediatrics at Wayne State University School of Medicine, Detroit, Michigan.

 

Spring 2022  |  Sections  |  Nephrology & Hypertension