Unrelated living organ donation: ULTRA needs to go

“Unrelated living organ donation: ULTRA needs to go” (2003) 29 Journal of Medical Ethics 169-70 (with A.S. Daar et al.).

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The recent review of the Unrelated Live Transplant Regulatory Authority (ULTRA) provides administrative and statistical information regarding living donor kidney transplantation in the United Kingdom. However, it leaves much unsaid. For example, although the report does mention the number of live kidney donations from unrelated donors that ULTRA has approved, it fails to mention that the United Kingdom has a low live kidney donation rate compared with other European countries (in 1999, 5.3 kidney donors per million population in the UK; 8.7 in Switzerland, 11.5 in Sweden, 24.6 in Norway). More importantly, the report does not address the fundamental question of whether the legal framework underlying ULTRA is morally justified. The legal regime in the United Kingdom proceeds on the tacit assumption that genetically unrelated donors are much more vulnerable to coercion than are related donors, and hence are more in need of protective regulation. In this article, we argue that the distinction drawn in the United Kingdom between genetically related and unrelated donors is difficult to justify, that it unnecessarily discourages live organ donation, and that the law should be changed.