International Travel for Living Donor Kidney Donation: A Proposal for Focused Screening of Vulnerable Groups

Abstract

As the gap between organ donors and patients on the recipient waiting list grows, residents of the United States who are in need of kidney transplantation occasionally contract with living donors from outside the United States. Those donors then travel to the United States to undergo living donor kidney donation at US transplant centers. This practice is not limited to the United States and occurs with some regularity around the world. However, there is very little written about this practice from the perspective of the US transplant system, and there is little in the way of guidance (either legal or ethical) to assist centers that accommodate it in distinguishing between ethically permissible travel for transplant and what could potentially be human trafficking for organ removal. This article will present an ethical analysis of travel for organ donation with particular attention to lessons that can be drawn from living donor donation in other countries. This inquiry is particularly germane because Organ Procurement and Transplantation Network has promulgated guidelines with respect to obligations owed to living donors, but those guidelines appear to assume that the donor is a US resident. The critical question then is whether or to what extent those guidelines are applicable to the instant scenario in which the living donor is a nonresident. In addition, this article addresses several critical ethical concerns implicated by the often vulnerable populations from which donors are drawn. Finally, this article proposes that focused inquiry by transplant centers is necessary when donors are nonresidents.