In their recent article published in the July issue of the Archives, Kleinman and Lowy1 convey the message that living organ donation is to be avoided if at all possible. They argue that living donation compromises the ethical principle of nonmaleficence and is complicated by concerns about achieving informed consent. In the hope of avoiding these troubling issues while increasing the supply of organs, they propose an incentive-based organ registry designed to encourage people to volunteer to become organ donors on their deaths. Although there is merit in their approach, I believe there are a few important omissions and inconsistencies that should be considered.
The duty of nonmaleficence says that one ought not to inflict evil or harm.2 At first, as suggested by Kleinman and Lowy, living donation appears to violate this duty. However, before reaching this conclusion, two related issues must be considered. First, as pointed out
Spital A. Living Organ Donation Is Still Ethically Acceptable. Arch Intern Med. 1993;153(4):529. doi:10.1001/archinte.1993.00410040089014