ETHICAL CONSIDERATIONS ON HEPATIC TRANSPLANTATION FROM LIVING-RELATEDDONORS

This review examines the ethical problems of liver transplantation fro m living parental donors regarding the main ethical principles. It app ears that this method of transplantation is a new possibility offered to patients that cannot be substracted from the parents' choice withou t interfering with their liberty. Moreover, there is a social decisive ness to ensure the offering of this option which is limited by the con ditions of realisation, timing and personal situations of the parents. The considerations of risks, benefits, advantages and prejudices betw een donor and recipient show a favourable balance for this type of tra nsplantation provided that adequate medical indications are respected. However, the considerations of psychological cost and burden deserve special attention and are detailed in this paper especially regarding the motivations and the long-term effects on the donor. Futility and e thical generalisation examinations favour such a procedure. Moral just ice will generally be respected. The consideration of autonomy require d special attention owing to the situation pressure upon the donor's c onsent. Consent deserves adapted sollicitation according to variable s ituations: whether the donor explicitly specifically wanted to donate part of his liver or only required information. Excessive solicitation of parents' participation to liver donation represents qualified ''fo rced choice''; in some situations where the parents cannot effectively refuse their participation, paternalistic action is ethically accepta ble. A general procedure is proposed to ensure the psychological, lega l and ethical protection of the donor and recipient.