In defense of altruistic kidney donation by strangers

A shortage of cadaveric donor kidneys has created waiting lists for patient s on chronic dialysis. Despite many ethical issues, donor kidneys are obtai ned from cadavers, first-degree living relatives, second-degree relatives ( uncles, aunts), emotionally related persons such as spouses, and non-geneti c altruistic donors who have a close relationship with the recipient. Most centers do not accept kidneys from miners, persons who have no genetic or p ersonal relationship with the recipient, organs offered by altruistic stran gers, or those that are purchased. The pros and cons of using kidneys from donors who are altruistic strangers (donors who have no genetic or personal relationship with the recipient) are reviewed. It may seem that organ acqu isition for renal transplantation has moved down a slippery slope from cada ver donors to Living non-related but emotionally related donors. However, i t can also be argued that the approach to obtaining kidneys has evolved wit h improvements in safety to the donor an dan increasing shortage of organs. It may also be argued that the approach should evolve from a paternalistic physician-centered role to a position in which the patient has more autono my in deciding whether or not to accept a kidney from an altruistic donor.