SHOULD CHILDREN EVER DONATE KIDNEYS - VIEWS OF US TRANSPLANT CENTERS

Background. Living donors provide the best outcome for children underg oing renal transplantation. Most of these donors are parents. When par ents are unable to donate, siblings are often considered. But what if the siblings are also children? Should they be permitted to donate? Me thods. To see how this difficult ethical question is currently handled , a survey was mailed to all U.S. renal transplant centers asking for their policies regarding kidney donation by miners (<18 years old). Re sults. Among the 117 responding centers that offer pediatric transplan tation, the vast majority (81%) prefer living related donors for pedia tric recipients. Yet, only 33% of responding centers would allow a mon ozygotic twin minor to donate a kidney to his or her twin, and even fe wer (21%) would allow a nontwin minor to donate to a sibling. In the y ear before the survey, only two of these centers had actually used a c hild as a kidney donor. Furthermore, the great majority of responding centers (68%) require living donors to be at least 18 years old. Concl usions. These data indicate that most U.S. transplant centers are oppo sed to using children as living kidney donors. On the other hand, a ca reful analysis of this issue suggests that although donation by a mino r should be uncommon, a complete ban of this practice may be unwarrant ed. In unusual circumstances in which no other suitable donor is avail able, consenting mature miners, and even rare immature miners who are highly likely to benefit from donating, may be ethically acceptable. A lthough there are probably no absolute wrong or right answers, the que stion of kidney donation by children should be readdressed.