Altruistic living kidney donation challenges psychosocial research and policy: A response to previous articles

Background. Policies with respect to altruistic living kidney donation to strangers (both nondirected and directed donation) should, in addition to medical criteria, preferably be based on valid attitude research data. However, deciding on what data are relevant is a normative issue. The challenge for both research and policy making is to bring together empirical and normative issues. Methods. By comparing two recent surveys, the authors shed light on the complex methodologic and ethical questions surrounding altruistic living kidney donation. Results. The authors found that the main methodologic issues were the distinction between the willingness to donate and the acceptability of the Offer, the difference between public attitudes observed in surveys ("facts") and well-considered moral judgments ("norms"), and biases caused by a misperception of central moral concepts (e.g., discrimination and injustice). The authors argue that transplantation centers have a good case for applying or initiating altruistic living donation programs. Centers should seek to influence public attitudes if these attitudes are shown to be biased by prejudice and misunderstanding. Conclusions. The authors advocate an interaction between research and policy making. Social research can best influence transplantation policies in altruistic living donation by in-depth interviews into the complicated background beliefs underlying personal preferences. In addition, the public should be encouraged to judge the immanent issues in a morally responsible way. In the end, a fair balance should be established between the impartial requirements of social justice and the partial motivations of individuals involved in altruistic living donation. Although discriminatory acts should be rejected categorically, donation policies should be willing to consider, support, and accept motivations based on personal loyalties.