Altruistic organ donation explored

Dr Julianna Challenor CPsychol reviews “My Kidney and Me”, shown on More 4  on Monday 6 August

Tom is a 26 year-old man who has decided to donate one of his kidneys to a stranger. He feels compelled to join a group of around 100 people in the UK who are 'altruistic' or living, non-directed kidney donors. Is this an act of "kindness or madness?: the programme asked the viewer at the start, getting straight to the heart of an emotive and for some, anxiety-provoking ethical issue. 

NHS Blood & Transplant (NHSBT) – the body responsible for blood and organ transplantation in the UK wants to increase the number of living kidney donors. This is to meet the increased demand and because there is a significantly better outcome when an organ from a living donor is transplanted. Set against this background, the issue of altruistic donation becomes increasingly relevant. Legal in the UK since 2006, it is a phenomenon that can elicit strong feelings. However, this film was not about waiting lists, or statistics. There was almost no background information given about the procedure, instead, the focus was on the emotions of Tom and those closest to him.

My interest in this subject comes from having carried out a qualitative study exploring how altruistic kidney donors construct their decision to donate. The binary approach identified at the beginning of the film, in which donors are considered either as saints or mentally ill with almost no available position between these two poles, is in my opinion, an accurate picture of society’s dualistic response to altruistic donation. This response means that there is no space for a more nuanced conversation about the ethics of this type of donation, in which the psychological aspects can be discussed in a more useful, non-pathologising way. 

In the film, we meet Tom three weeks before his operation, as he takes a phone call from the hospital transplant co-ordinator and learns that they have found a recipient who is a match for his kidney. Tom is clearly delighted, but his friends and family are not, and this tension forms the narrative spine of the half-hour programme. 

While Tom refers to the 1 in 3000 risk of death as a “small chance of dying for someone I’ll never know”, his mother and girlfriend find this possibility understandably distressing and difficult to accept. The pressure that Tom’s decision puts on his friends and particularly his family is difficult poignant. They don’t want him to take the risk and worry about the future and what will happen if something happens to his remaining kidney. His perplexed friends talk of their pride and admiration, but also confess their reservations. They try to be supportive, but worry that they ought to be stopping him, for his own good. As Tom describes how he is feeling “more and more excited” about the operation, those around him become visibly more upset. Tom hears their distress, and finds this the most difficult aspect of his decision, feeling guilty about making those he loves suffer. 

In spite of this, Tom seems compelled to go through with his donation. The opposition voiced by those closest to Tom was strikingly familiar to me from my own research. In the film, a Consultant transplant surgeon describes how when the practice of altruistic donation started in the US, clinicians tended to think that altruistic donors were “crazy”, and describes how he still sees this type of organ donation as an “experiment”. 

Tom’s response to the opposition of those who love him is stark in its logic. He explains that once he had decided that he would unhesitatingly give a kidney to someone he knew, he felt that there was no reason not to do the same for a stranger. He recognises that it is the major point of difference between him and his family and friends, saying; “The only difference is my understanding of a stranger over theirs”.

About half way through the film, it emerges that a 24 year-old friend of Tom’s had died the previous year, and he says that this, his first experience of loss, taught him the value of life, and that donating his kidney is his way of dealing constructively with the death of his friend, describing his donation as a response to grief. 

Attempting to tell this complex story in a 30-minute film was ambitious, and the trust that Tom, his friends and family had in the film-maker is evident as they speak bravely and honestly about their doubts and fears. It is a gentle and sensitive film that let the contributors speak for themselves. I felt that it addressed one of the most striking and interesting ethical dilemmas that face the altruistic donor and those around them; the problem of how others view the act, not just clinicians but all those involved on a personal level. As a consequence, this issue does not only affect the individuals who decide to become altruistic donors, but reflects what we as a society think and feel about organ transplants and provides an opportunity to begin a much-needed conversation.

For more information on altruistic kidney donation visit NHS Blood and Transplant.

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