Free and informed consent is generally acknowledged as the legal andethical basis for living organ donation, but assessments of livingdonors are not always an easy matter. Sometimes it is necessary toinvolve psychosomatics or ethics consultation to evaluate a prospectivedonor to make certain that the requirements for a voluntary andautonomous decision are met. The paper focuses on the conceptualquestions underlying this evaluation process. In order to illustrate howdifferent views of autonomy influence the decision if a donor's offer isethically acceptable, three cases (...) are presented – from Germany, theUnited States, and India. Each case features a person with questionabledecision-making capacity who offered to donate a kidney for a siblingwith severe renal insufficiency. Although the normative framework issimilar in the three countries, different or sometimes even contraryarguments for and against accepting the offer were brought forward. Thesubsequent analysis offers two explanations for the differences inargumentation and outcome in spite of the shared reference to autonomyas the guiding principle: (1) Decisions on the acceptability of a livingdonor cannot simply be deducted from the principle of autonomy but needto integrate contextual information; (2) understandings of the wayautonomy should be contextualized have an important influence on theevaluation of individual cases. Conclusion: Analyzing the conceptualassumptions about autonomy and its relationship to contextual factorscan help in working towards more transparent and better justifieddecisions in the assessment of living organ donors. (shrink)

Living organ donation is developing increasingly into an important therapeutic option in transplantation medicine. In spite of the existence of a normative-legal frame, medico-ethical questions remain open. Among these are in particular 1) who should be taken into consideration as a donor, 2) how information concerning the possibility of living organ donation should be passed on, and 3) what an adequate medical-psychosocial evaluation of potential donors should look like. The paper presents the results of a survey based on questionnaires, which (...) addresses the current practice in German transplantation centers as well as the opinions of clinical practioners regarding these three topics. The empirical data form the context for the formulation of medico-ethical ideas and suggestions concerning living organ donation in Germany. (shrink)