What drives altruism in living liver donors – a risk-decision analysis?

Here is my editorial highlight from the June edition of HPB the official journal of the IHPBA, A-HPBA and EA-HPBA

Living organ donation is unusual in medical practice because for the donor there is a significant health risk incurred through donation which is only offset by a sense of well being from helping another human who is in clinical need. In his contemporary analysis of Darwinist theory ‘The Selfish Gene’, Richard Dawkins explains altruism in terms of protecting lines of inheritance and in this analysis he questions the illogicality of altruistic acts outside of this framework.

This issue of HPB contains an analysis by Molinari and colleagues of the drivers for living liver donors to donate. The paper acknowledges the balance between risk and benefit and there is a several log order increased risk of serious harm or death to otherwise healthy individuals compared with for example living kidney donation. Molinari et al. did find that altruism wasn’t given completely freely. Apart from the obvious need for a biological or close emotional relationship between donor and recipient, donors had an expectation of reasonable prospects of survival for the recipient at one and 3 years. Donors were likely to donate if there was an expectation that the recipient would have a protracted wait for a cadaveric graft.

Interestingly donors were prepared to accept a greater level of risk than clinicians. This study provides an important insight into the decision-making processes of potential liver donors. The authors conclude that living donors are ‘risk takers’, while this may be true, the risks are calculated and the donors in this study seemed well equipped to make the decisions underpinning the risk.

Based on the following original article in the June issue of HPB

Live liver donors’ risk thresholds: risking a life to save a life (pages 560–574) Michele Molinari, Jacob Matz, Sarah DeCoutere, Karim El-Tawil, Bassam Abu-Wasel and Valerie KeoughArticle first published online: 20 NOV 2013 | DOI: 10.1111/hpb.12192
transplant copy
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