The New Paper has featured the story of a case of altruistic kidney donation over the past 2 days.

It is indeed very inspiring and uplifting to read about such altruistic act of selfless giving.  It gives us much hope that the society has not turned “cold” and there are still many heros and heroines out there in our midst.

Such altruistic organ donation with no expectation of reward or compensation  to a total stranger is rare in Singapore.  The shortage of cadaver organs in Singapore has resulted in a long waiting list for organ recipients, some waiting as long as 5-7 years.

In an attempt to address this problem, many transplant centres in other countries rely on living donors as an important kidney source. Many such donations from living donors are from loved  ones or close friends where there are often strong emotional bonds or even unspecified obligation to donate an organ.

Nonetheless, such unconventional altruistic donation is not that common because of the difficult ethical issues raised by this practice. This is especially when the donor happens to be a stranger, and there is always a lingering doubt on the underlying motivation for the donation.

The hesitancy to perform this procedure from these unconventional donors arises from a number of concerns:-

1) One of the arguments is the concern for the safety and welfare of the donor, particularly since the donor has a less favourable risk–benefit profile.

Whilst the procedure of removing a kidney is relatively safe in today’s context, it is not risk-free and the donor can potentially loose one’s life should the rare complication or eventuality occur.

2) The other major concern against the use of altruistic donors is based on ethical considerations. There is much concern about the donor’s motivation, and that the establishment of using strangers as donors would set transplant medicine on a slippery slope towards potential commercialism of vital organs.

However, there is a counter argument that the desire to donate an organ to a stranger is not necessarily a pathological obsession or something sinister.  In fact, if the offer to donate is made altruistically, there is a greater likelihood that the patient is truly acting autonomously after much careful considerations; likewise, it may be argued that these altruistic donors are the only living donors that can truly give an informed consent, since there is are no overlying emotional concerns or sense of obligation that would invalidate voluntary consent.

Some people do believe in the psychological benefit of such donation. It had been suggested that unrelated donors may experience an even more enhanced sense of self?esteem compared to related donors, since no sense of obligation exists, making the act of donation truly extraordinary.