Ethical issues in kidney transplantation – reflections from Nigeria

Abstract

Organ transplantation has become a life-saving procedure for many disease conditions hitherto considered incurable. Kidney transplantation, now the treatment of choice for end-stage renal disease, is the commonest solid organ transplantation carried out in the world at the moment and it is the only solid organ transplantation done in Nigeria. This procedure, in addition to prolonging lives, also provides better quality of life and is evaluated as cost-effective, because it makes more resources available to other sectors of the economy. Organ transplantation in general and kidney transplantation in particular are fraught with ethical issues and dilemmas worldwide. Some of the ethical issues arising in the setting of developing countries like Nigeria may differ from those in countries where this procedure is established. Informed consent of the donor and the recipient is a major requirement for both organ donation and transplantation. Regarding donation, the ethical issues may differ depending on the type of organ donation, ie, whether it is living-related, living-unrelated, cadaveric, or from brain-dead individuals. Commodification of organs is identified as an ethical dilemma, and arguments for and against this practice are put forward here. Confidentiality of donor information, fairness and equity in donor selection, and access to kidney transplantation when needed are also discussed. Finally, the issue of safety of organ harvesting for the donor and of the transplantation process itself, and the possible long-term consequences for both parties are investigated.