NEW YORK -- August 4, 2008 -- Although rare, children do serve as living solid-organ donors, and these donations raise serious ethical issues. The American Academy of Pediatrics (AAP) has published guidelines to examine the exceptional circumstances under which minors aged younger than 18 can morally serve as living organ donors.
The clinical report entitled, "Minors as Living Solid-Organ Donors," appears in the August issue of Pediatrics. The United States Live Organ Donor Consensus group suggested 4 of the 5 criteria published, with the approval of the AAP.
First, both the donor and recipient must be highly likely to benefit. The psychological benefit for the donor is most likely to be high if donations are restricted to an immediate family member. Minors should never be considered as potential donors for strangers, or in cases where the likelihood of success is low.
Second, the surgical risk for the donor should be extremely low. This suggests children should be restricted to serving as living kidney donors, which has lower risks than other types of living solid-organ donation.
Third, a child should be the donor of last resort and should not undergo donor evaluation until all other options are exhausted, including the potential for a deceased donor.
Fourth, the child should freely agree to donate without coercion and with full understanding of the process. Children who are too young to fully understand should not be allowed to donate.
The AAP adds a fifth criterion that the emotional and psychological risks to child donors be minimised. This may be accomplished through medical role playing, allowing them to ask questions and including them in the decision-making process.
A donor-advocacy team to work with the child should be required for all transplants that involve living minor donors. Finally, more research should be conducted into the long-term benefits and risks of donation for children.
The complete report can be viewed here: http://pediatrics.aappublications.org/cgi/content/full/122/2/454
SOURCE: American Academy of Pediatrics
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