The Water and the Blood: A Christian Ethic of Living Kidney Donation
Harrison Hines, MD, University of California, San Francisco
Introduction
There are 103,126 patients waiting for a kidney in the United States, and the median wait time is ~3-4 years. Approximately twelve people die each day waiting for a kidney and thousands more must be dialyzed three times a week to stay alive, so the amount of pain and suffering caused by end stage renal disease is immense.(1) Stratifying by race reveals that nonwhites wait much longer for their first transplant compared to their white counterparts (a disparity which is beginning to change with the implementation of a new kidney allocation system). (2) Blacks make up 32.3% of the waitlist, but they only receive 12.2% of living kidney transplants in part because they only comprise 6.9% of the living donor base.1 Much of the ethical language addressing these disparities in medical literature and popular news is utilitarian and centers on how to find more black donors, especially non-directed donors (NDD).
Thesis
The utilitarian framework—augmented by James Childress’ principlism and understanding of justice--that of most transplant centers use to determine who may donate to whom is internally inconsistent and directly contributes to the racial disparity in living kidney transplantation. Drawing from Christian doctrine, this paper offers a different model through consideration of 1) the primacy of community, 2) Paul’s discussion of giving in the body of Christ in 1 Corinthians, and 3) a preference for the vulnerable and marginalized.
Analysis
A utilitarian ethic must always first answer this question: whose common good is being sought? With few laws governing the allocation of living organs, individual surgeons and transplant centers must decide how to distribute living kidneys; minorities have inadvertently borne a disproportionate amount of the suffering caused by kidney disease. Most centers only accept directed donors or NDD, arguing that any other model would lead to an unjust distribution of kidneys as a public good. Minorities, particularly blacks, donate at low rates for multiple reasons, notably a mistrust of medical systems and belief that they will not benefit black communities.
Constructive Suggestion
The Christian ethic of valuing thick communal relationality, body membership and gift giving within that body, and Jesus’ continual movement to situate himself with those at the margins of society offers a different perspective when applied to living kidney donation. I propose that transplant centers work with local black congregations to set up exchange lists— open to all, but focused on black communities—so that black donors know their kidneys are going to others in their community. In this way, blacks will be able to honor their own internal commitments to their communities while embracing the distributive goods of altruistic giving.
1 “Organ Procurement and Transplantation Network: National Data.” US Department of Health and Human Services. Accessed 10/18/18. https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/.
2 Yoshio N. Hall et al. “Racial Ethnic Differences in Rates and Determinants of Deceased Donor Kidney
Transplantation.” Journal of the American Society of Nephrology: JASN 22.4 (2011): 743–751.
There are 103,126 patients waiting for a kidney in the United States, and the median wait time is ~3-4 years. Approximately twelve people die each day waiting for a kidney and thousands more must be dialyzed three times a week to stay alive, so the amount of pain and suffering caused by end stage renal disease is immense.(1) Stratifying by race reveals that nonwhites wait much longer for their first transplant compared to their white counterparts (a disparity which is beginning to change with the implementation of a new kidney allocation system). (2) Blacks make up 32.3% of the waitlist, but they only receive 12.2% of living kidney transplants in part because they only comprise 6.9% of the living donor base.1 Much of the ethical language addressing these disparities in medical literature and popular news is utilitarian and centers on how to find more black donors, especially non-directed donors (NDD).
Thesis
The utilitarian framework—augmented by James Childress’ principlism and understanding of justice--that of most transplant centers use to determine who may donate to whom is internally inconsistent and directly contributes to the racial disparity in living kidney transplantation. Drawing from Christian doctrine, this paper offers a different model through consideration of 1) the primacy of community, 2) Paul’s discussion of giving in the body of Christ in 1 Corinthians, and 3) a preference for the vulnerable and marginalized.
Analysis
A utilitarian ethic must always first answer this question: whose common good is being sought? With few laws governing the allocation of living organs, individual surgeons and transplant centers must decide how to distribute living kidneys; minorities have inadvertently borne a disproportionate amount of the suffering caused by kidney disease. Most centers only accept directed donors or NDD, arguing that any other model would lead to an unjust distribution of kidneys as a public good. Minorities, particularly blacks, donate at low rates for multiple reasons, notably a mistrust of medical systems and belief that they will not benefit black communities.
Constructive Suggestion
The Christian ethic of valuing thick communal relationality, body membership and gift giving within that body, and Jesus’ continual movement to situate himself with those at the margins of society offers a different perspective when applied to living kidney donation. I propose that transplant centers work with local black congregations to set up exchange lists— open to all, but focused on black communities—so that black donors know their kidneys are going to others in their community. In this way, blacks will be able to honor their own internal commitments to their communities while embracing the distributive goods of altruistic giving.
1 “Organ Procurement and Transplantation Network: National Data.” US Department of Health and Human Services. Accessed 10/18/18. https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/.
2 Yoshio N. Hall et al. “Racial Ethnic Differences in Rates and Determinants of Deceased Donor Kidney
Transplantation.” Journal of the American Society of Nephrology: JASN 22.4 (2011): 743–751.