Both living donor transplantation and human subjects research expose one set of individuals to clinical risks for the clinical benefits of others. In the Belmont Report, the National Commission for the Protection of Human Subjects of Biomedical and Behavior Research articulated three principles to serve as the basis for a research ethics framework: respect for persons, beneficence and justice. In contrast, living donor transplantation lacks a framework. In this manuscript, we adapt the three principles articulated in the Belmont Report to (...) serve as the foundation for an ethics framework for living donor transplantation which we supplement with the principles of vulnerability and responsibility. The National Commission supported additional protections for vulnerable groups of potential research participants. In 2001, Kenneth Kipnis effectively argued that the concept of vulnerable groups failed to explore in what ways particular groups of people were vulnerable, thereby risking unnecessary protections for some and inadequate protections for others. He proposed a taxonomy that explored different types of vulnerabilities that all research participants may experience to provide a more robust framework for human subjects protections, which we adapt to living donors. Robert Goodin claims that health professionals, who stand in special relationship with patients, are responsible for promoting and protecting their well-being. In living donor transplantation, the donor transplant team is responsible for empowering prospective donors to address their vulnerabilities and/or for protecting those who cannot by disqualifying them from donation. (shrink)

The present trend toward routine inquiry appears to be based on the false premise that the individual's wishes cannot be known and that, therefore, the family is the only alternative for making donation decisions. The UAGA states that the family should be turned to only when the wishes of the individual are not known.To protect the right of individuals to make their own decision, an effective and efficient process for making the wishes of individuals known should be devised and the (...) UAGA amended accordingly. I have presented the policy of strong required request as the best way to effectively protect the rights that the UAGA ostensibly gives to the individual. This policy ensures that the individual's wishes, both for and against donation, are known. It also alleviates some of the problems in the original approach that hindered the procurement of organs from willing donors. Strong required request saves families from making critical decisions, which may be painful and conflicted for some, at a time of emotional shock and grief. (shrink)