The ethics of organ donation by living donors.

n engl j med 353;5 www.nejm.org august 4, 2005 444 with the requisite training and expertise to evaluate donors fully, to ensure that donations are voluntary, and to perform livingdonor surgery. In addition, better data about the outcomes of living donors should be forthcoming. The OPTN is also working toward requiring that transplantation centers report within 72 hours the death of a living donor or the donor’s need for organ transplantation. Finally, OPTN/ UNOS will develop a nationwide mechanism for allocating organs from living donors who have not directed their donation to specific persons.5 The principles will be similar to those for allocating organs from cadaveric donors. Eventually, there might be a registry for altruistic kidney and liver donors, such as the National Marrow Donor Program, which lists volunteer marrow donors. The controversy over the public solicitation of organs has forced the transplantation community to address a difficult issue and to reexamine its approach to living donors. As long as there is a profound organ shortage, the challenge of trying to help patients in need of transplants while upholding the integrity of the overall allocation system will not go away.