Kidney Donation?

[sadie1263]

Md. philosophy class gets a real-world question: Should professor give a kidney?

By Jenna Johnson
Washington Post Staff Writer
Thursday, December 23, 2010; 9:30 AM

In late August, students in Philosophy 380 at St. Mary's College of Maryland received an unusual assignment centered on this question: Should the professor donate a kidney to a stranger?

Organ donation, a subject ancient philosophers hardly could have imagined, often comes up nowadays in college courses because of the ethical implications of the many stunning breakthoughs of modern medicine.

St. Mary's professor Michael Taber wanted to push the topic a step further, making it personal instead of theoretical. He figured it would show students a connection between their education and the real world. He also was curious whether the discussion would change with the stakes raised.

"It's easy for philosophy seminars to get lost in the clouds," Taber said. "I wanted them to take the readings and seminar discussions and apply it to a concrete decision."

In 2009, there were more than 13,600 kidney donors in United States, federal data show, about 6,300 of them living and the rest deceased. Meanwhile, more than 87,000 people are awaiting a kidney donation, which would enable them to forgo dialysis treatments and potentially add years to their lives.

Medical advances in the past 20 years have made it easier and safer for living donors to give one of their two kidneys. Still, most such donations are made to help a relative or close friend.

Taber first considered giving a kidney more than five years ago after one of his students wrote a paper about the end of life and how varying definitions of death affect organ harvesting. Sometimes he would broach the possibility of donation in a class discussion. A few years ago, he talked about donation with his wife and took a blood test.

As the school year began, though, he had yet to answer a number of daunting questions: What did his family think? What risks did he face? Would he need that kidney in the future? Would this be an altruistic act or an egotistic one?

He asked his eight students in the seminar to study the subject, formulate a yes or no recommendation and write a paper explaining their reasoning.

In an initial discussion in October, the students mostly agreed that donating a kidney was an upstanding thing to do. But as talk shifted to their professor, the issue became more complicated.

The students realized,"Oh wait, this is a real thing. This isn't an exercise," said Lex Cosenze, a junior majoring in anthropology, philosophy and history. Although philosophy students sometimes like to debate whether to save a train of orphans headed toward a cliff or save one beloved person, Cosenze said, "you don't get something this huge in your day-to-day life."

Many St. Mary's students meet Taber through a first-year leadership program. The 51-year-old, who has taught since 1987 at the public college in Southern Maryland, is known on campus as a friendly, fatherly mentor. He looks the part: bearded, with glasses, wearing jeans, a vest and hiking boots. Often students can be found sitting in the funky, swiveling chair in his bookcase-lined office.

About half of the Philosophy 380 students were majoring or minoring in the subject. All were sophomores or juniors.

The group included a tattooed junior who doesn't like to gender identify and loves fantasy role-playing games; an artsy rugby player from a small farm town whose career plan is being a mother; an athletic economics major who plans to do international service work after graduation; and a bearded junior who wears sandals in winter and considered the entire project "pointless."

The students researched organ donation, studied Taber's family medical history and health insurance plans, and compiled questions for the professor to ask his wife. Late one evening this month, the students e-mailed Taber a 15-page paper.

The introduction stunned him: "We took a vote on whether the answer to donate should be yes or no, and found that if we were really the ones making the choice, then we would have to say no."

He reread it. The students repeatedly wrote that it was not their decision whether to make a donation. One student dissented, saying he hopes himself one day to save a life by donating a kidney. But on the whole, the students argued they could not in good conscience advise Taber to donate because of the risks - albeit slight - of death or disfigurement.

The students wrote that being a live donor is "a morally good act, but it is not the opposite if someone chooses not to." They added that people "have a moral obligation to themselves that must be considered before moving to donate pieces of their body."

Taber had not expected that response. Especially at a small liberal arts school with a reputation for social activism. And especially in a philosophy class.

"Students are unpredictable," he said, shaking his head. "I thought they all would have been on board."

He reflected and realized this friction point was part of the learning experience. On Dec. 9 he e-mailed the class: "Last night I read your Project Kidney paper, and I [was] impressed with its thoughtfulness. Today I re-read it, and I am impressed with its cowardice."

He raised several objections and questioned why they were squeamish about giving a recommendation. The next afternoon, the class gathered again.

One student stressed that all they could do was provide the professor with information to make his own decision. Another drew a diagram on the chalkboard to explain to Taber that the paper was written for the professor's "spectator self" and not for his "personal self."

"I don't think any of us could say, 'Go take your kidney out today,' and then you die on the operating table," Cosenze said. Later in the class, the student asked: "What's so compelling about this ... that you are willing to take the risk?"

"We should help each other out whenever possible," Taber responded. He doesn't have billions of dollars to donate, the professor said, but he is "packing an extra kidney" that could improve the quality of life for someone else.

The class ended. The semester ended. Taber still has not decided what to do.

The seminar answered many questions for Taber but raised another: If he does donate a kidney, how many of his students will be disappointed?

[aubrey]

I don't know about this. I didn't want my sister giving me a kidney - I would have felt bad about it, for one thing. And there is the risk. Very slight risk, I know, but she has two young kids and, you know.

[sadie1263]

I have a friend that is a transplant patient. Her daughter also just had to have a transplant. I'm so very grateful to still have both of them. I am on the bone marrow donor list......but my family is against me donating anything more. But I feel such an......well almost obligation.......if my loved one was in need......and I could not donate......I would want someone else to step up.......so if I feel that way.......shouldn't I?

There are so many needy people out there...........

[Deleted]

I understand that all kidney donors are given priority for a transplant should their remaining organ fail. If this is true, would this knowledge help encourage more donors I wonder?

[pumpkinpie]

Dec 28, 2010 1:51:09 GMT sadie1263 said:

I have a friend that is a transplant patient. Her daughter also just had to have a transplant. I'm so very grateful to still have both of them. I am on the bone marrow donor list......but my family is against me donating anything more. But I feel such an......well almost obligation.......if my loved one was in need......and I could not donate......I would want someone else to step up.......so if I feel that way.......shouldn't I?

There are so many needy people out there...........

Yes, I agree.... I would probably try to do this for any of my loved ones, friends or family in need of this.

What are the risks though, or are there any- to having just one kidney, and would this affect the doner in anyway, after the healing process? I'm sure I would find all this out if I were to be in that particular situation.

[sadie1263]

I saw recently a really heartbreaking story about two brothers. One had been sick most of his life. The other had always been healthy....was married and had kids.

Came time for a transplant and the healthy one donated one of his kidneys. The transplant went fine....but the next day...something happened....and the healthy brother died. Now the one other one has tremendous guilt for taking the kidney and for being the survivor. They said it is very rare......but that it does happen.

[aubrey]

You can do OK on one kidney; you even manage pretty well on 20% kidney function, and only start dialysis when it drops to 15%.

Sadie, I think that eg must have had something to do with the operation, rather than losing a kidney.

[sadie1263]

I think so too.......I have heard the procedure is rather tough.

[trubble]

Dec 28, 2010 8:35:00 GMT @skylark said:

I understand that all kidney donors are given priority for a transplant should their remaining organ fail. If this is true, would this knowledge help encourage more donors I wonder?

It makes me feel more worried about the risks of failure, to be honest.

[trubble]

I am delighted to read about the students' decision.

The students repeatedly wrote that it was not their decision whether to make a donation. One student dissented, saying he hopes himself one day to save a life by donating a kidney. But on the whole, the students argued they could not in good conscience advise Taber to donate because of the risks - albeit slight - of death or disfigurement.

The students wrote that being a live donor is "a morally good act, but it is not the opposite if someone chooses not to." They added that people "have a moral obligation to themselves that must be considered before moving to donate pieces of their body."


Read more: biglinmarshall.proboards.com/index.cgi?action=display&board=philosophy&thread=2050&page=1#ixzz1AirfQtMH

We had this debate a couple of years ago on a messageboard when there was a story in the papers about a sibling who refused to donate to a sibling. The one needing a transplant was moaning in the press about how disappointed she was, but the one with the healthy kidney had a partner and children to consider.

My conclusion at the time was that we can't call something ''heroic'' if it's a commonplace activity. It is heroic to donate a kidney, no matter how ''small'' the risks might be. You can't expect everyone to be able to do it, can you. In fact, it would be highly irresponsible of me to take such a decision lightly if I had any dependants, right?

The professor says he came to see the students' choice as ''cowardice''. I think he is mis-teaching his students. I think he has lost the plot, in fact.

They made a morally sound choice; it is not in their remit, nor should it be, to do anything but provide full information - they should never advise on a decision of life/death and incapacity. If forced, they can only (ethically) advise caution and conservative action. That's all one human can morally do for another.

The professor is also a bit stupid. He is not, as he puts it, "packing an extra kidney". It's not superfluous.

[aubrey]

Packing an extra kidney is not a good way of putting it, no.

The operation for a donor is a bigger one, and so more dangerous, than that for the recipient. I don't know how much more dangerous in percentage terms, but I expect it could all be made to look pretty scary, if someone wanted.

[sadie1263]

It truly is a huge undertaking......and you are right. Should someone with dependents take that on?

It is not cowardice to not do it.

For the people needing the donation it has to be such an awful thing. You are dependent either on a loved one risking their life........or on an unknown stranger......or on someone dying and getting it that way. Must be a horrible limbo to be in.........