Should We Accept Kidney Donations from our Children?

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I’ve been looking into the phenomenon of organ donation from children to parents. Since I believe our national approach to Medicare injures future generations on behalf of us in the over 65 cohort, I wanted to see how we’re dealing with the most tangible form of intergenerational transfer – organ donation.

Here’s what the Handbook of Kidney Transplantation has to say about donation from children to parents:

Parents often are reluctant to turn to their children as potential donors, yet as those parents age, it becomes less and less likely that a donor from their own generation will be available. It is useful to point out to parents that their grown children are adults who are capable of making independent decisions; that the welfare of the donor will be protected in the evaluation and donation period; and that, if they exclude their children as donors, they may be preventing them from enjoying the psychological gain of helping a beloved parent. Older patients will often insist that they would have been prepared to donate to their own parents while simultaneously expressing reluctance to permit their own children to donate to them.

To my eye, the author evinces an unseemly rush to persuade us that it’s right to cannibalize our children’s bodies. He treats reluctance to accept kidney donation as an irrational stance. And with regard to the donor, he minimizes concern for physical and psychological risk, and envisions only “psychological gain [from] helping a beloved parent.”

By way of contrast, Sharon Kaufman, professor of anthropology at UCSF, has written a wonderfully thoughtful article based on interviews with kidney recipients over 65 and their donors, “Aging Bodies and Kinship Matters: The Ethical Field of Kidney Transplant.” She demonstrates that attitudes range from what I would call “entitlement” (in effect, “I have a right to your kidney so that I can go on living”) to a view that transfer of body parts from child to parent is wrong (in effect, “if you need a kidney I should give it to you, but absolutely not the other way around”).

Here’s a vignette from a patient who ultimately accepted a child-to-parent donation:

The children talked me into it. I said, I’m not taking my daughter’s kidney! But other family members persuaded me. You know, I kind of went along with my older daughter’s insistence, and we didn’t say too much one way or another, whether I wanted to or not. But I was hopeful that I could get a cadaver—right up to the night I was hospitalized. My point was, I didn’t want to take an organ from my child. If it were the other way around, I would have gladly given my kidney to one of them, but because it was coming as a hand-me-up sort of thing, I thought about it a lot. It didn’t feel like it was the right thing to do. Help should go the other way, from parent to child. I, really, there were periods of time I just really didn’t want to do it. There was no real point in time where I decided I wanted to have it done. I just went along with the flow. I was going along for the ride because things were being arranged for me.

The clinical and ethical issues will vary from family to family. Parental age matters. A 50 year old still raising children who dies from kidney disease is “abandoning” dependents and missing out on half of adult life. An 80 year old has lived a full life span. I don’t know how others would assess the ethics of taking a child or grandchild’s kidney at that age. In my view it would represent monstrous narcissism.

The fact that the 2010 Handbook of Kidney Transplantation discusses child-to-parent transplantation as if the only moral issue was clearing away impediments to going ahead suggests the degree to which the technological imperative to do what is technically possible to do has gone onto automatic pilot. Organ donation from a child to a parent demands careful medical, psychological and ethical attention. It deserves better than the superficialities the Handbook offers.

James Sabin, M.D., 73, is an organizer of Over 65 and a clinical professor of psychiatry at Harvard Medical School.

5 Responses to “Should We Accept Kidney Donations from our Children?”

  1. Ted Marmor

    Jim, thank you for setting out a thoughtful counter to the Handbook’s easy conclusion about children’s obligations to parents. I did, however, notice an opening aside about how our national approach to Medicare “injures” future generations. My guibble is not with the effects of having a social insurance program that began with over the over 65 year old population, then expanded to the disabled, and included victims of renal failure. Those are simply facts about the history of public health insuranc in the US. But that history has little to do with the demands of seniors when Medicare was started or the aims of the reformers who wanted to start with those on Social Security retirement so as to blunt the ideological objections to overall national health insurance. In short, the history has been one of disappointed broader hopes, nothing like the sense of “entitlement” you rightly criticize in the presumption that children should be expected to give organs to parents in need. best, Ted Marmor

    • Jim Sabin

      Hi Ted –
      My comment about how our approach to Medicare injures the futurewas intended to refer to (a) our refusal to apply a cost effectiveness perspective in Medicare policy, (b) the degree of overtreatment that Medicare fee-for-service reimbursement rewards – treatment that the elderly, especially near the end of life, don’t want, and that wastes substantial money, and (c) our preventing Medicare Part D programs from bargaining over the cost of pharmaceuticals.
      My view is that Medicare should follow the practices of the best not-for-profit prepaid programs. Medicare itself is, literally, a lifesaver, and, as well, a life-enhancer, for beneficiaries. But our national phobia about managing health care expenditures – as evidenced by public readiness to believe the “death panel” falsehoods – has led to substantially higher expenditures than our health and well-being require.
      Best
      Jim

  2. tammy

    Thanks for thoughtful piece. Just came across 62 yr old woman about to get kidney from living son. She showed not a hint of concern. I did not even know that living child to older parent transplants are ever done. I feel sad for the child who may have felt the mother was entitled to taking back that kidney since she gave it to him by conceiving him, a completely fallacious argument.

  3. Dire McCain

    It may be a tough call, but I do not think we conceive our children as a source for spare parts. I think a 60 year-old harvesting a kidney from a young daughter just beginning her life and with young children of her own is reprehensible. The daughter has an entire life to live and children who will depend on her health and well-being to continue to live their lives as well. The ultimate expression of the ‘me’ generation.

  4. Angel

    My mom just turned 55 and told me Thurs shes now in stage 4 her kidneys r only functioning at 29%. She refuses my offer. I may not evrn be a match as it turns out. Im A blood sge is O. My younger brother however is a O. But wont lemme steal his -_- she won’t either. He just had a son. He’s 25 im 27. Im still getting the test because im a blood relative. Unless they just tell me no due to blood type. I’ve been depressed since she told me. I dont have kids. And dont really want any. I cant function without the kidney. As long as I match I’d want her to have one. I go outta my way for my mom and this is no different