Should Children Ever Donate Kidneys?

BACKGROUND: Living donors provide the best outcome for children undergoing renal transplantation. Most of these donors are parents. When parents are unable to donate, siblings are often considered. But what if the siblings are also children? Should they be permitted to donate? METHODS: To see how this difficult ethical question is currently handled, a survey was mailed to all U.S. renal transplant centers asking for their policies regarding kidney donation by minors (< 18 years old). RESULTS: Among the 117 responding centers that offer pediatric transplantation, the vast majority (81%) prefer living related donors for pediatric recipients. Yet, only 33% of responding centers would allow a monozygotic twin minor to donate a kidney to his or her twin, and even fewer (21%) would allow a nontwin minor to donate to a sibling. In the year before the survey, only two of these centers had actually used a child as a kidney donor. Furthermore, the great majority of responding centers (68%) require living donors to be at least 18 years old. CONCLUSIONS: These data indicate that most U.S. transplant centers are opposed to using children as living kidney donors. On the other hand, a careful analysis of this issue suggests that although donation by a minor should be uncommon, a complete ban of this practice may be unwarranted. In unusual circumstances in which no other suitable donor is available, consenting mature minors, and even rare immature minors who are highly likely to benefit from donating, may be ethically acceptable. Although there are probably no absolute wrong or right answers, the question of kidney donation by children should be readdressed.