Nephrol Dial Transplant (1999) 14: 2043
© 1999 European Renal Association-European Dialysis and Transplant Association
Letters and Replies
`The spouse as a kidney donor: ethically sound?'
Transplantation Laboratory, Manchester Institute for Nephrology and Transplantation, Manchester Royal Infirmary, Oxford Road, Manchester, UK
Sir,
We commend the authors [1] in publicizing their efforts to increase the number of successful kidney transplants in their centre by the transplantation of kidneys from living genetically unrelated donors. As a member (PAD) and Chairman (MB) of the UK Unrelated Live Transplant Regulatory Authority (ULTRA) we wish to point out that the description of the procedure required by ULTRA as: `There is a complex regulatory procedure in the UK for assessment of the moral and ethical issues in proposed transplants between genetically unrelated individuals (ULTRA), part of which entails the potential donor and recipient writing personal statements' is somewhat misleading.
The UK Human Organ Transplants Act (1989) established ULTRA to ensure that every genetically unrelated living donor transplant complied with the terms of the Act, and to ensure that no payment of the donor should be involved. ULTRA has issued a single page form to be completed and signed for each donor and recipient, and countersigned by the clinicians responsible, including a statement that the terms of the Act have been complied with. In addition, an independent third party is required to submit a statement that the prospective donor and recipient have been interviewed separately and together and that there is no coercion nor payment. If the case is approved by ULTRA then authority to proceed with the planned transplant is usually issued within five working days.
The process aims to be efficient and not restrictive and ULTRA does not assess `moral and ethical issues' but compliance with the law. There is no requirement by ULTRA for `the potential donor and recipient writing personal statements'. The personal statements contained in the article are a valuable contribution to the literature on living donor kidney transplantation but they are not a requirement of ULTRA. ULTRA is always receptive to suggestions for its procedures.
References
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Mathieson PW, Jolliffe D, Jolliffe R, Dudley CRK, Hamilton K, Lear PA. `The spouse as a kidney donor: ethically sound?' Nephrol Dial Transplant (1999) 14: 46–48
[Abstract/Free Full Text]
Reply
Academic Renal Unit, Southmead Hospital, Westbury-on-Trym, Bristol, UK
Sir,
No criticism of the ULTRA procedures was made or intended. The existence of ULTRA provides important protection for all parties and we have found the assessment process to be efficient and fair. Clearly `moral and ethical issues' will have played a part in the framing of the law to which your correspondents refer: the personal statements made by our patients were included in their application to ULTRA because they addressed these issues so eloquently from the perspective of those individuals most closely involved. It was for precisely the same reason that we felt they deserved a wider readership, leading us to submit our paper.
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