Since at least 20 years the domain of transplantation is facing a severe shortage of available organs. Many countries are focusing on boosting living donation as the primary means for increasing the number of organs. To a considerable extent, the rise in the volume of living donation can be explained by the implementation of novel strategies. These include: (1) relaxing acceptable donor categories to allow living donation by total strangers and vulnerable persons; (2) approving more risky procedures such as living liver, lung, pancreas or intestine donation; (3) adopting protocols allowing incompatible donors to donate to an unknown recipient in exchange for an organ for their intended recipient (so-called paired exchanges); and (4) allowing internet solicitation of living organ donors and breaches of anonymity.
The proposed research will analyse to what extent these strategies, which are being implemented increasingly frequently, stretch the interpretation of or even shift the fragile balance between the key ethical principles of nonmaleficence, beneficence, autonomy, altruism and justice, principles which are enshrined in international ethical codes and legal instruments pertaining to the field of organ transplantation. The overarching goal of the research project is to assess the impact of the aforementioned strategies to alleviate the great medical need of transplant candidates on the
moral foundations of organ transplantation.