Development of a Donor-Centered Approach to Risk Assessment: Rebalancing Nonmaleficence and Autonomy

C. Thiessen, E. J. Gordon, P. P. Reese, S. Kulkarni*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

32 Scopus citations


Living kidney donors are often excluded from the shared decision making and patient-centered models that are advocated in medical practice. Thresholds for acceptable risk vary between transplant centers, and between clinicians and donors. Although donor selection committees commonly focus on medical risks, potential donors also consider nonmedical risks and burdens, which may alter their assessment of an acceptable level of medical risk. Thus, transplant centers may encounter ethical tensions between nonmaleficence and respect for donor autonomy. A donor-centered model of risk assessment and risk reconciliation would integrate the donor's values and preferences in a shared decision about their eligibility to donate. This paper argues for shifting to a donor-centered model of risk assessment, and presents a research agenda to facilitate the greater participation of donors in their own evaluation and approval processes. This viewpoint advocates for the adoption of a donor-centered approach to living kidney donor evaluation, thereby enhancing donor autonomy and involvement in determining acceptable levels of donation-related medical risk.

Original languageEnglish (US)
Pages (from-to)2314-2323
Number of pages10
JournalAmerican Journal of Transplantation
Issue number9
StatePublished - Sep 1 2015


  • Donors and donation: donor evaluation
  • donors and donation: living
  • editorial/personal viewpoint
  • ethics
  • ethics and public policy
  • kidney transplantation/nephrology
  • kidney transplantation: living donor
  • risk assessment/risk stratification

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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