When duties collide: Beneficence and veracity in the evaluation of living organ donors

PURPOSE OF REVIEW: Although the medical excuse is routinely used by many transplant programs, ethical issues arising from its use have received little critical attention. The present review will define the medical excuse and briefly discuss its history, purposes, and use in the context of evaluating donor candidates, and will provide a framework for evaluating some of the ethical issues related to its use through consideration of, and comparison with, ethical issues arising from the use of deception in medical practice. RECENT FINDINGS: No empirical evidence supports or contradicts claims about whether using the medical excuse in transplantation fosters the short-term or long-term benefits or harms commonly attributed to it. The literature on using deception in medical practice provides illustrative comparisons and suggests the medical excuse may have ramifications not yet well understood. SUMMARY: The medical excuse is used by many transplant programs to assist or usher donor candidates out of donation. The present review explores ethical issues that may arise from maintaining or abandoning this practice, and suggests that it merits further empiric and analytic attention from the transplant community.