At the end of chapter 2 of Principles of Bioethics by Beauchamp and Childress, the issue of live organ donors was brought up, and a case of a prisoner who wanted to donate his one kidney to his teenage daughter was briefly mentioned (55).  I did some additional online research concerning the case of the daughter, Renada Daniel-Patterson and her father, David Patterson.

Background

Renada had been born with one malfunctioning kidney, and David, who was serving a prison sentence, was absent from the first decade or so of his daughter’s life.  However, when Renada was 13, she needed a kidney transplant, and her mother, as a diabetic, was not able to donate.  Her father contacted Renada, volunteering to donate a kidney, expressing guilt about not having been a competent and caring father (Nieves; “Inmate…”).  The transplant succeeded, but several years later, Renada began to reject the kidney David had given her.  At this time, David volunteered to give his daughter his remaining kidney.  This time, there were many ethical protests.  The procedure would put David’s life at great risk, and as a prisoner, the state would have to pay $40,000 a year for the dialysis he would need following the procedure.  Furthermore, there was no guarantee that the transplant would be successful; Renada’s body had already rejected one of her father’s kidneys, so it was possible that it would reject the other one as well.  An ethics committee discussed this case in great detail.  Some respected David’s offer and sympathized with his love for his daughter.  Others thought that it did not make sense for them to risk one life to save another.  Renada’s mother Vicki was upset that the matter was even up for discussion; David was a willing donor and Renada a willing acceptor, and to Vicki, that was all that mattered (Nieves).  Ultimately, the donation was decided against.  Renada later received a kidney from an uncle, but her body eventually rejected that kidney as well.  Renada passed away shortly before her 25^th birthday (Lagos).

The Dilemma

The ethics committee in this case are faced with two options: accept David’s offer or reject it.  The moral principles at play here include respect for autonomy, nonmaleficence, and beneficence (Beauchamp and Childress 13).  Beauchamp and Childress argue that “encouraging prospective living donors are ethically acceptable as long as they do not turn into undue influence or coercion” (Beauchamp and Childress 55).  David had not been part of his daughter’s life throughout her childhood, and he had never been coerced into giving his daughter a kidney (“Inmate…”).  Rather, he made the choice on his own and took the initiative to contact Renata and offer her the first kidney and later, the second.  However, the issue of nonmaleficence also arises.  If the physicians were to perform the procedure, they would be directly responsible for causing harm towards David; they would be putting the life of David, who I assume to be a relatively healthy man, into danger, and the transplant might not even be able to save Renata.  Additionally, the cost of David’s dialysis following the removal of the second kidney would place a great burden on the state.  However, the procedure could also provide great benefits, the most obvious being the prolonging of Renata’s life.  Additionally, David expressed guilt for not being there for his daughter throughout her childhood, and might feel that the pain and suffering he would have to endure following the procedure is the least he can do to make up for this (“Inmate…”).  Going through with the transplant would give David the chance to further reconcile with her daughter and help ease his guilt of not having been an ideal father.

Reflections

Beauchamp and Childress consider sacrificial acts to be examples of supererogation (Beauchamp and Childress 47), and I agree that David’s desire to donate his second kidney, and even his act of donating his first kidney to be not obligatory, but heroic.  While his intentions are admirable and understandable, I feel like the ethics committee chose the right course of action by refusing the transplant.  That they were later able to find an uncle to give Renata a kidney suggests that not all possible options had been considered prior to the discussion of the case.  Even if another donor had not been found, and although David, Vicki, and Renata were all in favor of the transplant, the doctor has a duty to preserve a patient’s life, but not at the cost of a healthy life.  In this situation, I feel like the goal of nonmaleficience takes precedence over the respect of the patient’s and family’s wishes.

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2009. 13, 47, 55. Print.

“Inmate Donates Kidney to Daughter.” Los Angeles Times. Los Angeles Times, 13 Mar. 1996. Web. 22 Jan. 2015. <http://articles.latimes.com/1996-03-13/news/mn-46515_1_pediatric-kidney>.

Lagos, Marisa. “BAY AREA / Woman Whose Inmate Dad Donated Kidney to Her Dies / She and Her Mom, from Oakland, Had Moved to Atlanta.”SFGate.  20 Mar. 2007. Web. 22 Jan. 2015. <http://www.sfgate.com/bayarea/article/BAY-AREA-Woman-whose-inmate-dad-donated-kidney-2609092.php>.

Nieves, Evelyn. “Girl Awaits Father’s 2d Kidney, And Decision by Medical Ethicists.” The New York Times. The New York Times, 04 Dec. 1998. Web. 22 Jan. 2015. <http://www.nytimes.com/1998/12/05/us/girl-awaits-father-s-2d-kidney-and-decision-by-medical-ethicists.html>.