Although rare, children do serve as living solid-organ donors, and these donations raise serious ethical issues. In the clinical report, "Minors as Living Solid-Organ Donors," the American Academy of Pediatrics (AAP) examines the exceptional circumstances under which minors younger than 18 can morally serve as living organ donors. Four of these criteria are suggested by the U.S. Live Organ Donor Consensus group and have the agreement of the AAP. First, both the donor and recipient must be highly likely to benefit.

The psychological benefit for the donor is most likely to be high if donations are restricted to an immediate family member. Minors should never be considered as potential donors for strangers, or in cases where the likelihood of success is low.Second, the surgical risk for the donor should be extremely low. This suggests children should be restricted to serving as living kidney donors, which has lower risks than other types of living solid-organ donation.

Third, a child should be the donor of last resort, and should not undergo donor evaluation until all other options are exhausted, including the potential for a deceased donor. Fourth, the child should freely agree to donate without coercion and with full understanding of the process. Children who are too young to fully understand should not be allowed to donate.

The AAP adds a fifth criterion that the emotional and psychological risks to child donors be minimized. This may be accomplished through medical role playing, allowing them to ask questions and including them in the decision-making process. A donor-advocacy team to work with the child should be required for all transplants that involve living minor donors. Finally, more research should be conducted into the long-term benefits and risks of donation for children. The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well being of infants, children, adolescents and young adults.

American Academy of Pediatrics

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