Purpose: The number of living organ donors in the US has stagnated for 20 years, in part due to the rising prevalence of obesity, a common disqualifying comorbidity. While anti-obesity medications and surgery could help potential living donors lose weight, these interventions create a number of ethical concerns, including the potential for weight regain and inequitable access to therapies. Here, we propose an ethical approach to implementation of anti-obesity interventions in living donor candidates.
Methods: We conducted a normative analysis of ethical and policy implications of anti-obesity therapy for prospective living donors, grounded in medical ethics principles. Based on this analysis, we identify next steps in the ethical implementation of anti-obesity therapy as part of living donor care.
Results: Ethical considerations include maximizing recipient benefit, protecting donor autonomy, balancing donor risks and benefits, and promoting fair access to transplantation (Table 1). To honor the 4 grounding principles, 1) prospective donors should only receive anti-obesity interventions for which they would be medically eligible in absence of their intention to donate, and 2) transplant programs offering pre-donation anti-obesity interventions must prioritize weight loss sustainability and equitable access to therapies. We also identify national-level policy changes, including consensus-based clarification of NOTA, that are urgently needed to ensure ethical implementation.
Conclusions: Anti-obesity therapies may facilitate living donation, but guidance is needed to balance the ethical tensions between the obesity medicine landscape, payment policies, and the transplant system.
Keywords: Living organ donation, Weight management, Equity and access to organ transplantation
Learning Objectives:
After participating in this conference, attendees should be able to:
Articulate the ethical concerns associated with weight loss interventions for potential living organ donors.
Appraise the most pressing ethical issues transplant programs should consider in their living organ donor eligibility criteria and evaluation process including long-term risks, known and unknown.
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