Library Header Image
LSE Research Online LSE Library Services

An ethical appraisal of living-anonymous kidney donation using Adam Smith’s theory of moral sentiments

Khetpal, Vishal and Mossialos, Elias (2018) An ethical appraisal of living-anonymous kidney donation using Adam Smith’s theory of moral sentiments. Health Policy. ISSN 0168-8510

[img] Text - Published Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (685kB)

Identification Number: 10.1016/j.healthpol.2018.08.015


Ethical debates continue to shape organ transplant policies, particularly for kidneys. Facing organ shortages, governments have created incentives targeting prospective living-anonymous donors - socially and biologically unrelated to the recipient. However, these policies may transform altruistic exchanges of tissues into trades of commodities. We use Adam Smith's concept of sympathy to outline a new approach to transplantation ethics. This is accomplished using a case study analysis of six countries with established living-anonymous kidney donation practices – Iran, Israel, the Netherlands, Saudi Arabia, the United Kingdom, and the United States. An ethical test was also developed from ethnographies of donors and Smith's Theory of Moral Sentiments. The case study analysis considered the role of religious and historic norms, media campaigns, adherence to the 2008 Declaration of Istanbul guidelines for each case, and how each factor related to Smith's sympathy, categorizing the countries into four tiers of altruism. Iran occupied the least altruistic tier, followed by the Netherlands, the UK and the US, and Saudi Arabia and Israel. The ethical test identified a similar ranking. Our findings suggest that a highly-selected cohort of states with established living-anonymous kidney donation programs may already utilize a Smithian approach for recruiting donors, and that socially-valued government incentives can preserve altruism. The ethical test could become a useful instrument to assess the altruism of emerging incentive policies.

Item Type: Article
Official URL:
Additional Information: © 2018 The Authors © CC BY-NC-ND 4.0
Divisions: Health Policy
Subjects: R Medicine > RA Public aspects of medicine
Date Deposited: 11 Oct 2018 12:48
Last Modified: 20 Oct 2021 01:29

Actions (login required)

View Item View Item


Downloads per month over past year

View more statistics