NIV Congres

The issue of public solicitation is amongst the most controversial in living organ donation. The objective of our paper is to critically assess the arguments concerning public solicitation and to offer recommendations. While the legal framework is not that different between the EU and US (both condemn financially-driven solicitation), the practices of both transplant centers and of individuals needing a transplant vary. The main difference can be observed between certain liberal practices in the US (where one can find commercially operated websites soliciting organs altruistically donated from living donors), and more conservative practices in the EU (where such websites are absent). This is an attempt to clarify the terminology concerning public solicitation, the different levels of public solicitation, and the motivations of recipients and donors. Firstly we elaborate an operational definition for public solicitation that is consistent with the ELPAT classification of living donors. Secondly we evaluate the various arguments from the literature, both in favor of public solicitation and against it. Although they look contradictory, in most cases the same arguments are used both to defend the legitimacy of public solicitation and to condemn it. The arguments are classified according to the manner in which they influence the actions of recipients and/or donors, and regarding the influence on the donation/transplantation process at individual and societal level. Finally, we offer a set of recommendations. While we do not recommend it as a general practice, in our opinion, the acceptability of public solicitation by the patient or medical team could be explored for special cases, e.g. highly sensitized individuals or other patients with little chance of receiving a transplant otherwise.