Consent and living organ donation

By Maximilian Kiener.

Many people feel very gratified if they can donate an organ to their child or spouse in need. Others, however, are extremely frightened and secretly hope not to be compatible. In interviews, they admit to be ‘scared to death’ and ‘terrified all the way down.’ Yet, many of the most frightened eventually feel compelled to donate because they see themselves as under a moral obligation, experience pressure from social expectations, or are subject to explicit third-party pressure. Empirical evidence shows that, in one form or another, prospective donors can indeed be subject to serious pressure.

This situation poses an urgent question: when, if at all, do donors give voluntary consent? Voluntariness is key because it is a necessary condition for valid consent, i.e. necessary for consent to make transplantation surgery permissible. Moreover, the standards for consent must be very high: people would consent to a procedure that is risky, highly intrusive, and lacking in any medical benefit for them. Should it turn out that their consent is involuntary, this would be devastating for clinical practice.

In my paper ‘Consent and Living Organ Donation’, I analyse the conditions of voluntary donor consent. I was intrigued by this topic as the challenge to voluntary consent is both exceptionally complex and practically urgent. Arguing against three dominant views, I claim that voluntariness must not be equated with willingness, that voluntariness does not require the exercise of relational moral agency, and that, in cases of third-party pressure, voluntariness critically depends on the role of the surgeon and the medical team, and not just on the pressure from other people. On this basis, I conclude that an adequate account of voluntary consent cannot understand voluntariness as a purely psychological concept, that it has to be consistent with people pursuing various different conceptions of the good, and that it needs to make the interaction between the person giving consent and the person (or people) receiving consent central to its approach.


Paper title: Consent and Living Organ Donation

Author(s): Maximilian Kiener

Affiliations: University of Oxford

Competing interests: None

Social media accounts of post author(s): Twitter: @Maximilian.Kien2 ; personal website:

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