When Opportunity Knocks Twice: Dual Living Kidney Donation, Autonomy and the Public Interest

Living kidney transplantation offers the best treatment in terms of life‐expectancy and quality of life for those with end‐stage renal disease. The long‐term risks of living donor nephrectomy, although real, are very small, with evidence of good medium‐term outcomes. Who should be entitled to donate, and in which circumstances, is nevertheless a live question. We explore the ethical dimensions of a request by an individual to donate both of their kidneys during life: ‘dual living kidney donation’. Our ethical analysis is tethered to a hypothetical case study in which a father asks to donate a kidney to each of his twin boys. We explore the autonomy of the protagonists, alongside different dimensions of the public interest, such as the need to protect not only the recipients, but also the donor and even the wider community. Whilst acknowledging objections to ‘dual‐donation’, not least by reference to the harms that the donor might be expected to endure, we suggest there is a prima facie case for permitting this, provided that both donor and recipients are willing and that due attention is paid to such considerations as the autonomy and welfare of all parties, as well as to the wider ramifications of acting on such a request. We argue for broader interpretations of the concepts of autonomy and welfare, recognizing the importance of relationships and the relevance of more than merely physical well‐being. Equipped with such a holistic assessment, we suggest there is a prima facie case for allowing ‘dual living kidney donation’.