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To the Editor: The consensus statement on the live organ donor was a welcome step toward the development of practice guidelines.¹ The section in the article entitled "Live Organ Donor Source" documented a variety of exchange mechanisms for increasing the supply of living donors. Although the panel noted that there has been concern in the literature regarding the ethics of exchanges, the panel failed to acknowledge the existing literature regarding each of these exchanges.^2-4

While the consensus panel supported the use of a live donor paired exchange, they raised the possibility that asking living donors of blood group O whose recipient is not of blood type O to consider donating to a stranger would double the possible numbers of live donations. We previously considered the option of an unbalanced paired exchange³ and found it problematic. First, there are potential medical and psychological reasons for a donor to prefer to give . . . [Full Text of this Article]