Living Donor Kidney Transplants and the Good Samaritan: Religious, Legal and Ethical Challenges of Nonsimultaneous, Extended, Altruistic Donor Chains (2014-2015)

This Bass Connections project team researched ways to increase the pool of living kidney donors through altruistic donor chains, which could lead to never-ending donor-recipient pairings. Team members engaged in planning and implementation of a working group and symposium on the subject of nonsimultaneous, extended, altruistic donor (NEAD) chains in the arena of kidney transplants.

NEAD chains provide one possible solution to the real-world problem of end-stage renal disease (ESRD), which leads to 90,000 deaths each year in the U.S. and costs Medicare $28 billion. Even more, ESRD highlights the health disparities of African Americans and Hispanics, among others, and it raises a host of important questions across a wide variety of disciplines, including medicine, law, religion, public policy, global health and various disciplines within the brain sciences.

The team considered such research questions as:

  1. What motivates the small number of people in the U.S. each year (approximately 160) who give a kidney to a complete stranger? How do they come to make this decision? What moral attitude guides them?
  2. The Orthodox Jewish community, numbering only 300,000, contributes one third of the total number of annual non-directed donors in the U.S. (albeit with the qualification that the strangers be other Orthodox Jews). What is it about Orthodox Judaism that makes this small community so successful in producing altruistic donors?
  3. Might their successes be duplicated in Christian communities, or in other religious traditions?
  4. To what extent, if at all, might the experience of Orthodox Jews translate to other religious subcultures, such as the Black Church – and might engaging African American churches help address the living donor and transplant disparities that plague African Americans?
  5. NEAD chains depend on trust and on people fulfilling a promise in the future. Are the agreements between paired donors contractual and enforceable? Would the attempt to enforce a donation be coercion? If not, why not? 
  6. The shortage of kidneys for transplant leads some people to leave the U.S. as transplant tourists, which, among other things, encourages a black market of organ donation. What if, instead, we found a way to increase the size of the donor pool by making it global? What would be entailed in addressing global disparities by implementing what some have called “reverse transplant tourism”?

Team members also planned and participated in a working group meeting of Duke faculty members and practitioners (surgeons, physicians, clergy) on November 11, 2014.



Team Outcomes

Working group meeting of Duke faculty members and practitioners (November 11, 2014)

This Team in the News

Where Are They Now?

See related team, Generosity and Gratitude: Mechanisms, Motivations and Models of Living Kidney Donation (2015-2016).


Team Leaders

  • David Toole, Divinity School

/graduate Team Members

  • Dorothy Mangale, Global Health - MSc
  • Michael McCarty, Doctor of Theology
  • Kathleen Perry, Global Health - MSc

/undergraduate Team Members

  • Camila Vargas, Interdept Psych/VisMediaSt(AB)
  • Selina Wilson, Psychology (BS)

/yfaculty/staff Team Members

  • Kimberly Krawiec, Duke Law