'Not a matter of choice' : ethical perspectives on decision making about living parental liver donation

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Since 2004 children waiting for a liver transplant can also receive a partial liver graft from a living donor, usually a parent. The introduction of parent to child LRLT changed the character of the involvement between the transplant team and the family of the patient. When this option of living liver donations was introduced, professionals and relatives around a patient faced new responsibilities. Parents of young patients or other relatives had to consider whether to donate or wait for a deceased donor liver graft, whether their family could cope with an extra patient, and if they were willing to accept the risk. Professionals also had to reconsider their responsibilities. Under which circumstances could they account for the involvement in risking the life and health of a healthy donor? How should they handle different vieuws of colleagues on the subject? how could they inform and talk with parents or other relatives about the option of living donation without presurring hem? In the views that parents and professionals developed on such questions, understandings about professional and family relations formed an important background. This background of moral understandings about parenthood, about what it means to be a good doctor, about good patient-doctor relationships surround the course of decision about LRLT.
The aim of this thesis is threefold. 1. To undertake a refelctive ananlysis of moral understandings in decision making about LRLT. Reflective analysis involves mapping how participants in the practise of LRLT understand what they are doing. 2. To offer a critical reflection on the moral understandings that guide decision making. In critical refelction the authority and adequacy of moral understandings are examined. 3. To offer a normative reflection on questions about good moral understandings. Are the moral understandings good or better than other that might be imagined? These different forms of analysis and reflection are intertwined, and they are based on qualitative ethical research.

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