Decision-Making Processes in the Context of Living Kidney Donation – Medical Ethics and Medical Anthropological Aspects

Department of Medical Ethics and History of Medicine

Carried out by: Dr. Sabine Wöhlke


Living donation is playing an increasingly important role in transplant medicine. It is usually advertised as an uncomplicated act of love and duty of care. The present study takes a precise look at the issue of living kidney donation in Germany. The empirical study opens the “black box” for family decision-making when it comes to donating live kidneys to science.

The focus is on the perspective of those affected. In view of the frequently observed shortage of organs, it is important to investigate the arguments, positions and uncertainties of those directly and indirectly affected by organ donation in more detail. The result of my work shows that the decision-making process is influenced by the reciprocal relationship of the donor-recipient-couple, since the kidney is given according to the rules of the “gift”. In addition, the decision is heavily influenced by self-determination in a relationship that includes role assignments and role expectations as well as gendered social and moral identities. In order to give an organ, body concepts are also essential, e.g. to ensure organ integration.

The motives of donors and recipients showed that family decisions are essentially reciprocity and that the entire family is involved in the process. The empirical evaluation of the dose makes an important contribution to the discussion on medical ethics, since reciprocity logics are activated in the family context for living donation. In addition, there are strong ambivalences and uncertainties among those affected because the symbolic value of a donation cannot be precisely determined. The consequences are subtle forms of gratitude and often feelings of guilt towards the donor.

Those affected have different ideas about the body, these have an impact on how and whether they can handle living donation. The fragmented body concept, which is shaped by biomedical ideas, is most widespread, but reference can be made to sub-types that are particularly powerful due to the processes of gender. Women with a reproductive understanding of the body often equate organ donation with birth and biological reproduction, men on the other hand with economic labor. It can be shown that a holistic understanding of the body can also be practically combined with organ donation /? Transplantation.

Not least due to the establishment in the Transplantation Act, the voluntary nature of the action is given high priority within the framework of the decision. But this is difficult to check. Donors as well as recipients refer to a relational autonomy concept, insofar as a decision was made in the context of the family. This family context also includes the respective roles of the individual in the family structure.

The results point to considerable differences between donors and recipients in terms of motivations and scope of action, so that a demand for a difference in perspective is an essential methodological result. The investigation therefore helps to take a closer look at the burdens on the donor-recipient relationship and provides concrete recommendations for action for all those involved in a live organ transplant.


  • Sabine Wöhlke (2015). Donated organs? Ethical and cultural challenges in family living kidney donation, Campus, 300 Seiten. 
  • Wöhlke, Sabine & Doyé, Lutz, (Hrsg.): So you can continue to live: The gift of kidney – Affected people tell their story


Workshop: "Frauen geben, Männer nehmen?" Genderaspekte in der Organtransplantation – empirische, theoretische und normative Fragen, Erlangen, Januar 2014

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