Doctor's unique donation prompts ethical concerns

A Chicago-area nephrologist's gift of a kidney to her patient raises the question of whether doctors should be living organ donors.

By Damon Adams, AMNews staff. May 19, 2003.

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Dead or alive, Susan Hou, MD, was going to donate a kidney.

She thought about it 30 years ago when a fellow medical student was fighting kidney disease, but the student's brother stepped up. Dr. Hou, now a nephrologist near Chicago, pondered being a living donor to some of her patients, but the match was never right.

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Then, about six years ago, she broke her back when she fell off a horse and thought she might have to be a cadaveric donor.

"I did make a point of telling [paramedics] that if I didn't make it, I wanted my kidneys to go to my patients," she said, her blue eyes aglow. "They kind of rolled their eyes at me and said, 'You'll make it.' "

Make it, she did. In more ways than one.

Last October, Dr. Hou, 56, donated a kidney to Hermelinda Gutierrez, 34, a mother of two.

Dr. Hou, medical director of the renal transplant program at Loyola University Medical Center in Maywood, Ill., had told Gutierrez at their second meeting as doctor and patient that she wanted to give a kidney to her.

The transplant is believed to be the first time a U.S. physician has donated a kidney to a patient who is not family.

While many in the medical community praised Dr. Hou for her altruism, the transplant also sparked debate about whether it is ethically proper for a doctor to give an organ to a patient.

"If you have one kidney to give, how do you decide who to give it to? It's a precious gift," said Jeffrey Kahn, PhD, MPH, director of the Center for Bioethics at the University of Minnesota, Minneapolis.

Mark Fox, MD, chair of the ethics committee for the United Network for Organ Sharing, said continuing to treat someone who received one of your organs could be problematic.

"It's called the tyranny of the gift ... that they feel some sort of ownership over the direction of the recipient's life," Dr. Fox said. "You literally owe your life to this physician. The moral dimension of that is staggering."

From doctor to donor

Dr. Hou reminds skeptics she had contemplated being a donor for quite some time.

Her parents instilled in her the importance of organ donations before she went to medical school. She said she became committed to donating a kidney after seeing what her ill friend went through when the two attended the University of Massachusetts Medical School in Worcester.

"He kind of kept reading the chapter in [Harrison's Principles of Internal Medicine] on renal failure, describing death. I think the last line is, 'coma mercifully precedes the end,' " she said.

Since coming to Loyola in 2000, Dr. Hou seriously has considered donating to patients, but never had a sound antigen match. Dr. Hou also wanted to make sure she found a responsible recipient.

"I knew 90% of the people I ran into I would have liked to have gotten off of dialysis. But I wanted to make sure I gave it to somebody who was going to take care of it," Dr. Hou said.

Size mattered, too. Dr. Hou is 4 feet 10 inches tall. Because her kidneys were small, too, she needed a small recipient. "[NBA center] Alonzo Mourning, it wouldn't work for him," she said with dry humor.

Then, in January 2002, Gutierrez's doctor sent her to Loyola to be considered for a transplant. She met with Dr. Hou.

"I thought, 'Gee, I can't give this [kidney] to anybody, and then I walked in and saw her and here she is, she's 4 feet 7 [inches] and weighs less than I do," Dr. Hou said.

Initially, the physician didn't mention her intentions to Gutierrez. She continued tests on herself and spoke to her husband, endocrinologist Mark Molitch, MD, and her three children. She also ensured her children's kidneys were healthy.

In September, Gutierrez returned to Loyola, and Dr. Hou made her offer. A few weeks later, on Oct. 10, the kidney was transplanted during a 3 ½-hour surgery at Loyola.

Dr. Hou was out of the hospital two days later, but was sore for a few weeks. Neither she nor Gutierrez have had any major complications yet.

Changing the relationship?

Although Dr. Fox said health professionals who want to donate organs should go to a different transplant center to avoid potential conflicts with colleagues, Dr. Hou said Loyola was the most logical place. "Come on, I know these guys are good. I'm not going to another center."

Dr. Hou continues to see Gutierrez as a patient -- something ethicists also say could cause problems.

Dr. Kahn said it's probably not a good idea to have the donor doctor continue to treat the recipient patient because it may be tough for the physician to remain objective.

"[The transplant] obviously makes it a different relationship than it was before," he said.

But Dr. Hou doesn't see it that way. She said she took a hands-off approach the first three months after the transplant, and now typically sees Gutierrez at the medical center once a month. But other doctors sometimes see her, too.

Gutierrez is understandably grateful. "I feel very good. I feel happy, too," said Gutierrez, who lives in suburban Bridgeview, Ill., with husband Juan and their two children. "I'm glad to know there are people like her out there."

Dr. Hou doesn't think she's extraordinary for what she did. She just wishes others would consider giving the gift of life.

"I hope people call in and say they want to donate kidneys. Two people did yesterday. I've had a couple of doctors talk to me and say they are thinking about doing it."

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