In this chapter, two demographic traits of living donors are observed: the over-representation of women and the under-representation of Blacks. This raises the question of whether these differences should be considered a disparity or a preference. A traditional bioethics approach would state that as long as living donors believe that the benefits of participation outweigh the risks and harms (beneficence) and the donors give a voluntary and informed consent (autonomy or, more accurately, respect for persons), then the demographics reflect a mere difference in preferences. Such an analysis, however, ignores the social, economic, and cultural determinants as well as various forms of structural discrimination (such as racism and sexism) that may imply that the distribution is less voluntary than may appear initially. The distribution also raises justice concerns regarding the fair recruitment and selection of living donors and their recipients. A vulnerabilities analysis can help explain the demographics of living donation.
Nudging to donate organs: do what you like or like what we do?