Should narrative coherence be considered in the assessment of motivation in the non-directed kidney donation?

Donating a kidney to a stranger is known as a Good Samaritan, altruistic, or non-directed donation. Living donation is the only instance in medicine where the "do-no-harm" dictum is intentionally violated. Healthcare professionals 'doing the harm' are ethically responsible to ensure the lowest risk for both the physical and psychological health of the potential donor. To this end, experts in the transplant community published Guidelines for the Psychosocial Evaluation of Living Unrelated Kidney Donors in the United States [1]. These Guidelines focus on the identification of risk and protective factors, and basic principles underlying informed consent and outlined a recommended process for donor evaluation. The components of the evaluation include a comprehensive history and current status, capacity to consent, psychological status, relationship to recipient, motivation, donor knowledge and understanding, social support, and financial suitability. The case of a donor, Ms. Angelo, is presented because her responses during evaluation raised questions about how best to understand her motivation. My proposal is that altruism and motivation are best understood by considering the narrative coherence in the donor's story.