This offer should come from a stable relationship which should survive the emotional turmoil which accompanies the procedure. Careful psychological and psychiatric assessment and counselling are crucial to allow these conflicts to be resolved satisfactorily. Yet if this donation comes as a free gift without any external pressure, with no financial or emotional incentive and without moral blackmail, it should surely be welcome. Living unrelated donor transplantation is more complicated. Strictly speaking spouses fall into this category as they are not blood related, and the tissue match is unlikely to be as close as a blood relative even if the blood group is the same.
Financial pressures are often minor in relation to others that can be brought to bear upon a person.
The consideration of the ethics of xenotransplantation consists of more than a simple analysis of whether or not it is immoral to use animals as a source of organs or tissues for transplantation. The moral acceptance of xenografting will for many people only be possible provided there is no plausible alternative source of transplantable organs or tissues. As discussed above there is little doubt that no initiative will yield additional donors in sufficient numbers to satisfy the demand that current waiting lists place on scarce resources. The use of tissue from living donors will only ever provide the solution to a handful of patients. Mechanical or artificial substitutes have been suggested as another potential solution, and while great advances have been made, particularly with the artificial heart, the prospect of safe, efficient, reliable and implantable mechanical alternatives still appears to be some years distant.