We would like to thank Spital for his comments and to add that his and his coworkers'1-5 contributions to the literature on organ donation have been very much appreciated. Our discussion on living organ donation was not intended to discredit this approach as a viable option. Living organ donation serves and will continue to serve an important function when cadaveric organ transplantation is not possible.
We did an ethical comparison of living organ donation and a proposed Advanced Directive Organ Registry6 to clarify that both systems involve compromises. We disagree with Spital's assertion that the risks living organ donors assume are just another variant of the risks patients take every day in medicine. Nowhere else in medicine is a part of a healthy person removed without the procedure being of direct physical benefit to that individual. We believe that the principle of nonmaleficence is compromised when a donor