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QUESTIONS ORGAN DONOR SHOULD FIRST ANSWER

Q:My aging father needs a kidney transplant. A brother and I are willing donors, but I am a perfect blood match, while he is only an acceptable match. The hospital says either will do for the next round of testing, but it prefers the perfect blood match. We could flip a coin, a fair way to choose between us, but our dad could get the second-best kidney. Whose needs take precedence?

A: Here is a better way to phrase the question: How should we make this decision? The answer is, not by a coin toss but by a more sophisticated method - rock-paper-scissors. Sorry. No.

You and your brother, having already settled the ethical crux by agreeing to be donors, should now let the hospital answer the medical question: How to promote the best outcome for a transplant? Hence you, as the better blood match, should undergo this round of tests.

Those tests are only the next step. Before making a final decision, you need more information. Dr. Robert Klitzman, a bioethicist at Columbia University Medical Center, suggests a few things to discuss with the transplant team: "Why does (the) father need a kidney transplant? What is his diagnosis? Does he have a genetically related kidney disease? Do the brothers have wives and children with other serious medical problems?"

As Klitzman rightly implies, there can be medical (and nonmedical) implications not just for you, your brother and your father, but also for other people you love.

UPDATE: The letter writer was tested - the insurance company will pay for only one person at a time to go through the process - and ruled out as a donor. A third brother, also an ideal blood match, is considering whether he will be the next member of the family to undergo testing.

This column originates in the New York Times Magazine. Send questions and comments by e-mail to ethicist@nytimes.com.

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