**3. Altruism**

Although there are partial similarities in the assessment of potential organ donors, there are regional differences in how assessments are carried out. The criteria explaining who is allowed to donate and who will be disqualified as a donor also differ.

Family members who make an organ donation will benefit from a successful organ transplant operation to their loved ones, which can be effective in the risk and benefit discussion during the approval process. It may be necessary to limit the sacrifice allowed. For example, while we do not accept a living heart donor for obvious reasons, we know that most donors can live with a single kidney.

It is difficult to predict whether a particular organ donation is an altruistic act because while most recipients benefit from the transplant, the recipient may be in a worse condition if an organ is rejected or the operation fails. As an altruistic action/ practice is judged by the outcome, it is difficult to pre-operationally determine whether any special donation proposal is acceptable. Altruism is one of the basic principles of organ transplantation. In organ transplantation;

1. altruistic action must be an action that leads to an outcome,

2.the action should be directly linked to the aim,

*Coupling and Deviating of Altruism-Voluntariness Relationship in Organ Transplantation DOI: http://dx.doi.org/10.5772/intechopen.95895*


## **3.1 Definitions of altruism and altruism in the context of organ transplantation**

Merriam-Webster dictionary defines altruism as unselfish respect and commitment to the well-being of others [10]. The Contemporary Turkish Dictionary of the Turkish Language Association defines the concept of altruism as "the state of being altruistic, selflessness". The synonyms of altruist and altruism are given as selfless and selflessness. According to the same dictionary, an altruist is a person who tries to be useful to someone else without pursuing any personal benefits [11].

The word altruism is derived from the word alter, which comes from Latin meaning "other". In the 1830s, Auguste Comte used this word as a general term to mean "care for others". While altruism often points out to sparing thought for another, people can self-sacrifice due to environmental pressure while taking an altruistic approach. While volunteering and personal preference come to the fore in altruism, it may be possible for the person to act as a donor even if they are not willing. If a person acts with completely altruistic motives, that is, if the self-seeking motives are completely absent, we can define this action as a "pure" state of altruism. We must be careful to distinguish purely altruistic behavior from self-sacrificing behavior: the former does not pursue personal gains, while the latter involves some loss. Altruism is the opposite of egoism. However, the person who transcends egoism can be altruistic. A person, not who takes action in a situation where their interests are not harmed at all, but who does what is necessary in a situation that touches their own interests or who can do what should be done and act fairly will be altruistic.

Sacrifice can be seen as a manifestation of individual autonomy. In this case, it is necessary to accept a certain risk in advance. It is unavoidable that the operation to be performed to remove the transplantable graft is risky even if the donor's health is excellent. The short-term mortality risk for living kidney donors is roughly the same as the risk taken by any patient under general anesthesia. People take risks in their daily lives, which are far greater than the risks often imposed by donor surgery, with little or no direct benefit to their health. The risk of damage from kidney donation is much less compared to the many risks we all face in daily life. Therefore, if both the donor and the recipient are informed about the risks of the surgery, the long-term outcomes of the donation, and the forecast of factors that may affect the success of the transplant, the living organ donation will not push the limits of an acceptable sacrifice.

Schopenhauer mentions denial of the will, silencing the ego, and transcending egoism, which are essential for the existence of freedom, justice, and love in the world and says that this can occur in two ways: by gaining knowledge of the suffering of others or by the person's own great suffering. Schopenhauer says that the vast majority of those who deny the will achieve it in the latter way; not only by the acquisition of knowledge but also by the experience of pain. According to Kant I, the fact that action or the will at the basis of the action is determined by the self-love of maxims makes that action unethical. Therefore, it would not be wrong to say that morality and freedom can only be achieved when the person who determines the actions does not have desires and tendencies [8].

If a social behavior decreases the appropriateness of the organism performing the behavior but increases the suitability of others, it is considered an altruistic behavior. Although the concept of altruism was first introduced within the discipline of sociology, today it is frequently used in fields, such as sociology, psychology, theology, and education. Definitions of altruism handled in different perspectives and different disciplines naturally vary, too. In almost all disciplines, altruism is not understood as showing helping behavior without an expectation of personal reward or benefit. Should altruism be understood as the individual's consideration of well-being of others as much as his/her own or as seeing the well-being of others above his/her own? If a person sees others' well-being over/before his/her own, he/she will be seen to be sacrificing for others without expecting a response. When altruistic behavior is shown with the expectation of gaining benefit from the person sacrificing, this situation may sometimes appear in the form of cooperation or showing off.

Since the altruism in question here is realized with the expectation of selfinterest, this situation is based on mutual altruism, and it can be said that altruism is a kind of strategy that aims to gain respect in society. Gaining public reputation and the desire to benefit from the new opportunities that society offers to them can also support this type of behavior. The person who acts altruistically in the latter form of altruistic behavior, which is based on volunteering without any expectation of benefit, and where the motivation to live for others is dominant, does not seek reward, and deterrent effects do not influence him/her in any way. It should not be forgotten that in the domain between these two views regarding altruism, a spiritual gain to be obtained from the person who has sacrificed will be dominant. It is in this domain that one's moral gains in return for altruistic behavior are called theological and moral altruism [12].

The most important factor that distinguishes altruism from other purposive behaviors such as "helping" and "obeying social rules" is that the altruist sacrifices something from themselves and takes on a burden depending on their behaviors. This burden distinguishes altruistic behavior from individual behavior, such as "benevolent" or "kind, manners". The behavior of the altruist, which emerges in social life and is "for the benefit of someone else but brings harm to themselves", varies by the conditions, the cause that leads to the behavior, and the behavior process. For this reason, the concept of altruism also swings between Kropotkin's understanding of absolute altruism [13] and mutual altruism approaches based on expectations.

Pro-social behaviors include behaviors that may be for the benefit of another person or a group, which are shown without being under pressure and voluntarily. Bierhoff [14] distinguishes helping behavior, pro-social behavior, and altruistic behavior as follows. Helping is a broad term covering all types of interpersonal support. Pro-social behavior is a rather narrower concept than helping because the action is intended to improve the status of the recipient, and the recipient is not an institution but a person. Altruism, on the other hand, is pro-social behavior, which means that with an additional restriction, the motivation of the person who helps is determined by perspective acquisition and empathy.

The proportion of healthy adults who are potentially able to donate kidneys is greater than the number of deaths under conditions that comply with a donation. The number of people willing to donate instead is limited. It is not surprising that a healthy person may be reluctant to undergo surgery without clinical benefit, and some donors in most countries donate to family or close friends. Some factors affecting this situation, such as the number of people waiting for transplantation and the benefits of organ donation, can be presented through various channels, and this can highlight the person in terms of donation. Some organ donation campaigns
