**1. Introduction**

Wouldn't the world be a better place if there were no limits to sacrifice? Most people will answer yes to this question. When it comes to organ transplantation, can this fact occasionally contradict primum non nocere, "first, do no harm", which is the basic doctrine of medicine. Although selfishness is rarely accepted as a strategy for the benefit of the group, in evolutionary formulation, altruism benefits the group and selfishness interferes with altruism. While the living donor benefits the person who needs organ transplantation, they assume a group of life risks in advance. In this case, assessments will be multi-layered. Can the recipient's physician take a paternalistic approach to the benefit of their patient? How much risk can the donor take with the thought of benefiting another person? How should the decision of the potential donor to donate organs be handled? How should the organ donation decision based on their altruistic approach be evaluated within the scope of autonomy? Do the risks undertaken by the donor mean that they will be harmed?

It is of course possible to augment the number of questions, but the need for organ transplantation is increasing every other day. The number of donors does not match the needs, and this increases the need for organs every other day and causes the waiting lists for organs to get longer. Due to the scarcity of cadaver donations especially in some countries, organ transplantation, including kidney transplantation, is performed mainly from living donors.

With the increasing need for organs, organ transplantation from living donors, who are relatives of the recipient or not, is becoming more common, and even scientific studies on organ and tissue transplantation present living organ donors as an alternative to long-term dialysis treatment [1].

In justification of transplantation procedures with organs obtained from living donors, one has to be genuinely volunteer and to give informed consent under free will. Saving an individual's life and donating living organs can be a commendable option. However, to make sure the utility reaches its aim, a balance must be maintained between the utility provided to the sick person and the cost that the person taking an altruistic approach will pay. It should be essential to minimize the damage and maximize the possible utility in organ transplantation practice.

Various ethical statements suggest that the individual should voluntarily donate organs of their free will by giving informed consent, the donation should be exempt from exploitation and pressure, the donor should have the freedom to withdraw from the donation process at any time, and that the transplant team should make sure that the donor's decision to donate is voluntary and not manipulated. The correct definition of volunteering is an issue of practical importance. The answer to the question of how donors' volunteering should be properly assessed is far from a resolution today. Although standards about informing donors and how to control the information they understand have been developed (for example, the US Medicare Program), an empirical assessment standard of whether the decision to donate is voluntary is not developed enough to meet the relevant ethical norms [2]. One of the most important studies on the topic is the one carried out by Al-Khader. This study aimed to develop a scoring and rating system for assessing the volunteering of potential living donors [3]. In light of, a scoring and grading model was proposed in our country too, to determine the volunteering of living donors in kidney transplantation [1].

The assessment of potential donors' willingness to volunteer for organ donation, which is basically a difficult process, handles issues, such as motivation to donate, social status and family ties, economic status, relationship with the recipient, evidence of volunteering, and proof of a financial reward. Various ethical guidelines on organ transplantation from living donors have been developed around the world. One of the first ethical guidelines suggested is "Consensus Statement on the Live Organ Donor" [4]. In the light of this guideline, other ethical guidelines for the assessment of living donors have been developed [5].

When living donors want to donate organs, it is important to determine whether they are really volunteers or whether they are subject to a relationship of interest or control over their volunteering. It is an ethical and legal requirement for the donor to donate of their free will and by fully volunteering. The creation of a measurement tool on organ transplant volunteering is considered to be important in terms of the value and non-instrumentalization of human beings.

Contrary to the expectations of transplant surgeons, the use of living donors in countries, such as Turkey, Saudi Arabia, or South Korea is increasing every other day, resulting in more transplants from living donors than cadavers [6].

Nowadays, with the acceptance of cross organ transplants and living organ donations from non-relatives, the issue of volunteering and altruism of volunteers has become much more important. Lack of a standard approach to these issues is one of the biggest problem areas.

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

Utility of organ transplantation is available to the recipient under all circumstances. Health business is a utilitarian business. For this reason, utility fits the basic philosophy of healthcare very well. However, no matter how the individual's actions are conditioned to positive and beneficial results, negative and undesirable consequences may accompany these beneficial results as well. In the context of doing no harm, one of the main topics that need to be addressed is who or what is responsible for the damage, if any, and the other is assessment of the damage. Undoubtedly, balancing the benefit and harm is of particular importance for high-risk healthcare providers.
