ArticleJournal of evaluation in clinical practice2025
Alternate Choice Organ Counselling in Altruistic Non-Directed Solid Organ Donation: An Ethical Analysis.
Article in Journal of evaluation in clinical practice, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionCurrently, recruitment of non-directed altruistic (NDA) kidney and liver lobe donors in the UK regards these individuals as potential NDA donors of the particular organ type they initially express an interest in donating. Conceptualising these individuals instead as potential NDA donors of either a kidney or a liver lobe would require them to be counselled on both kidney donation and liver lobe donation. This can be referred to as 'alternate choice organ counselling'.
methodsThis paper conducts an ethical analysis of alternate choice organ counselling using the ethical framework of Principlism, and suggests changes to current policy and practice, accordingly.
findingsThis paper finds multiple strong ethical reasons to carry out alternate choice organ counselling for potential NDA donors of kidneys or liver lobes: the duty to respect autonomy requires alternate choice organ counselling such that the potential donor's decision to become a NDA donor of a particular organ type is fully informed; the duty of non-maleficence requires alternate choice organ counselling such that the harm subjected to the donor through living donation can be minimised (although such counselling might generate serial NDA donors, which would expose them to greater total harm); the asymmetry in the degree to which the living kidney and living liver lobe donation mechanisms promote justice requires alternate choice organ counselling for potential donors who wish to maximise the utility of their single NDA donation; finally, alternate choice organ counselling is likely to promote beneficence in potential NDA donors. DISCUSSION: This paper finds ethical reasons for potential NDA donors to be conceptualised as potential NDA donors of either a kidney or liver lobe, and for these individuals to be provided with alternate choice organ counselling. Suggestions on how this might be delivered in practice are offered, and the necessary further quantitative and qualitative research outlined.
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