# Alternate Choice Organ Counselling in Altruistic Non‐Directed Solid Organ Donation: An Ethical Analysis

## TL;DR

This paper argues that potential altruistic organ donors should be counseled about both kidney and liver donation options to make fully informed decisions.

## Contribution

The paper introduces 'alternate choice organ counselling' as an ethical approach to expand donor autonomy in non-directed altruistic organ donation.

## Key findings

- Alternate choice counselling respects donor autonomy by providing full information about both organ donation options.
- It helps minimize donor harm by allowing informed decisions about which organ to donate.
- The approach promotes justice and utility by aligning donations with ethical and practical considerations.

## Abstract

Currently, 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’.

This 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.

This 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.

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.