{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:36:42Z","timestamp":1753879002112,"version":"3.41.2"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Currently, recruitment of non\u2010directed 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 \u2018alternate choice organ counselling\u2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>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\u2010maleficence 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jep.70055","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T22:29:37Z","timestamp":1743200977000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Alternate Choice Organ Counselling in Altruistic Non\u2010Directed Solid Organ Donation: An Ethical Analysis"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1165-6753","authenticated-orcid":false,"given":"Richard C.","family":"Armitage","sequence":"first","affiliation":[{"name":"School of Medicine, Academic Unit of Population and Lifespan Sciences, Clinical Sciences Building, Nottingham City Hospital Campus University of Nottingham Nottingham UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,3,25]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"\u201cNHS Blood & Transplant \u201d Organ Donation \u2013 Become a Living Donor accessed September 11 2024 https:\/\/www.organdonation.nhs.uk\/become-a-living-donor\/."},{"key":"e_1_2_10_3_1","unstructured":"\u201cNHS Blood & Transplant \u201d Organ and Tissue Donation and Transplantation\u2014Activity Report 2023\/2024 accessed September 11 2024 https:\/\/nhsbtdbe.blob.core.windows.net\/umbraco-assets-corp\/33778\/activity-report-2023-2024.pdf."},{"key":"e_1_2_10_4_1","unstructured":"\u201cNHS Blood & Transplant \u201d ODT Clinical\u2014UK Living Kidney Sharing Scheme accessed September 11 2024 https:\/\/www.odt.nhs.uk\/living-donation\/uk-living-kidney-sharing-scheme\/."},{"key":"e_1_2_10_5_1","unstructured":"\u201cNHS Blood & Transplant \u201d Organ Donation\u2014Donating a Kidney to Someone You Don't Know accessed September 11 2024 https:\/\/www.organdonation.nhs.uk\/become-a-living-donor\/donating-your-kidney\/donating-a-kidney-to-someone-you-dont-know."},{"key":"e_1_2_10_6_1","unstructured":"\u201cNHS Blood & Transplant \u201d Organ and Tissue Donation and Transplantation\u2014Activity Report 2023\/2024: Kidney Activity accessed September 11 2024 https:\/\/nhsbtdbe.blob.core.windows.net\/umbraco-assets-corp\/33795\/section-5-kidney-activity.pdf."},{"key":"e_1_2_10_7_1","unstructured":"\u201cNHS Blood & Transplant \u201d Organ Donation\u2014Donate Part of Your Liver to Someone You Don't Know accessed September 11 2024 https:\/\/www.organdonation.nhs.uk\/become-a-living-donor\/donating-part-of-your-liver\/donate-part-of-your-liver-to-someone-you-dont-know\/."},{"key":"e_1_2_10_8_1","unstructured":"\u201cBritish Transplant Society and the Renal Association \u201d Guidelines for Living Donor Kidney Transplantation\u20144th Edition accessed September 11 2024 https:\/\/bts.org.uk\/wp-content\/uploads\/2018\/07\/FINAL_LDKT-guidelines_June-2018.pdf."},{"key":"e_1_2_10_9_1","unstructured":"\u201cBritish Transplantation Society and the British Association for Studies of the Liver \u201d Living Donor Liver Transplantation accessed September 11 2024 https:\/\/bts.org.uk\/wp-content\/uploads\/2016\/09\/03_BTS_LivingDonorLiver-1.pdf."},{"volume-title":"Principles of Biomedical Ethics","year":"2019","author":"Beauchamp T. 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