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

IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES
Richard C. Armitage
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Abstract

Introduction

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’.

Methods

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.

Findings

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.

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.

利他性非定向实体器官捐献中的替代选择器官咨询:伦理分析
目前,在英国,非定向利他(NDA)肾脏和肝脏捐赠者的招募将这些人视为他们最初表达捐赠兴趣的特定器官类型的潜在NDA捐赠者。将这些人定义为肾脏或肝叶的潜在NDA捐赠者,需要对他们进行肾脏捐赠和肝叶捐赠的咨询。这可以被称为“替代选择器官咨询”。方法运用原则主义的伦理框架对替代选择器官咨询进行伦理分析,并提出相应的政策和实践改革建议。研究发现,对肾脏或肝叶的潜在非自愿捐献者进行替代选择器官咨询有多种强有力的伦理理由:尊重自主权的责任要求进行替代选择器官咨询,从而使潜在捐赠者的决定成为特定器官类型的非自愿捐献者得到充分的告知;非恶意义务要求提供替代选择器官咨询,以尽量减少通过活体捐赠对捐赠者造成的伤害(尽管这种咨询可能会产生一系列不愿透露姓名的捐赠者,这将使他们受到更大的总体伤害);活体肾脏和活体肝叶捐赠机制促进正义的程度不对称,需要为希望最大限度地发挥其单一非自愿捐赠效用的潜在捐赠者提供替代选择器官咨询;最后,替代选择器官咨询可能会促进潜在的非自愿捐献者的慈善行为。这篇论文发现了潜在的非自愿捐赠被定义为潜在的非自愿捐赠肾或肝的伦理原因,并为这些人提供替代选择器官的咨询。就如何在实践中实现这一点提出了建议,并概述了必要的进一步定量和定性研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.80
自引率
4.20%
发文量
143
审稿时长
3-8 weeks
期刊介绍: The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.
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