6th ELPAT congress: ethical, legal and psychosocial aspects of transplantation: new technologies – evolving humanities

As science advances, these dilemmas evolve rather than disappear. The questions we debated 20 years ago are no longer the same or they require different answers, as the assumed constants have proven to be variables. Political and economic shifts, the impact of the pandemic, the rise of technology and AI, global power dynamics, climate change, financial constraints, and migration, all create new dilemmas, or reshape old ones.This is what the humanities and social sciences bring to transplantation: frameworks for reflection, the ability to adopt other perspectives, a moral compass, the capacity to learn from the past, and the means to shape decisions consciously and deliberately.Yet here lies a paradox. In an era dominated by technology, cost-efficiency and rising inequalities, the humanities are increasingly forced out of universities and funding systems, precisely when their reflective function is most needed. This Special Issue reflects on transplantation practices and advances at a time when its boundaries are stretching. It presents selected contributions that were presented at the 6th ELPAT Congress in Seville, Spain from 9 th -11 th October 2025, entitled Emerging Technologies -Evolving Humanities. ELPAT is the European Platform on Ethical, Legal and Psychosocial Aspects of Organ Transplantation. As one of the official sections of ESOT, its multidisciplinary community of clinicians, ethicists, lawyers, psychologists and social scientists, for two decades, has examined the questions that transplantation raises in and beyond the operating theatre.This special issue presents a contemporary mix of cutting-edge original research, viewpoints and position statements, all addressing contemporary challenges in transplantation ethics, psychology and law.The issue opens with the question of who cares for the people behind the organs. Mega and colleagues make the case with an ELPAT position statement on the role of mental health specialist in transplant teams, and that psychosocial expertise should not be optional, but belongs at the centre of transplant care. This is backed up by the study of Dahlqvist and colleagues supporting a life-long integrated psychosocial follow-up for the specific needs of liver allograft recipients transplanted during childhood. A point of view paper by experts on the current landscape of alcohol related liver disease and transplantation builds on this discussion, addressing aspects of care, access and the dual nature of the disease, proposing directions for harmonised, evidence based and equitable practice. Kyriakouli et al. turn the focus to the partners of kidney transplant patients, their pivotal role and their often overlooked voices, as transplantation does not occur in a void but affects and mobilizes a whole network of relationships.Building on the perspective that donation and transplantation are embedded in complex relationships, the paper Beyond the Gift, a large bi-center study with living kidney donors, examines how the donor-recipient relationship relates to the donor's quality of life and mental health, showing that caregiving burden and perceived responsibility carried by donors are key predictors for psychological distress. Similarly, Lim and colleagues delve deeper into relational dynamics of donor-recipient pairs and ask what informed consent requires when marital infidelity comes into play, and how transplant programmes can balance clinical benefit with ethical stewardship. Both papers make a case for how clinical decisions regarding transplants should not be viewed separately from their intertwined relational, psychological and ethical dimensions and how guidance and reflection on that can promote solid, fair and beneficial actions for all parties involved.Two studies from the Netherlands raise difficult ethical questions and demonstrate how sometimes practice moves faster than guidance. With 3 extraordinary cases of patients wishing to become living donors prior to euthanasia for psychiatric reasons, Massey et al. challenge both our notions of who and when is allowed to give, but also the practice of euthanasia, and highlight the transforming power of organ donation, advocating for handling living donation and euthanasia as two independent practices. Van Dijk and colleagues on the other side look at the practice of organ donation after euthanasia, starting at home through the perspective of professionals involved in the process. They similarly argue for strict separation between donation and euthanasia, while their experiences represent a valuable learning source for future policy development.A position paper, a case study and a research paper dive into grey areas of who should have access to organs and at what and whose cost. While Holland et al. discuss access to transplantation in older patients with cognitive impairment and the associated ethical and legal issues,, Courtney challenges our decision standards and capacities with a case of extended criteria deceased kidney transplantation in a patient with limited life expectancy whereas Ramaekers et al. with Organs, Bodies and Borders explore the issues of invisible inequalities, organ sales and migration across the Euro-Mediterranean border.Last, the issue includes four papers that look into the future and highlight how novel developments challenge established practices and beliefs. A common theme is that public trust needs to be given significant consideration.. Blazier et al. worked towards this direction by examining the ethics and acceptability of perfusion techniques from a patient perspective. Similarly, Liu et al. and Al-Haboubi et al. examine the public attitudes and perceptions on xenotransplantation in Sweden and the UK placing public engagement and public trust in the centre of the discussion when it comes to developing new policies. Finally, Primc tackles specific ethical challenges AI poses in transplantation by proposing a framework for systematically addressing the ethics of AI in the distinct field of transplantation that carries shifting obligations to multiple stakeholders from donors and recipients to their families and the public.The contributions in this Special Issue make clear that we are drastically called upon to think anew about a variety of issues: from emerging technologies, xenotransplantation and blurred lines between species, to consent and risk, about the tensions between technological innovation and equitable access, AI, transparency, accountability and fairness, about personalised care, trust, digital integrity, donor criteria, and much more. Whether these developments excite or unsettle us, and often they do both, one thing is certain: these transformations demand to be contained and reflected upon, not individually, not within isolated disciplines, but collectively.Organised initiatives and thinking systems of social and behavioural sciences and humanities, like ELPAT, when operating in an extroverted manner and in dialogue with medicine and technology can act as a "containing and holding space": a vessel in which such questions can be examined in their full complexity. We hope that this issue can act as a holding space, that it will enrich the intense dialogue taking place in an accelerated environment of transplantation and that it will encourage readers to use the evidence and guidance presented here in their daily practice and join the conversation. Transplantation, as perhaps the most interdisciplinary field in medicine, needs every discipline at the table.