Realising the digital twin: a thematic review and analysis of the ethical, legal, and social issues for digital twins in healthcare

This paper examines ethical, legal, and social issues (ELSI) associated with healthcare digital twins (DTs). Using a systematic thematic analysis, we identify key themes across ethical, legal, and social categories, as well as practical barriers to adoption and implementation. Findings reveal a range of concerns (e.g. lack of empirical validation of DT value propositions) and gaps between the promise of healthcare DTs and the reality of deploying them within existing healthcare systems. By mapping the identified barriers to the Non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework, we seek to demonstrate how healthcare DTs require systematic assurance and capability development. We provide practical recommendations for how this can be achieved, with specified stakeholder groups, to help build trustworthy and ethical DTs with demonstrable healthcare value. Supplementary Information: The online version contains supplementary material available at 10.1007/s00146-025-02833-6.