Ethical Implications of Current Organ Donation Systems

by Xiwen Liang

Clinical organ transplantation saves millions of lives but also poses profound ethical challenges at nearly every stage, from identifying candidates for transplants to allocating scarce organs for equitable treatment and distribution. 

While both organ donors and waitlist candidates have increased in the past few years, the persistence gap between supply and demand makes rationing inevitable (HRSA), treating moral tensions around fairness, autonomy and societal obligations. 

Here, we’ll examine the ethical dilemmas inherent in the transplant process, particularly in one of the two most critical stages, donor consent, by examining how different systems of consent have been used around the world and their ethical applications.

For starters, let’s dive into the two main organ donation systems we see around the world today: opt-in vs. opt-out systems. In America (and other countries such as Canada, Denmark, and the Republic of Ireland), we use the opt-in system, where organs are donated only after one has stated clear consent of such a move. However, due to the clear gap between the number of organs available and the number of patients on the waitlist, some countries, such Spain, France, Chile, and Singapore, utilize an opt-out system, where individuals are presumed to donate after death unless explicitly stated otherwise. 

By examining the four medical ethics principles followed by America (autonomy, beneficence, non-maleficence, and justice), which system do you think is more ethical to utilize and why?

Citation: U.S. Department of Health and Human Services, Health Resources and Services Administration. Organ Donation and Transplantation. Health Systems Bureau, last updated 18 Aug. 2025, data.hrsa.gov/topics/health-systems/organ-donation.