New ACP Paper Provides Ethical Guidance Amid Controversies and Changing Practices in Organ Transplantation
PHILADELPHIA, October 28, 2025 – The American College of Physicians today issued a position paper on ethical considerations surrounding organ transplantation, saying the needs of the donor patient and family must be prioritized and the process should be trustworthy and transparent. “Ethical Issues in Organ Transplantation: A position paper from the American College of Physicians” was published in Annals of Internal Medicine. It clarifies the duties and roles of care teams of prospective donor-patients, recipient-patients, and organ procurement teams, reaffirming that end-of-life decision making for prospective donor-patients must center on their best interests independent of organ donation potential. It also emphasizes the importance of truly informed consent for organ donation.
Current organ transplantation practices can prioritize the benefit to the community at the expense of patient-centered care. According to ACP, physicians must always act in the best interests of the patient and that care must align with the patient’s wishes and preferences. Recent advancements and controversies—and growing criticism—of the current transplantation system and practices underscore the need for reaffirmation of long-standing ethical principles and examination of conflicts between current practices and the best interests of patients, especially the potential donor. Recent press accounts have documented troubling organ procurement practices; the United Network for Organ Sharing and the system it manages have been criticized as unfair, ineffective, and opaque; and an overhaul of the system, the Organ Procurement and Transplantation Network (OPTN) Modernization Initiative, is underway.
ACP says that increasing the number of organs for transplant does not override physicians’ duties and responsibilities to patients and suggests in the paper’s positions that:
- When caring for a patient who may become a donor, the physician’s obligation is to that patient first and foremost. The physician’s primary duties are to the patients under their care. End of life decision making for prospective donor patients must center on the best interests of the patient, regardless of the organ donation potential.
- Discussions about organ donation should support the patient or their family in making the best possible decision for the donor, while also ensuring the process is open, honest, and trustworthy. Physicians should respect and act on patients' and families' fully informed, voluntary decisions.
- Advance care planning should help patients express their future medical treatment preferences and/or choose someone to make decisions for them if they can’t do so themselves. Organ donation should not take priority over the patients’ preferences for end-of-life care.
- Metrics or financial/other incentives must not override the physician’s primary responsibility to always act in the best interest of the patient. Patients come first, regardless of any outside pressures or institutional interests.
- Fair and equitable access to organ donation and transplantation should be a top priority. The system must be built on trust and use fair, transparent, and ethical practices.
“This guidance is relevant to all involved in organ transplantation and particularly to internal medicine physicians who advise their patients about advance care planning and organ donation, caring for them prior to organ transplantation,” said Jason M. Goldman, MD, MACP, President, ACP. “As physicians, we should work to strengthen these ethical norms to ensure we are always doing what’s in the best interests of our patients.”
In a 2023 paper, ACP’s Ethics, Professionalism and Human Rights Committee (EPHRC) emphasized how determination of death is a distinct issue that must be kept separate from organ transplantation, reaffirming the fundamental ethical importance of the dead donor rule and raising ethical concerns about practices such as thoracoabdominal normothermic regional perfusion (TA-NRP, commonly called NRP).
This position paper was developed on behalf of the ACP Ethics, Professionalism and Human Rights Committee to provide ethical guidance for physicians, organ donor and recipient patients and families, the public, policymakers, and other stakeholders.
About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 172 countries worldwide. ACP membership includes 162,000 internal medicine physicians, related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on X, Facebook, Instagram, Threads, and LinkedIn, and subscribe to our new RSS feed.
Contact: Lori Bookbinder, 215-351-2431, Lbookbinder@acponline.org