Is organ transplantation morally acceptable, and how should organs be obtained and allocated?
Organ transplantation: consent and the opt-in versus opt-out (presumed consent) debate, the definition of death, the allocation of scarce organs, the sale of organs, and religious and ethical arguments.
The ethics of organ transplantation in SQA Advanced Higher RMPS Medical Ethics. Covers consent and the opt-in versus opt-out (presumed consent) debate, the definition of death, the allocation of scarce organs, the sale of organs, and religious and ethical arguments, with how to evaluate the debate.
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What this key area is asking
Organ transplantation is the third medical issue, and it shifts the focus from ending life to consent, the definition of death, and the fair use of scarce resources. You must understand the consent debate (opt-in versus opt-out / presumed consent), the definition of death that makes donation possible, the allocation of scarce organs, the sale of organs, and the religious and ethical arguments, then evaluate the hardest of these questions.
Consent: opt-in versus opt-out
This is the most heavily examined sub-issue, and it sets beneficence and justice (saving more lives) against autonomy and non-maleficence (not overriding genuine consent). A strong answer notes that a "soft" opt-out, involving the family, is an attempt to capture the benefits while protecting consent.
The definition of death
The definition matters because retrieving organs from someone not yet dead would be killing; the brain-stem criterion is meant to mark genuine death while preserving organ viability. Disputes about the criterion therefore bear directly on the ethics of donation.
Allocation of scarce organs
Allocation is where the principle of justice does its hardest work: maximising total benefit (a utilitarian aim) can conflict with treating each patient fairly and without discrimination. Evaluation should weigh these competing demands rather than assume one criterion.
The sale of organs and religious views
The sale debate concentrates the contrast between autonomy and utility on one side and dignity, exploitation and justice on the other. As with the other issues, religious positions are diverse and must be represented fairly, not as a single voice.
Worked example
Try this
Q1. What is the difference between opt-in and opt-out organ donation? [2 marks]
- Cue. Opt-in requires explicit consent to donate; opt-out (presumed consent) treats everyone as a donor unless they have registered a refusal.
Q2. Give one ethical argument for and one against allowing the sale of organs. [2 marks]
- Cue. For: autonomy and increased supply saving lives. Against: it risks exploiting the poor and treats the body as a commodity, offending dignity and justice.
Exam-style practice questions
Practice questions written in the style of SQA exam questions on this dot point, with worked answer explainers. The year tag is the paper they imitate, not the source.
SQA AH (Medical Ethics)20 marksHow far is a system of presumed consent (opt-out) for organ donation ethically justified?Show worked answer →
A strong essay sets out the opt-in / opt-out debate, applies ethical frameworks, and reaches a judgement.
Explain the systems: opt-in requires explicit consent to donate, while opt-out (presumed consent) treats everyone as a donor unless they have registered a refusal. The case for opt-out is largely utilitarian: it increases the supply of organs and so saves lives, addressing the chronic shortage, and many who would willingly donate never register. The case against rests on autonomy and consent: presumed consent may not be genuine consent, especially for those unaware of the system or unable to opt out, and the body and its disposal are widely felt to belong to the person and family, raising worries about the state's role. Bring in the four principles (beneficence and justice favour saving more lives; autonomy and non-maleficence caution against overriding genuine consent) and religious views, which vary from encouraging donation as charitable to concerns about bodily integrity. Evaluate the safeguards (soft opt-out with family involvement) and conclude on whether the gain in lives justifies the shift in how consent is treated.
SQA AH (Medical Ethics)12 marksExplain the ethical arguments for and against allowing the sale of organs.Show worked answer →
The marks reward a balanced, analytical account of both sides.
For: a regulated market could increase supply and save lives (a utilitarian benefit), and autonomy supports a person's right to do what they choose with their own body, including selling a kidney; payment might be fairer than expecting unpaid donation. Against: the sale of organs risks exploiting the poor, who would be pressured by need to sell, undermining genuine autonomy and offending against justice; it treats the body as a commodity, which many hold to be a violation of human dignity (a Kantian concern about treating persons, or their parts, as mere means); and it could erode altruistic donation and create unequal access. Religious and sanctity-based views often stress the body's dignity and caution against commodification. A full answer weighs the utilitarian and autonomy case against the exploitation, dignity and justice objections, rather than listing points on one side only.
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