Beyond Consent: Sustained Moral Responsibility in Ethical Organ Transplantation

Abstract

Informed consent has long been regarded as the ethical cornerstone of organ transplantation. While indispensable, consent alone is increasingly recognized as insufficient to guarantee ethical legitimacy, particularly in living organ donation and in transplant systems operating under social vulnerability, economic pressure, or weak regulatory oversight. This conceptual ethics article advances the framework of Sustained Moral Responsibility (SMR), arguing that ethical accountability in organ transplantation must extend beyond the moment of consent to encompass enduring moral obligations across the entire transplant continuum. Drawing on bioethics, relational ethics, care ethics, and global health justice, the article conceptualizes SMR as a shared, longitudinal responsibility involving donors, recipients, healthcare professionals, institutions, and the state. The framework is discussed in relation to living organ donation, post-transplant care, and transplant governance, with particular relevance to low- and middle-income and fragile health systems. The article concludes that embedding SMR into ethical analysis and policy strengthens donor protection, public trust, and moral resilience in transplantation practice.