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Ethical Issues in Organ Transplantation: A Position Paper From the American College of Physicians. Recent developments and controversies in organ transplantation necessitate the reaffirmation and application of foundational ethical norms as the laudable goal of increasing viable organs for transplantation is pursued. The physician's primary duties are to individual patients under the physician's care. For physicians of prospective donor-patients, the "bright line" between serving the best interests of donor-patients and their families and serving potential recipient-patients and the public interest can become blurred in ethically problematic ways. This paper provides ethical guidance for clinicians involved in organ transplantation as well as for patients, families, the public, policymakers, and others to help maintain trust and encourage participation in this life-saving enterprise. 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 the best interests of donor-patients and their families independent of organ donation potential. It also emphasizes the importance of truly informed consent for organ donation and advocates for prioritizing equity and transparency in transplantation processes.