Medicine, Health Care and Philosophy

, Volume 22, Issue 4, pp 583–591 | Cite as

Confucianism and organ donation: moral duties from xiao (filial piety) to ren (humaneness)

  • Jing-Bao NieEmail author
  • D. Gareth Jones
Scientific Contribution


There exists a serious shortage of organs for transplantation in China, more so than in most Western countries. Confucianism has been commonly used as the cultural and ethical reason to explain the reluctance of Chinese and other East-Asian people to donate organs for medical purposes. It is asserted that the Confucian emphasis on xiao (filial piety) requires individuals to ensure body intactness at death. However, based on the original texts of classical Confucianism and other primary materials, we refute this popular view. We base our position on the related Confucian norms of filial piety and ren (humaneness, humanity or benevolence), the tension between differentiated love and universal love, and belief in the goodness of human nature. In light of this, we argue that the Confucian ethical outlook actually calls for organ donation at an individual level, and supports an opt-out (presumed consent) system at the level of social policy. Furthermore, because the popular view is based on a number of dominant but misleading modes of thinking about cultural differences, our revisionist account of Confucian moral duties regarding organ donation has implications for developing a more adequate transcultural and global bioethics. These will be discussed and expanded upon.


Organ donation Confucianism Xiao (filial piety) Ren (humaneness or benevolence) China Transcultural bioethics 



Thanks to Arthur Kleinman and David Jones, the paper was presented (by Nie) at the Department of the History of Science, Harvard University, in September 2018. The comments and questions from the audience proved stimulating for the revision of this paper. We thank Ted Kaptchuk and Rabbi Dani Passow for the material on Jewish ethics. The advice by the anonymous reviewer of this journal has also been helpful for revising this paper.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Bioethics CentreUniversity of OtagoDunedinNew Zealand
  2. 2.Department of AnatomyUniversity of OtagoDunedinNew Zealand

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