This chapter, Autonomy, Beneficence, Non-maleficence, and Justice in Organ Transplantation, by Claudio S. Cinà outlines the interconnections between these ethical principles, thus creating an overarching ethical framework that can be applied to organ transplantation. It looks at informed consent, just allocation, and how cultural and religious considerations impact the choices made by donors and recipients. Both living and cadaveric donations are considered, and an array of ethical tensions are noted, encompassing: the implications of coercion; reluctance on the part of family members; and the definition of the condition of brain death. It also contemplates emerging technologies, such as xenotransplantation and AI-powered matching systems, which have the potential to alleviate organ scarcity and, perhaps, to also exacerbate inequity. The psychological effects on both donors and recipients, identity changes, and moral responsibility feelings, for example, are explored, along with strategies to offer mental health support. A section on sustainability underlines the need for environmentally friendly approaches in transplantation. Global disparities, organ trafficking, and transplant tourism are placed in the context of the need for culturally sensitive, transparent, and collaborative approaches.