Abstract: China’s organ donation undertaking has gradually developed an organ donation and transplantation management system that aligns with international standards while also suiting China’s national conditions, driven by a dual mechanism of administrative and philosophical guidance. At present, this field still faces complex ethical tensions involving individual rights, family ethics, fairness in the allocation of medical resources, and the conflict between traditional cultural values and modern concepts of life. This situation is partly due to the fact that domestic ethical research on organ donation has largely been shaped by specific policy needs and has lagged behind the rapid development of practice and institutional construction. It also reflects significant differences between Chinese and Western ethical perspectives on organ donation, particularly regarding concepts of bodily ownership, ethical subjectivity and distributive justice. To achieve mature development and gain deeper societal acceptance, China’s organ donation undertaking urgently needs to fully leverage the guiding role of philosophical thinking: exploring common ground between traditional ethics and modern donation ethics; promoting the local adaptation of death-related philosophical concepts; dismantling traditional notions of bodily integrity that hinder donation; ensuring substantive autonomy for vulnerable groups; reinforcing the principles of voluntary donation, fair distribution and respect for life; building a multi-layered incentive system; and strengthening public education and value guidance. These efforts will lay a solid ethical foundation for the sustainable development of organ donation in China.