Socio, I would say generally natural but with socially created bias through in there too. I do think there is a possibility of mengele in extreme circumstances or if politics did get particularly nasty. Which frankly at this juncture, with the rise of support for authoritarianism I'm not ruling out.
Its something that was known to happen in China with executed prisoners until very recently. There was a particularly big scandal that was exposed in 2006 regarding persecution of a certain group who were felt to be a threat to the state. Its is claimed that the practice was stopped in 2015, but since there is no way of verifying this there are doubts that this has really happened.
thediplomat.com/2017/03/chinas-organ-transplant-problem/
This is an article from last year about organ donation in China.
Also see
en.wikipedia.org/wiki/Organ_transplantation_in_China
This certainly isn't something that happened only in the distant past. The Chinese revelations have continued to come out with suggestions in 2016 that as many as 1,500,000 people could have been the victims of illicit organ harvesting.
I don't think that we are likely to go down that route - certainly in the immediate future - in the UK, but its always possible.
I certainly see erosion of human rights in the US under Trump and how politics are going there, leading to criticism of dubious practices in organ donation being silenced as there are huge potential profits to be made.
In the UK today, I think its more about things like, how far do you go to save someone's life. If they are 'worthier person' or 'higher social status person' do you go to extra lengths compared to someone else who is 'a drain on society'. And does subconscious basis or institutional prejudice also come into it?
Doctors are sworn to do no harm, but in the age of targets and pressure with decreasing budgets who is to say that a hospital might make some dodgy decisions? How do you ensure that doesn't happen. What level of accountability to track who donates and who recieves and their social background will there be to double check there is no disparity going on? How transparent will authorities be about this?
There could be the possibility of 'improving' its number of transplants whilst simulataineously reducing its liability to complex mental health cases. For example that a troubled teen just out of care who 'no one will miss' might not get an equal level of care, if there is a nice middle class family on floor 5 just waiting for a heart to save their 'much loved, beautiful, clever, funny and popular' daughter Poppy.
Or if the NHS is privatised, you might end up with a situation where transplant receptiants are only those who can afford organs and those who can't afford even basic care are much more likely to die in the first place. Presumed consent then therefore only really benefits the rich, but those who are least able to navigate the beaucracy of lodging an objection don't get the potential of the benefit of more organs being available anyway. Thus poor people end up becoming by default the commodity of rich people.
This is why I see the value and importance of donation being a gift, rather than the state having effective ownership of your body unless you make the effect to object (noting that these systems are difficult by nature to navigate and require awareness and an ability to do).
I regard these systems that protect the vulnerable as fragile and undervalued. Its complacency and taking safeguarding for granted that leads to scandals arising. It might be thought of as scaremongering to raise what has happened in China as a warning, but I do think its relevant to put it into a modern day context and to show that authoritarian regimes don't care about citizens who they regard as a 'problem'.
People who are advocating presumed consent, I am positive are massively well meaning and well intentioned, but the road to hell is paved with good intentions. I am also mindful that many of the most vocal advocates have a real emotional and personal reason to be encouraging a change to the system which has a tendancy to be difficult to put a rational and sometimes seemingly almost cold counter argument in contrast against. People who are naturally disposed to making the world better don't always realise that not everyone is nice like them, nor has someone looking out for their interests in the same way.
I don't know, but I'm seeing a general erosion of ethics and safeguarding in the UK and how there is an increase in private enterprise is frankly profiting from human misery of the poor, vulnerable and minorities.
I find it all deeply disturbing. The timing of everything, makes me particularly nervous.