Comment by dale_glass

A simple answer to such thought experiments is that actual consequentialism has to operate in the real world, not on carefully constructed hypotheticals.

So for instance, in the real world you can't guarantee you will get away with it. Real surgeons operate in teams, not alone, and are surrounded by other well trained professionals. Real people have loved ones that may press for an investigation of what happened, especially if the patient's death was suspiciously convenient.

So now the real calculus is more complicated. Your calculus isn't nearly as simple as "1 patient vs 4 recipients". You could get caught. The organs might be unusable. The transplant might get rejected. Investigations may result in enormous negative consequences. Etc.