The ventromedial prefrontal cortex (vmPFC) has been suggested to be of great importance for moral decision-making. It has been suggested that during moral decision-making, lesions to the vmPFC increases what researchers term “utilitarian” decision-making. This systematic review summarizes four peer-reviewed studies that were filtered and selected from the databases Web of Science, Scopus and Medline EBSCO. The studies selected compared participants with vmPFC lesions to controls during moral decision-making. One study tested moral evaluation through moral transgressions and distractions. Two studies tested moral responses during personal, impersonal and non-moral dilemmas. One study tested whether direct involvement in a dilemma alters the utilitarian response. The overall results all point towards the vmPFC being directly involved in moral decision-making and that higher rates of utilitarian decision-making were shown in patients with vmPFC lesions compared to controls.