In the German transplant scandals, doctors falsified patient data to move their patients up the organ waiting list. What was the ethical error?

They gave the interests of "their" suffering patient more weight than their duties to the system. Their solidarity came from small-group ethics ("the neighbour is whoever is closest"), but organ allocation rests on society-wide solidarity, which takes priority.

Why they did it: care for the patient (Fürsorge) and compassion, but also vanity and greed, since pay was partly outcome-based.

Why it is unacceptable:

• Doctors are obliged to rank patients by a catalogue of criteria so that organs go to those for whom urgency and prospects of success are greatest.
• Donor organs are a case of hard rationing: an organ given to one patient is taken from another, who may be sicker.
• The doctor's partisan solidarity comes from small-group ethics (Kleingruppenethik), in which the "neighbour" is the person nearest to you. The transplant law, by contrast, is built on societal solidarity in distributing organs. Duties arising from that system take priority over a morality fed by particularist motives.

The lesson generalises: a doctor's duty of care for the individual patient is real, but within a shared, scarce system it is limited by the fair claims of the patients the doctor cannot see.

Go deeper:

• Wikipedia: Organ donation — allocation systems, consent models and their ethical issues.