Most public discourse around medical ethics centers on debates and dilemmas such as stem cell research and the infamous Terry Schiavo case. Another type of ethics problem – ethical violations – makes the news but there is typically little discussion beyond the initial outrage and tsk-tsking. The latest scandal to hit the front page regards fraud within the organ procurement and transplant system. This was blatant, obvious abuse involving faking the identity of a recipient in order to move him from fifty-second on the list up to number one. There is little, if any, room to debate whether or not this was wrong. But there is still plenty to talk about. What incentive could be so great that surgeons were willing to directly harm another person (the one who should have received the organ and was subsequently removed from the list because the procurement agency thought she had received it), jeopardize their own program and careers, and tarnish the public’s trust in a national system that depends on the public’s good will to continue operating? Even after reading the news articles I don’t know the answer to that. But since this isn’t the first scandal, real or imagined, involving this system, it’s time to do more than shake our collective heads. When people hear about these scandals and lose faith that the system is a just one, donations of organs drop. And that hurts everyone. Most people don’t know that transplantation is the only field in medicine in which patients have a formal role in making policies. And any member of the public can raise an issue regarding the policies of the United Network for Organ Sharing (UNOS).