[From altruism to altruistic punishment: a criticism on granting priority in the waiting list to donor-card holders].

In 2008 Israel enacted a new law on organ transplantation which granted priority on the waiting list to holders of donor-cards who become patients in need of organ transplantation. This paper offers ethical criticism of the priority system arguing that the "reward" is by necessary also a "punishment". Moreover, because donor-cards have no binding power in Israeli law, the reward/punishment is actually directed at declarations, not actions, and, consequently, violates the freedom of conscience and expression. The reward system is also incompatible with fundamental values of medical ethics and with the very logic of talion, because the law punishes non-signers but not patients who are responsible for the loss of their organs. Lastly, I argue, that because priority on a waiting list is a positional good, it communicates a false message as if donation is an excellence of the few, and it legitimizes a rational choice to prefer wholesomeness of the cadaver to the risk of low rank in the priority list.