Today, The New York Times reported disturbing news about a transplant surgeon accused of manipulating the waitlist, potentially preventing many patients from receiving liver transplants. An investigation is currently underway, and not all the facts are known yet. However, one major concern is that the surgeon allegedly demoted sicker patients on the waiting list, an unethical practice yet somewhat predictable when considering the perverse incentives and Goodhart’s Law. In recent years, transplant programs have faced penalties and the risk of losing contracts if their outcomes fall below certain benchmarks. Programs that prioritize the sickest patients, who are most in need of transplants, often have poorer outcomes compared to those selecting more stable patients. Consequently, a rule intended to discourage reckless behavior ironically harms the very patients who urgently need help.