Prisoner organ donation proposal worrisome
■ The South Carolina legislation is misguided, experts say, but draws needed attention to the nation's dire shortage of available organs.
By Kevin B. O’Reilly — Posted April 9, 2007
A South Carolina proposal to shorten prisoners' sentences in exchange for bone marrow or kidney donations is drawing fire from physicians and ethicists. Some doctors say the legislation was well-intentioned, but that it is grossly unethical and probably violates federal law.
While the controversial idea has stalled, it has prompted discussion about the ethical permissibility of compensating donors.
Democratic State Sen. Ralph Anderson proposed two bills: One would release prisoners 60 days early for donating bone marrow; the other would give good-behavior credit of up to 180 days to "any inmate who performs a particularly meritorious or humanitarian act," which Anderson said could include living kidney donation.
Inspired by a guest speaker at his church who noted the shortage of black bone marrow donors -- blacks account for 8% of donors, but represent 12% of the population -- Anderson began to think about how to expand the pool of black donors.
"I prayed over it and I thought about the prison system," said Anderson, an African-American who represents Greenville. "We have enough people in there that I believe, with some encouragement, they will be standing in line to donate."
About 65% of South Carolina's roughly 30,000 inmates are black, and 70% of the 572 patients on the state's kidney waiting list are African-American, according to Donate Life South Carolina. Nationally, 18 people die every day waiting for a transplant.
Physicians and ethicists said the proposal came from the heart but would be tragic if enacted.
"Trying to explore all possible avenues for increasing organ availability is commendable," said Amy L. Friedman, MD, a kidney and pancreas transplant surgeon at the Yale University School of Medicine in New Haven, Conn. "But this particular approach is extremely inappropriate."
The ability for free and informed consent without coercion "is totally absent in the prisoner's circumstance," Dr. Friedman said. The prevalence of mental illness and sexually transmitted diseases among prison populations, the cost of follow-up care for donors, and the incentive for inmates to lie about their health are other major flaws with the proposal, she added.
Legal experts said that reduced prison sentences in exchange for organ or tissue donation would likely count as "valuable consideration," which is banned under the National Organ Transplant Act.
Sigrid Fry-Revere, PhD, a bioethicist at the libertarian Cato Institute, said she supports financial incentives to increase organ donation rates but that prison is the wrong place to start.
"To essentially say, 'Your freedom or your organ,' that's pretty coercive," she said.
Republican Sen. Michael L. Fair, chair of the South Carolina Senate Committee on Corrections and Penology, said Anderson's proposals will likely not proceed because they probably violate federal law. He has co-sponsored another bill with Anderson to create an incentive-free, purely voluntary organ and tissue donor program within the South Carolina corrections system.
Lawrence O. Gostin, PhD, a Georgetown University health law professor and chair of the Institute of Medicine's panel on biomedical research involving prisoners, said even a no-reward organ and bone marrow prison donor proposal should be scrapped.
"If you want to increase organ donation," he said, "do it among people who have their liberty and have a degree of autonomy."