Prisoners and Organ Transplants: Do Society’s Most Dangerous Deserve Priority Medical Care?

Plate230Description: Are prisoners worthy of receiving organ transplants? If so, who should bear the responsibility of paying for their transplants? In January 2002, an unnamed prisoner with end stage congestive heart failure serving a fourteen-year sentence for armed robbery was given a heart transplant at the Stanford University Medical Center. His medical costs approximately amounted to an astronomical $1 million dollars, all which were paid by taxpayers. This prisoner’s procedure had sparked controversy. With the continued organ scarcity and the pressure to ensure that each organ is utilized to the best of its capability, many have begun to question whether social status, such of that of prisoners, should be used as a criterion in the allocation of organs. This paper will ultimately address this issue and will also address what quality of health care should be offered in prisons.The main ethical issues that will be discussed in my paper are fairness (fairness of allotting payment of prisoners’ organ transplants and fairness of allocating organs to prisoners with regards to moral worth) and what constitutes the good use of an organ, including how the chance of success of a transplant relates to good use.


In January 2002, an unnamed prisoner with end stage congestive heart failure serving a fourteen-year sentence for armed robbery was given a heart transplant at the Stanford University Medical Center. His medical costs approximately amounted to an astronomical one million dollars, all which were paid by taxpayers. He died nearly a year after his transplant (Leung). Later, in 2011, Kenneth L. Pike, a Syracuse prisoner convicted of raping a thirteen-year-old relative, was supposed to become New York’s first inmate to receive a heart transplant. Due to public outrage, Pike eventually refused his transplant, which would have cost the state approximately $800,000 (Salahi). Both of these cases sparked outrage. Many disagreed with the decision to give these prisoners organ transplants and demanded laws to ensure that organs would only be transplanted into ‘worthy’ recipients. Particularly, California senator, Jeff Denham, championed a bill that would have permitted California organ donors to decide whether their organs would go to inmates (Lee).

Because the number of individuals placed on the waiting list is constantly increasing while there is a continued scarcity of organs, our society has the arduous task of deciding who should be eligible to receive organ transplants. Currently, according to the United Sharing Network, 120, 895 citizens are placed on the organ transplant waiting list. Unfortunately, only about 28,000 of individuals on the list are able to obtain transplants per year. On average eighteen people awaiting transplants die each day due to the shortage of organs (UNOS).

Organ scarcity and the pressure to ensure that each organ is utilized to the best of its capability has led to the overarching question of whether social status, such of that of prisoners, be a criterion in the allocation of organs. This paper will ultimately address this issue and will also address the quality of health care offered in prisons.The main ethical issues that will be discussed are fairness (fairness of allocating organs to prisoners with regards to moral worth and fairness of allotting payment of prisoners’ organ transplants) and what determines the good use of an organ. In the ‘good use’ section, I will discuss the chance of success regarding prisoners and organ transplants.

I will not discuss prisoners as organ donors and death row prisoners as recipients of organ transplants in this essay. In addition, while I am discussing whether organs should be allocated to prisoners based on degree of crime, I will not discuss in depth how much medical care and what organs should be given to prisoners of certain crimes. I will not discuss whether former prisoners or individuals that were placed on the list prior to incarceration should be placed on the waiting list in this paper. Furthermore, I will not address whether they should also be eligible to receive directed donations from family members and friends. I will only address whether prisoners should be eligible to receive transplants from anonymous donors.


Policies Regarding Transplants and the Quality of Health Care of Prisoners

Any individual, such as a prisoner, in need of an organ transplant must go through a process in order to determine his or her eligibility for a transplant. First, the individual must be referred to a hospital transplant team by a physician and have his or her physical condition evaluated by a hospital team (Transplant Living). In addition to reviewing the patient’s physical condition, the medical team considers a multitude of other factors, including the patient’s attitude, psychological health, and history of substance abuse. A patient who refuses to stop his or her use of harmful drugs, such as alcohol, will be automatically denied a transplant. Those items could potentially damage the transplanted organs (Harris). If the patient is approved by the hospital transplant team, the patient’s name will be added to the national waiting list (Transplant Living). Time on the waiting list depends on blood and tissue type, height and weight of transplant candidate, size of donated organ, medical urgency, time on the waiting list, the proximity between the donor’s hospital and the potential donor organ, and how many donors there are in the local area, among other factors (Transplant Living). However, as stated by the Organ Procurement and Transplant Network, “[One’s status in society, including status as a prisoner does not] preclude [him or her] from consideration for a transplant…Screening for all potential recipients should be done at the candidacy stage and once listed, all candidates should be eligible for equitable allocation of organs” (qtd. in Slade and McKneally). Although social status is not utilized presently as a criterion in the allocation of organs, many still wonder: Should we begin to use social status as a factor in this organ distribution process?

The quality of healthcare in prison was determined by the landmark case of Estelle vs. Gamble. J.W. Gamble, an inmate of the Texas Department of Corrections, was injured on November 9, 1973, while working in prison. On February 11, 1974, he instituted a civil rights action against W. J. Estelle, Jr., Director of the Department of Corrections, H.H. Husbands, warden of the prison, and Dr. Ralph Gray, medical director of the Department of Corrections and chief medical officer of the prison hospital, complaining of the incompetent treatment he was given subsequent to his injury. According to the complaint, Gamble was injured on November 9, 1973, when a bale of cotton fell on him while he was unloading a truck. He continued to work, but he soon felt unwell and was ill for an extensive amount of time after this incident. He attempted to tell the prisoner officials that he was unable to work due to his injury, but they refused to listen to his pleas, asserting that he was in “first-class” medical condition and was therefore able to work. Supreme Court ruled that that the defendants were demonstrating “deliberate indifference” by cognizantly disregarding a significant medical need of this prisoner and that withholding treatment from prisoners is “cruel and unusual punishment” and is in violation of the Eighth Amendment of the Constitution. Under this amendment, prisoners are entitled to receive sufficient care, which includes organ transplants (Estelle v. Gamble). Prison officials must provide facilities inside or outside of the prison that are able to address the medical needs of the prison.

Proof of deliberate indifference involves circumstantial evidence, which would include sharp weight loss or obvious symptoms of prisoner. It also includes direct evidence, such as a prisoner telling an official that he or she is sick. An injury requires treatment if it greatly affects daily activities, and it causes chronic pains in an individual. However, disagreement about treatment among doctors does not always constitute as deliberate indifference (ACLU).


Perspectives on Fairness Regarding Moral Worth of Prisoners

One aspect of this topic that is argued is whether prisoners are morally worthy to receive transplants. Although there are a myriad of definitions and perspectives on what constitutes a person as morally worthy, moral worth, in the context of this paper, is a person who has or exhibits “the differentiation of intentions, decisions, and actions between those that are “‘good’ (or right) and those that are ‘bad’ (or wrong)” (Morality).

Some individuals support organ transplants for prisoners and account for the circumstances that led to their imprisonment. In “A New Heart, or Liver, For a Convict,” Victoria Lee, a columnist for the Massachusetts Institute of Technology’s The Tech, argues that prisoners could, in fact, be equally as or more morally worthy than regular citizens but had to commit immoral crimes due to their situations. “Just because one is imprisoned does not necessarily mean that he or she is more morally corrupted than a free businessman who embezzles and deceives,” she states, “Is a robber who takes good care of his elderly parents more immoral than a politician who lies to the public and neglects his family?” (Lee). Another ethicist, McKneally addresses the idea that people are imprisoned for political reasons. He mentions that the decision to prohibit prisoners the right to medical treatment, such as organ transplants, would unfairly “deprive Nelson Mandela of treatment for his prison-acquired tuberculosis.” McKneally further notes that prisoners could be innocent, so utilizing their crimes as a way to determine their worth would be futile (McKneally). In fact, between 2.3% and 5.0% of those in prison have been wrongly convicted for their crimes (Innocence Project).

Likewise, these people believe that a higher power should solely be the judge of the moral worth of an individual. Renee C. Fox, a bioethicist at the University of Pennsylvania, argues that a system in which possible organ recipients are ranked according to moral worth should not be established. “[The determination of the moral worth of an individual] is best left to God” (Landsberg). This system is often compared to the infamous Seattle “God Committee” in the 1960’s. Unable to decide whom to allocate the finite amount of dialysis machines to, doctors established a group of local denizens to decide who would receive treatment. This committee utilized each patient’s medical history as well as social worth through his or her net wealth, gender, marital status, educational background, job, and emotional health. Because people, such as those involved in the Seattle “God Committee,” have varied perspectives on what constitutes as ‘worthy’, the determination of someone’s worth is never equitable or absolute (Bernstein, Meyers, Lyckholm). As well as arguing that individuals are not given the right to determine another’s worth, some contend that they are unable to prohibit organ transplants for prisoners because the refusal would constitute as a second punishment. Prisoners are currently paying their debt for their crimes, and a refusal for medical care would additionally cause them to suffer.

In addition, these people recognize that the decision whether to grant prisoners organ transplants will not only affect those in need of transplants but also will affect the prisoners’ friends and family. Tina Woods, the ex-fiancé of Pike, and her five children, were eagerly awaiting Pike’s surgery. Woods, once asked about Pike’s transplant asserted, “We’re all humans. Everyone has sins, but everyone has family, too” (Salahi). Some argue that prisoners are still humans, regardless of their crimes, and there are people that are concerned about their wellbeing. It would be unlawful to those personally connected to the prisoner, as it would cause them emotional pain to see their loved ones suffer.

Ultimately, these individuals inquire: Is it truly fair to punish those who had to commit a crime without malicious intentions due to their circumstances? Is it fair to the family who cares for the prisoner in need of a transplant? It is salient to remember the humanity of prisoners when making the decision of whether they should receive organs. While prisoners have committed crimes, they are humans and should be treated with respect. The crime that they had committed had not stripped them of their humanity.

On the other hand, while many argue that prisoners should receive organ transplants, others disagree. Although prisoners may be imprisoned for a varied number of reasons, they still committed a crime and therefore are considered unworthy compared to citizens who abide by the law. It is unfair, these individuals declare, that law-abiding citizens continue to live in pain while prisoners receive organ transplants. “I personally don’t think it’s a sin to take a look at two lives, and to give a few points to the guy on the outside who is paying for his health insurance – who is caring for a family, who can be a productive tax-paying citizen,” one person states when inquired about his or her opinion on the California prisoner obtaining a heart transplant (Leung).

Furthermore, these groups of people do not see the refusal of organ transplants as another punishment added to a prisoner’s current punishment. Medical care, some contend, is not a privilege but a right. When people are imprisoned, they relinquish many rights, such as the right to vote. Therefore, some argue that medical care should also be taken from prisoners and even consider giving prisoners organ transplants as tantamount to rewarding them (Sade).

Is it fair to grant prisoners sentenced for different crimes the same medical care? A third group of people empathize with both arguments stated above and have formulated alternative organ allocation systems to this ethical question. David L. Perry, Ph.D., of Santa Clara University suggests that organs should be distributed based on three factors: degree of needs, probability that the transplant will be successful, and history of violent crimes (Perry). He believes that those who deliberately harm innocent persons should not be eligible for an organ transplant (Perry). Generally, more individuals would prefer that a transplant be given to a prisoner who had committed a less severe crime than a prisoner who had committed a heinous crime. In response to a scenario about a prisoner convicted of child sexual abuse at the 2007 Mayo Clinic Course in Transplant Ethics, 62% of audience members subsequent to the discussion voted to “unconditionally deny listing for a heart transplantation” to this inmate imprisoned for a serious crime. When asked if the prisoner had committed a crime of tax fraud rather than of child sexual abuse, 51% initially responded ‘yes’ to allowing the prisoner the transplant (Griffin and Prieto).

Furthermore, some consider that the amount of time a prisoner had completed in his or her sentence should affect his or her eligibility. Others, such as, Laurie Lyckholm in “A New Liver for a Prisoner” propose that medical criteria should be utilized to decide qualification for a transplant and then the name of each person, whether a prisoner or regular citizen, should be placed in a lottery or on a waiting list for government financial assistance (Bernstein, Meyers, and Lyckholm).

To sum up, there are three opinions above on the allocation of organs based on moral worth. The first group stresses the humanity of the prisoners. The crime, they proclaim, does not always reflect the morality of the person committed the crime. It is unfair to judge others, especially because often judgments are influenced by personal biases. Others argue that medical care is a right taken from prisoners and that it is unfair to those who abide by the law and therefore are more morally worthy than prisoners to have the same opportunity to receive organs. A third group of individuals offer perspectives on new systems for allocation of organs.

It is important to recognize the humanity of prisoners. While prisoners have committed crimes, they are fellow humans and should be treated as such. Therefore, it is not lawful that prisoners should be prohibited all aspects of medical care. Medical care with the basic necessities is a right that all individuals should be entitled to. However, other forms of medical services, such as cosmetic surgery, should not necessarily be given to prisoners. There is a distinct line between medical services for treatment and for enhancement. Out of the all proposed systems stated above, the allocation of organs by degree of crime is the most fair for all involved. Prisoners would be able to receive transplants, and prisoners convicted of less severe crimes would be more eligible to receive transplants. Meanwhile, regular citizens would have a better chance at obtaining organs transplants. To clarify, while I am discussing whether organs should be allocated to prisoners based on degree of crime, I will not discuss in depth how much medical care and what organs should be given to prisoners of certain crimes.


Medical Care Provided in Prisons

Different regions of the world provide varied levels of medical care to their inmates. In Canada, prisoners are legally entitled to “essential” health care and “reasonable access” to nonessential mental health rehabilitation. The quality of health care “shall conform to professionally accepted standards” and “shall take into consideration an offender’s state of health and health care needs” (qtd. in Miller). In Britain, prisoners receive the same medical care as regular citizens (McKneally).

Most prisons in the United States have managed health care, which is a term used to describe “a variety of administrative and treatment practices that attempt to improve the quality, efficiency, and cost-effectiveness of the health care system.” The three roles in a managed health care system are: the managed care organization (MCO), which is the insurer and is financially responsible for medical care, the health care provider, which includes a physician or hospital team, and the person that is receiving health care. Before providing care, the medical professional must have any tests or surgeries approved by the MCO and follow the standards set by the MCO. As a result, the MCO has control over a doctor’s decisions (Robbins).

Regarding health care programs, Medicare and Medicaid are available only to a small percentage of inmates, primarily low-income pregnant inmates and children. However, as of September 30, 2013, twenty-five states had opted to participate in the Medicaid expansion under the Affordable Care Act in 2014. Inmates who are under the age of sixty-five, childless, and have an income below the government income poverty standard of 138% will be covered under the plan. In California particularly, $70 million will be saved if Medicaid is expanded in that state. However, the Medicaid will only reimburse payment for services provided outside the prisons (McArthur Foundation).

Generally, a prisoner is expected to pay a small co-pay for medical services; however, if a prisoner is financially unable to afford the co-pay, states are expected to cover these costs and cannot legally deny the offender care. To clarify, although the prisoner is expected to pay, the prisoner most often is unable to pay, and therefore, the state bears the responsibility of paying for the medical care (McKinney et al.).

Unfortunately, the quality of health care in prisons is significantly less than the quality of health care in regular society. As the costs of inmate medical care continue to rise, health care providers are attempting to find ways to reduce costs. Prisons have done so by releasing inmates prematurely and utilizing over-the-counter medications to cure serious illnesses (Robbins). Specifically, in California, in 2010, forty-seven incapacitated prisoners were granted medical parole, reducing health care spending in prisons by $20 million. In Ohio, a geriatric parole legislation in 2011 was approved that would release inmates that had completed 80% of their sentences, among other requirements, in order to reduce costs (McArthur Foundation).

The increased costs can be attributed to three reasons: the increased growth of occupants in prisons, the aging inmate populations, and the prevalence of physical and mental illness and substance abuse (McArthur Foundation). The United States has the highest incarceration rate of 716 prisoners per 100,000 people and has 2.2 million inmates, roughly five times higher than Canada, which has 40,000 individuals in prison (Miller). With the number of inmates rising astronomically, states have the responsibility of caring for and paying the medical care of more people.

From 2001 to 2008, the number of state and federal prisoners age fifty-five and older increased approximately 94% from 40,200 to 77,900. This was caused by the escalation of longer sentences, such as life sentences. In fact, between 1984 and 2008, the amount of prisoners with life sentences quadrupled. With the number of older inmates in prisons and with their susceptibility to illness, the annual costs are dramatically affected. In Georgia, for example, medical care for older prisoners cost about $7,404 more than that of younger ones (McArthur Foundation). As the prison population ages, the cost of taking care of them increases and the states’ funds for medical care are becoming insufficient to pay for these costs.

Prisoners are susceptible to many diseases. Hepatitis C and HIV/AIDS are two illnesses that are extremely prevalent in prisons. Hepatitis C, a disease that produces inflammation of the liver cells and is transferred through bodily fluids, is one of the leading causes of liver damage that ends in its victim needing a liver transplant. About 29% of inmates are found to have Hepatitis C (Robbins). While only 1% of the United States population is Hepatitis C positive, 17.4% of inmates in 2006 had Hepatitis C (McArthur Foundation). In regards to HIV/AIDS, at least 17% living with HIV/AIDS have been incarcerated at some point in their life; about 1.4% of inmates are diagnosed with HIV/AIDS (“HIV/AIDS and Incarceration”). Most illnesses were obtained prior to incarceration (McArthur Foundation). Many treatments for these diseases are exceptionally costly.

If prisoners are offered inadequate health care, they have no choice but to receive that care. They are only allowed to receive health care that is offered by the prison since they unable to obtain treatment elsewhere. Because prisoners are not often paying customers, insurance providers lack the incentive to provide quality health care (Robbins). Since the goal of managed health care companies is essentially quantity over quality, the prison population has to suffer greatly.


Fairness Regarding Payment of Prisoners’ Medical Treatment

As stated in the introduction and the previous section, prisoners’ organ transplants, such as those of both Pike and the unnamed prisoner, are required to be paid by state and taxpayers’ money. However, does the state bear the responsibility of paying for the prisoners’ medical care? How much medical care should be offered to prisoners?

Because the state is responsible for placing inmates in prison in order to protect the public, many individuals assert, it bears the responsibility of caring for prisoners and of paying for their medical care, including organ transplants. Prisoners are financially unable to obtain transplants because of the lack of financial options in prison and therefore are dependant on society to take care of them (Kahn). By prohibiting health care to prisoners, society is unfairly placing them in unnecessary danger, which could result in death. This is evident in the case of Billy Roberts, an inmate at Alabama State Prison. A managed health care company, Correctional Medical Services (CMS), was responsible for the health care at his prison. A CMS director ordered that Robert’s and other prisoners’ medication be discontinued to get as many prisoners off of psychotropic drugs as possible in order to keep costs down. Six days later, Roberts hung himself. In another instance, in 1996, inmate Melony Bird died from a heart attack because her medical director, Dr. David R. Webb, was given a $250 bonus for every 911 call that was avoided and therefore did not call for help for her (Robbins). Ultimately, the goal of efficiency versus quality in medical health care is detrimental and harmful to the prisoners. They are not treated as humans; their lives are valued less.

Furthermore, these individuals assert that the care provided necessarily does not need to be the most expensive care available. Jeffrey Kahn of the Center for Bioethics, University of Minnesota, states, “[Adequate medical care] doesn’t mean ‘Cadillac’ care or access to the latest in newly developed medical technologies, but it does seem to require that access to what we consider basic medical services” (Kahn).

In addition, some declare that some transplants are cost-efficient in the long run compared to other treatments. Consequently, less of the state and taxpayers’ money will be spent, and prisoners will receive better quality of life (Brandon). In fact, dialysis cost annually about $74,118.76 per patient in 2009. A person must be on dialysis for the rest of her or his life. Meanwhile, a kidney transplant costs about $262,000 (Transplant Living). Costs in general for organ transplants for all patients include laboratory tests, organ procurement, transplant surgeons and other operating room personnel, in-hospital stays, transportation to and from the transplant hospital for surgery and for checkups, and rehabilitation, including physical or occupational therapy. Immunosuppressive or anti-rejection drugs subsequent to the transplant may cost up to $2,500 per month. The average cost of transplants in 2008 ranged from $259,000 for a single kidney to over $1,200,000 for a heart-lung transplant (US Department of Health and Human Services). While costs for an organ transplant may initially surpass those of dialysis, eventually the cost of dialysis will be greater.

Others, however, contend that taxpayers and the state should not pay for the medical care of prisoners. Prisoners, they argue, placed themselves in the situation that they are in by not abiding by the law. Even if the prisons offer less expensive but adequate health care, which still includes organ transplants, to the inmates, it will continue to be unfair to law-abiding citizens who do not have the resources to pay for a transplant. Regular patients are often uninsured or unable to pay and are consequently not able to receive a transplant. Los Angeles Times columnist Steve Lopez argues in response to a question about the Californian prisoner that “[providing health care to prisoners] doesn’t seem fair to [his father], who has heart trouble, lives on a fixed income and at one point had his health insurance cancelled” (Leung). Currently, 44 million people residing in the United States, about one in four free Americans, do not have health insurance and would not normally be able to access transplant services. Therefore, some propose that the family of the prisoner should pay if the prisoner is incapable of doing so. This practice has been used in Texas; family members are able to donate to offenders as long as they pay for the fees involved in the transplant (McKinney et al.). To note, since directed donations are not as common and the question of allocating non-directed donations is still relevant, I will not be exploring this particular practice further. Additionally, some assert that even if prisoners were entitled to some level of care, almost certainly this care would not include transplants (West et al.). Some even argue that occasionally prisoners have more access to health care in general than regular citizens, stating cases where individuals, once freed, attempted to return to prison to obtain the health care. For instance, Frank J. Morroco shop-lifted $23 worth of merchandise because he “felt that [he] didn’t have any other way to get the care that [he needed] for [his] leukemia” (Herbeck).

Robert M. Sade, M.D., argues that the decision to allow prisoners organ transplant, regardless of whether it is unfair to those outside of prisoner walls, depends on whether the prison system can pay. “If there is not sufficient money for [transplantation], and there is every reason to suppose there is not, then prison officials have solid grounds for saying ‘no’ to heart transplants for prisoners” (Sade).

Regarding the basic medical care of prisoners, many contend that organ transplants should not be included in their medical care and that other treatments should be offered instead. These individuals note that although some transplants may provide better quality of health compared to short-term treatments that is not the case for all organs. For example, LVAD’s, left-ventricle assist devices, which were once used for individuals awaiting heart transplants, now can be used as treatment in themselves (“Heart Transplant after LVAD”). The organs can be saved for law-abiding citizens.

In conclusion, there are two arguments regarding the fairness involved with the payment of the medical services of prisoners. One argument is that because prisoners are under the control of the public, the public has the obligation to take care of the prisoners’ medical care. It is immoral to place prisoners in injurious situations because of the costs. On the other hand, many argue that it is unfair for law-abiding citizens, who are uninsured or indigent, to not have the same resources as prisoners and suggest that those close to the prisoner should bear the financial responsibility. Both sides argue the cost efficiency and success of other forms of treatment for organ failure.

Because prisoners often lack sufficient money and are dependent on the community for all aspects of life, the states should be responsible for their medical needs to a certain point. Because it would be inequitable to the general public, the family and friends of the prisoner should be required to pay if and only if they are financially able to do so. Otherwise, the state should become involved. Furthermore, whether a prisoner should receive a transplant should primarily depend on the prisoner’s health rather than cost. For some treatments, such as heart transplants, if an alternative treatment is equally successful and increases the quality of life of a prisoner, then it is ethical to provide the prisoner with that treatment instead of the organ transplant.


Good Use of Organ: Individual vs. Societal Benefit and Chance of Success

Many people have different views on what constitutes the ‘good use’ of an organ. In this paper, good use of an organ will be determined based on two factors: whether the person receiving the organ is able to contribute to society and how likely that transplant will be successful.

Should an individual benefit or a societal benefit matter more? What does the decision to grant prisoners the right to organ transplants tell us about society as a whole? An individual in need of a transplant benefits if he or she receives the transplant. Society benefits from a transplant if the person who receives the transplant can help better society. Many argue that the individual benefit of prisoners is important. It is our responsibility to care for all citizens, including prisoners, regardless of their situations. David L. Perry states, “I can imagine situations where denying basic medical care to a prisoner would indeed be cruel and unjust. We may not keep antibiotics or pain killers from prisoners and still call ourselves a compassionate, civilized society.” Furthermore, Perry argues that prisoners that are not serving life in prison can become productive members of society once their sentence is completed (Perry).

On the other hand, others believe that the needs of society supersede the needs of the individual. The individual is only one part of the community, and it is of the utmost importance and our responsibility to care for the largest number of people rather than one person. Organ transplants may contribute to future criminal behavior in a prisoner, which would not aid society. For instance, a forty-one-year-old Caucasian male with end-state renal disease was incarcerated twice for pedophilia. After being evaluated by a physician, he was placed on the transplant waiting list and successfully received a transplant. Subsequent to his release and transplant, he was convicted for several pedophilic episodes. This man, “while in the throes of chronic renal failure,” stopped committing crimes. Therefore, his criminal behavior was believed to be restored by his transplant (West et al.). Although all criminals cannot be generalized, it is possible that criminals can choose to return to crime upon completing their sentences and regaining their health. Future crime could harm citizens, which would not benefit society.

The chance of success of a transplant depends on how successfully that transplant will work or last in the recipient’s body and affects whether an organ is in good use. For instance, many assert that because the Californian prisoner whose transplant cost approximately one million dollars died eleven months after his transplant surgery, the organ was not in good use.

Prisoners are more prone to illness due to the environment in which they live. As stated in the factual background section on the medical care of prisoners, inmates have higher rates of substance abuse, hepatitis, and AIDS; most were infected prior to their time in incarceration. At least 17% living with HIV/AIDS have been incarcerated at some point in their life. In addition, 23.1% of the male prison population has Hepatitis C (McArthur Foundation). People fear that if organs are transplanted into prisoners, they will fail in a brief amount of time. As a result, the organs would not be in good use. Although some prisoners receive adequate medical care, the prison often is unable to offer the specialized care need, for instance, providing immunosuppressant drugs, which places both the prisoner and organ at risk. Because organs are scarce, it is especially important that each is used to the best of its capability.

However, is society responsible for ameliorating their living conditions? Is this problem easily fixable? Or, should we ameliorate the health care of those in regular society rather than taking away the care from prisoners? Because of limited resources and funds, prison officials often do not treat or screen for diseases, which could affect the success of a transplant. For instance, the Hepatitis C treatment, which is a combination of pegylated interferon and ribavirin, costs about $9,000 and $38,851. This disease often goes untreated, which can lead to organ failure and consequently place the prisoner in a situation that could have been prevented (McKinney et al). As a result, many argue that prisoners’ surroundings cannot be utilized as an excuse to withhold transplants from prisoners if prisoners depend on society for all their medical needs. “They don’t have the choice to go to a doctor or to go to an emergency room…They’re entirely dependent on the institution to provide for their basic needs,” says Dr. Robert Greifinger, a prison health care consultant employed at Rikers Island Prison in New York City in the 1980’s (Miller).

Likewise, those who support transplants for prisoners proclaim that some regular citizens tend to engage in dangerous behavior or are more prone to diseases that place their organs at risk. According to Arthur Caplan, Chairman of Biomedical Ethics at the University of Pennsylvania, examples of unsafe behavior would include suicide attempts, obesity, and binge drinking. In fact, about 50% of all liver transplants are related to alcohol-induced disease (West et al.). Even though prisoners are very susceptible to illness, it has been reported that diseases were found to be more prevalent in other groups in society. For instance, HIV/AID was found to be more prevalent in the African American community in 2008 (2050/100,000 individuals) than in the prison population (1,392.6/100,000 individuals) illustrating that the prevalence of diseases in prisons cannot be utilized as a reason not to give prisoners organ transplants (University of Chicago). If many groups of society, such as the prison population, are prone to certain diseases, why should prison populations be discriminated against?

To conclude, many argue that society should be concerned with the wellbeing of the individual in need of a transplant rather than whether society benefits. Prisoners, some assert, can be productive members of society. Meanwhile, others mention that criminal behavior is not eradicated in prisoners and that prisoners can continue to commit crimes if released from prison and if their health is improved as a result of an organ transplant. This would harm society. However, the futures of all prisoners cannot be predicted. In order to determine whether a prisoner is a threat to society, each individual case should be reviewed.

Furthermore, some argue that prisoners cannot receive transplants due to the decreased chance of success as a result of their living conditions. Because society can ameliorate their conditions, this argument is irrelevant. Additionally, improving the living conditions and testing could prevent diseases that would lead to organ failure. If regular citizens’ risky behaviors are not always taken into account in the allocation of organs, it is unfair to use prisoners’ surroundings as reasons to not allow them to receive transplants.



I believe that both sides of the argument make points that are salient to the allocation of organs. First, I do believe that it is vital to remember that these individuals are human beings. Because they have committed crimes, regardless of the severity of the crime, they deserve to be treated as humans. By forbidding them the access to transplants, they are essentially sentenced to a second punishment—death. Additionally, it is important to remember that like all humans, prisoners have personal connections with other people. They have family members and friends that will be emotionally affected and concerned about their wellbeing. Many individuals overlook the fact that the decision to grant prisoners the right to transplants will affect not only prisoners but also a larger group of people.

On the topic of the payment of health care, I do understand the argument that the state should bear the responsibility of paying for the transplant because the prisoners are under society’s control and care. However, I do not believe it is fair to the law-abiding citizens who are left without the resources to pay for their treatment. I propose that possibly the family of the prisoner is initially asked to pay, and if that family does not have the financial capability to do so, then the state pays for the transplant.

Additionally, I consider how this topic branches out into the larger topic of health care of prisoners. How much medical care and what quality of medical care do prisoners deserve to receive? There is a fine line between what is considered a necessity in medical care. I would not consider a cosmetic surgery as a necessity, but I would consider an organ transplant a surgery that is vital to the quality of life of a prisoner as essential. Ultimately, prisoners deserve adequate health care that includes organ transplants, but not necessarily the other aspects of health care that are granted to regular citizens. By ameliorating the living environment and providing medical services to prisoners, we can eliminate and reduce the chances of organ failure, which would produce larger expenses for the states. However, the well being of prisoners should always be a priority over the financial aspect of medical care. To note, once a prisoner had completed his or her sentence and was released from prison, all rights of medical care should be returned to the prisoner.

Regarding the good use of an organ, I believe that chance of success rather than contribution to society is a crucial aspect to consider. Because of the lack of organs, we must consider how long each transplanted organ will last in a recipient. If the health care in prisons is improved, I believe that organs will more likely last in prisoners. Prisoners that have the chance to be released may or may not return to criminal behavior. If we allotted organs based on a prisoner’s contribution to society, we would be generalizing the behavior of prisoners rather than each individual case.

To sum up, I would give all prisoners organs if there were an infinite supply. As stated above, I believe that prisoners should be respected. However, due to the organ scarcity, that is not possible. I conclude that prisoners should receive transplants and that the best option to allocate organs to prisoners is by degree of crime. To clarify, I believe that all crimes are immoral, but I believe that some types of crimes should be punished less austerely than others. Prisoners that are convicted of less severe, nonviolent crimes, such as tax fraud, should be allowed to receive transplants while prisoners convicted of murder and sexual crimes should be placed lower on the list or should not receive the transplants at all. In order to be fair to law-abiding citizens, they should have first priority on the list. Please note, I do not believe that the transplant doctors should be involved in determining which prisoners of a certain crime should be granted the right to organ transplants. Physicians have the responsibility of providing adequate service and of caring for their patients, and if they are included in this process, the inherent trust between patients and doctors could be broken beyond repair. I suggest that a group of individuals from various backgrounds and who have different beliefs should determine which prisoners could receive transplants. This would possibly prevent one individual’s personal bias from influencing a decision.

Regarding the issue of social status as a whole as a criterion, I do not believe that we should use that as a criterion in the allocation of organs except for degree of crime. Using social status beyond this aspect will open a “Pandora’s Box” in the distribution of organs. At what point do we begin considering too many factors when allocating organs? Where is the limit? I fear that through the introduction of social status in this process, society could then begin using other factors, such as sexual orientation and skin color, to determine who is ‘worthy’ of organs.

By Kristen Plate

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