Saturday, March 10, 2007

Get out of jail free organ?

There is of course considerable debate about the ethics of commercial organ donation, possible commodification of body parts, exploitation of the potential donors and so. South Carolina, has hit on an innovative possibility to solve the shortage of organs, without offering money for organs... Give prisoners the opportunity to get up to 180 days off their sentence in exchange for their kidney.

"We have a lot of people dying as they wait for organs, so I thought about the prison population," said state Sen. Ralph Anderson, the bill's main sponsor. "I believe we have to do something to motivate them. If they get some good time off, if they get out early, that's motivation."

While there is a genuine need for more organs, this seems a clearly worrisome means to get these organs. There seem to be four distinct concerns about this means of acquiring organs as opposed to say altruistic or even commercial organ donation.

1. Coercion: There must be a significant concern of coercion being involved either directly or indirectly. Prisons are not pleasant places, and you could imagine people being willing to having good reasons for wanting to get out, at any cost.

2. Exploitation: Similar to concerns about coercion, there are significant concerns about locking people up, and then asking if they would kindly like to donate their organs. This is especially the case in the States given the the disproportionately high levels of African Americans, and those from lower economic levels in jail.

3. Justice: On at least retributive accounts of punishment, the punishment for the crime is the just desert that the criminal deserves, on this account mitigating their sentence, is likely to be contrary to justice.

4. Informed consent: Perhaps the biggest concern however is the quality of the consent that would be obtained from the prisoners who donate their organs. There is reasonable solid evidence (hardly surprisingly, given that these are the criminals who get caught) that inmates typically have low levels of risk adversity and low abilities at critical thinking. Both factors lead to concerns about the quality of the consent that would be obtained.

This is further reinforced with evidence from research from Iran, which has a commercial organ donation system.

Of the donors 76% agreed that kidney sale should be banned and if there was another chance they would prefer to beg (39%) or obtain a loan from usurers (60%) instead of vending a kidney. All 6 related donors were paid. The goals of vending were achieved not at all by 75% of donors.

Javaad Z. Iranian kidney donors: motivations and relations with recipients. J Urol 2001;165:386-92.

This seems to make it clear that many of those who end up commercially donating their organs in Iran (predominantly the very poor) end up regretting their decision, it seems likely that many inmates would experience the same long term feelings.

You can read more about the story here and here and comment on it below.


SteveG said...

Perhaps we need to alter the old saying, "it costs an arm and a leg" to refer to soft tissue rather than extremities...

David Hunter said...

Indeed, it seems they will be trying to claim their pound of flesh... which ever way they can. It seems a strange leap to me, from worrying about commercialisation of organs, straight to getting organs from prisoners. There is a legal stumbling block which will hopefully stall this, in the USA according to federal law you cannot give a "material consideration" for the donation of organs. It seems sensible to consider time off for good behaviour as a material consideration, after all loosely speaking time is money...