Organ Donation: Who, How,Why and also What are the Ethics? (2)

One of the ethical issues that face the transplant program in the United States involve “who”gets to donate an organ and “who” gets to receive the organ. Of current ethical concern pertaining to “who” gets to donate is the condemned prisoner on death row. The other ethical concern pertaining to “who” gets to receive the organ is the convicted criminal. There are other ethical “who”s which I will note later.

There is always discussion with regard to increasing the pool of potential organ donors. There has been a suggestion made for a proposal or law which would allow a prisoner condemned to die to have the sentence changed from death to life imprisonment by, for example, a kidney donation. The concerns are summarized in white papers written by the ethics committee of UNOS (United Network for Organ Sharing), the U.S. government designated organ procurement network. The committee wonders whether the “proposals would be coercive to particular classes of individuals--minorities and the poor” which may well represent the classes most likely found on death-row. Further, “would the reduction in sentence apply to the offer to donate, or would it only be honored if the act of donation took place? If the act of donation would exclusively qualify for the reduction in sentence, then the law or policy would discriminate against individuals found to be medically unsuitable to donate organ.” Additionally, concern is expressed about the reaction of jurors deciding punishment if they were aware of the possibility of trading an organ for reduction of sentence from death to life in prison. “…potential jurors could be influenced and ultimately impose the death penalty more often with a potential societal benefit in mind. Jurors might hope that the convicted persons would choose to trade their kidney for their life. This would present a gross inequity for those unable or unwilling to donate a kidney and who might otherwise have not received a death sentence.” Another issue would be if physicians were involved in the execution process itself in order to procure healthy organs for transplant. This would represent unprofessional and unethical behavior on the part of those physicians. Can you think of some more ethical problems with prisoners as organ donors?

With regard to convicted prisoners receiving organs, the UNOS ethics committee paper reminds us of the view that “convicted criminal status should be irrelevant in the evaluation for candidacy as a potential transplant recipient. This position assumes that convicted criminals have been sentenced only to a specific punishment, i.e., incarceration, fines, or probation. However, the convicted criminal has not been sentenced by society to an additional punishment of an inability to receive consideration for medical services. This argument also emphasizes that criminals not sentenced to death are expected to return to society and be deemed worthy of equal treatment in the receipt of other items/services distributed by society.” However, the medical and psycho-social criteria that are used to evaluate any potential recipient for organ transplant would equally apply to the prisoner.

Finally, I might add a couple more “who”s to the list of ethical issues that have been written about regarding organ transplant. Should a parent give permission for their minor child, who may be at an age without the capacity to make their own decision, to donate a kidney for a needy sibling? And with regard to “who” gets the organ, if the recipient is specifically designated by the donor to receive the organ, should this trump other worthy patients on a transplant recipient list? Should a patient use the Internet to try to directly contact potential donors and bypass the UNOS system to obtain the needed organ? And if you were a Supreme Court justice and because you were a Supreme Court justice, would you expect to get a kidney, bypassing others on the list? To the last question, the answer from UNOS is a resounding “NO”. Although the example of a justice is not mentioned, all patients on the list are to be justly evaluated. ..Maurice.