Organ transplants for inmates

Ethical questions and concerns are being raised in cities and towns all over the United States as a number of prison inmates seem to be receiving better and/or reduced rate healthcare for otherwise costly medical procedures.

The situation begs the question, for people who break the law, in addition to losing their freedom, what other rights do they lose, or for that matter, gain? Inmates probably would have less of an opportunity to receive a life-saving organ transplant or other expensive healthcare if they weren't in a state or federal penitentiary.

Senators and taxpayers alike are demanding that these questions of ethics be addressed by lawmakers so that taxpayers are not bearing the burden of costly inmate medical care. In the news recently was convicted rapist Kenneth Pike, an inmate at Coxsackie Correctional Institution in upstate New York, who was set to receive a heart transplant. That transplant ultimately could have cost taxpayers upward of $800,000. The United Network for Organ Sharing (UNOS), the organization that determines who receives transplants, does not recognize any "categories," which means an incarcerated individual has the same chances of receiving a transplant as say, a CEO or a Hollywood celebrity, because no matter what the individuals status in life, it doesn't change where they are on the transplant list.

"The U.S. Supreme Court has determined that withholding medical treatment from those who are incarcerated is cruel and unusual punishment, because prisoners are not allowed to seek healthcare for themselves. The court did not say which treatments are obligated, which could be withheld, or whether prisoners ought to be listed for transplants," according to Richard Demme, MD, FACP, associate professor of Medicine and Humanities, chair of the Ethics Committee, University of Rochester (NY) Medical Center, Strong Memorial Hospital.

As an ethicist, Demme agrees with the Supreme Court ruling. "It became clear early on in the history of transplantation that criteria of 'social worth' should not be a significant consideration in the allocation of organs," he says.

Questions raised by members of the upstate New York town of Rochester broached many ethical questions: Should an imprisoned rapist be in line for a transplanted organ that could otherwise go to someone leading an honest, productive life? Who makes that call? What about people committed to state mental institutions or under state care for disabilities?

"It is simply not ethically defensible for a politician or celebrity to have a greater chance to receive an organ than an electrician, teacher, or homemaker. But there is a difference between 'social worth' and the rights of and obligations to those who have been found to have caused significant harm to the community," says Demme.

Many people in the town and others came to the forefront with these concerns about Pike and his bid to receive a heart transplant. Demme says, "Transplantation is a unique field in medicine, in its requirement for community support. If the community does not donate organs, there can be no transplantation. The community donates a tremendous amount of financial support to transplantation by funding research and Medicare funding of transplants."

Community involvement in the transplant process can make or break a patient's bid to be a recipient. "A prisoner is someone who has been convicted of causing harm to a community. It is possible that if a prisoner receives a transplant, another community member who did not receive the organ could die," Demme says.

Strong Memorial Hospital, part of the University of Rochester Medical Center, was involved in the firestorm from the community because it was the hospital that would perform the surgery for Pike, but fortunately, not in a negative way. "I don't believe the hospital was negatively impacted in the short-term as a result of recent media coverage in our area. We provided media with a general statement that explained our ethical responsibility to evaluate all patients equally for transplant, with no bias related to whom they are or where they reside, how much money they make, or what insurance they carry," Demme says. (To view the Strong Memorial Hospital media statement in its entirety, see box below.) "What cannot be determined are the long-term effects on local rates of organ donation if there is concern by members of a community about the choice of specific organ recipients."

Media Statement

As a provider of healthcare to a large and diverse population, we have an ethical responsibility to treat everyone who comes to us in need of care. Strong Memorial Hospital doctors, nurses and staff membes are committed to providing that care without discrimination. We believe in and follow the organ allocation policies and guidelines of the federally regulated OPTN/United Network for Organ Sharing, which ensure equal cnsideration for transplantation and access to donated organs.

SOURCE: Strong Memorial Hospital, Rochester, NY.

After townspeople raised concerns, NY state Sen. Mike Nozzolio called for a Senate hearing to address the issue of inmate healthcare and outrage around the state of New York. Pike has since withdrawn his name from the transplant list. "It could be argued that a prisoner should not be eligible for transplantation until after he has completed serving his sentence," Demme says. "It also is certainly true that some prisoners have been wrongly convicted."

As hardly an 'all's well that ends well' situation for Pike and his family, this case has certainly heightened the role of the community, healthcare institutions, and lawmakers when it comes to healthcare bias, and this case is not an isolated incident.

"In general, the role of hospitals should be to try to extend lives and to provide medical services, not to limit or forbid treatments," says Demme.

Source/Resource:

  • Richard Demme, MD FACP, Associate Professor of Medicine and Humanities, Chair, Ethics Committee, University of Rochester Medical Center, Rochester, NY. E-mail: richard_demme@urmc.rochester.edu.