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Providing Organ Transplants to Offenders
Providing Organ Transplants to Offenders
The project team is currently examining the legal and ethical issues associated with providing organ transplants to offenders.
Some correctional institutions and systems have limited access to expensive health care through policies that place constraints on eligibility that are based on matters other than patient need. The courts are beginning to question the constitutionality of these policies, especially in instances in which offenders experience harm due to delays in treatment or denials of care.
The issue of organ transplants is a growing concern partly because of the expense involved. The aging of the prison population and the accompanying impact of age-related diseases, along with improvements in technology, cut-backs in correctional health funding, and ever-increasing numbers of offenders with long sentences are placing burdens on correctional systems of a nature and magnitude beyond anything previously anticipated. There are fears that providing organ transplants to offenders will quickly overwhelm the budget.
Organ destroying illnesses and injuries afflict prison populations in greater percentages than in the general population. According to Baillargeon and colleagues, the incidence of hepatitis C among people incarcerated by the Texas Department of Criminal Justice (TDCJ) is approximately 29%, 10 to 20 times the incidence in the general population (1). The researchers also state that the incidence of HIV in the TDCJ is 5 times the incidence in the general population (2). Although their research shows that the incidence of several other organ destroying ailments in TDCJ is comparable to what is found in the general population, they note that offenders tend to exhibit serious morbidity at an earlier age (3). Generally speaking, offenders are considered geriatric patients at age 50-55 (4).
The extraordinary expense of organ transplants is not confined to the transplant procedure. For example, liver transplants require extensive testing to determine eligibility prior to being placed on a transplant list. Follow-up treatment may include careful monitoring of the organ and ongoing use of anti-rejection medications. Prison health-care personnel are usually not qualified to provide the kind of care that transplant patients need. Therefore, the offender who receives a transplant needs transportation, security, and access to the specialists and facilities that can provide the appropriate type and level of care. Finally, because transplant recipients are vulnerable to opportunistic infections due to the need to take immunosuppressant drugs to prevent organ rejection, they need to have a living environment that minimizes health risks. Ordinary prison conditions are inadequate to meet the special needs of people who receive transplants. The additional costs of providing a sufficiently sanitary environment add to budgetary concerns.
On closer examination, concerns about the budget represent concerns about the political fallout from providing costly health care to offenders at public expense, especially when many law-abiding citizens are unable to afford necessary health care. Correctional systems must find a balance between abiding by law that requires providing necessary care to offenders and inviting the ire of tax payers who must cover the costs of the care and who have little or no sympathy for those who have violated society's rules. The scarcity of organs adds to the potential turmoil. When giving an organ to one person means that another may die, some make the assumption that social worth should be the determining factor in deciding who will receive the organ.
The project team is carefully researching laws, attitudes, historical precedents, ethical arguments, and economic considerations to assist others in developing policies relevant to the question of whether offenders should receive organ transplants.
1. Jacques Baillargeon, Roger D. Soloway, David Paar, Thomas P. Giordano, Owen J. Murray, James Grady, Brie Williams, John Pulvino, and Ben G. Raimer, "End-Stage Liver Disease in a State Prison Population," in unpublished (Galveston, Texas: University of Texas Medical Branch, 2007).
2. Ibid.
3. Ibid.
4. Mike Mitka, "Aging Prisoners Stressing Health Care System,"
Journal of the American Medical Association
292, no. 4 (2004): 423.
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