A New Incentive for Organ Donors: Shorter Prison Terms

That is the proposal being considered in the South Carolina Senate. Prisoners would receive up to 180 days of time served for donating an organ or bone marrow. The following exchange of quotes from an A.P. article pretty much sums up the positions of nearly every debate over how organ donation should be incentivized:

Mary Jo Cagle, chief medical officer of Bon Secours St. Francis Health System in Greenville, urged senators to find an allowable incentive. “We have a huge need for organs and bone marrow,” Cagle said.

But Melissa Blevins, executive director of Donate Life South Carolina, said any incentive would break the law and the principle behind donations. “It really muddies the water about motive. We want to keep it a clearly altruistic act,” she said.

As we argued here, the current system of treating organ donations as a “clearly altruistic act” clearly isn’t working very well. This is pointed out in the final sentence of the A.P. article:

More than 95,300 Americans are awaiting an organ transplant, according to the Organ Procurement and Transplantation Network. About 6,700 die each year.

The biggest recent news on the organ transplant front is a proposal spelled out in a fascinating Wall Street Journal article in which the United Network for Organ Sharing would radically shift the way it rations donated kidneys. Instead of awarding kidneys based primarily on a recipient’s time spent on the waiting list, the new UNOS plan would factor in the recipient’s age. Younger recipients would get preference over older patients, the idea being that a new organ is more valuable to a younger person with more years to live.

FWIW, here are a variety of our earlier posts on the subject.

(Hat tip: Rian Stockbower)


Innocent Bystander

But Melissa Blevins, executive director of Donate Life South Carolina, said any incentive would break the law and the principle behind donations. “It really muddies the water about motive. We want to keep it a clearly altruistic act,” she said.

Yes. And I'm sure the people dying for lack of an organ donation are somehow consoled by the moral righteousness you strictly enforce.

scott cunningham

The link is broken.

zadig

Who cares about motive? But a lot of people are in prison for War On Drugs-related offenses. I would worry more about Hepatitis and HIV than I would about motive.

The article didn't say anything about the likelihood that prisoners would either be clean enough to donate or what the odds are that they'd match anyone on the list.

RJS

"The article didn't say anything about the likelihood that prisoners would either be clean enough to donate or what the odds are that they'd match anyone on the list."

Well obviously they would be checked, first.

prosa

Last time I made this suggestion on another forum I was horrendously flamed, but I'm a glutton for punishment so I'll say it again: the only real long-term and humane solution to the shortage of organs for transplant is figuring out how to stop so many organs from failing in the first place. Some cases are unavoidable, of course, but I'm certain that more research and more preventitive medicine could help reduce the rates of organ failure.

Flame away.

pkimelma

Prosa, I do not think this forum is much for flames, but I could be wrong. Preventing organ failure is clearly a primary goal, but such failures are caused by many things, many of which are not preventable in the sense you mean. Liver damage from poisoning is a good example. Others are related to diseases that are not well under control either (e.g. diabetes, some Hepatitis forms, etc).
The real long-term solution, other than prevention, is growing organs in the lab or in the body. This is coming, but not for a while; stem cells are the most likely way forward, but it takes lot of testing before we have a standard therapy.
In the mean time, the question is an ethical and societal one involving the best way to get organs donated by the survivors of the recently deceased, and secondarily from living donors. The recent focus on living donors is in large part due to the problems of getting families to allow recovery from the recently deceased. If this societal problem could be resolved, there would be a large enough supply for the demand.

Read more...

scott cunningham

prosa - Why do you think the two are mutually exclusive? Organ markets and medical advances on the front of healthcare go together. It's a sterile argument - we live in a world in which people demand kidneys and which people would be willing to sell them at a price. What you're saying is we need to reduce demand, which is true, of course. But presently, there is a shortage that causes thousands of deaths, and these could be alleviated at enormously low cost to society by allowing exchanges to occur between the interested parties. That is not at odds with also continuing R&D investment to reduce demand.

lermit

It came out in the WS Journal, thus, it must be true and sound.

.lermit

MRDOUG

Before we go openign the floodgates here, what is the ecconomic impact on the healthcare system if Organs became availabe? Does the cost of transplats outweigh the cost of keeping the alive?

As we have an allready strained healthcare systems do we really want to do an extra 100,000 transplants a year? Who will pay for this? Who will pay for the additional prison health care costs?

This one is a non-starter.

jeffstier

Those opposed to this want a feel good answer at the expense of more lives saved. There just aren't enough "angels" waiting to donate- so we have to provide some incentives beyond altruism.

pkimelma

MRDOUG, I believe a number of studies have concluded that transplants are generally always cheaper than waiting for someone to die from organ failure. The studies have to make some assumptions of course (such as whether the person has other problems that would keep them in the hospital, average recovery times, how many would stay in the hospital to die, cost of life sustaining techniques such as dialysis, and so on). But, the economic advantage of a transplant is also seen in societal benefits, including productivity of the healthy person, etc.

egretman

"...the only real long-term and humane solution to the shortage of organs for transplant is figuring out how to stop so many organs from failing in the first place."

Cure diabetes.

blindstef

Checking for disease isn't as simple as it sounds. A definite majority of these people have substance problems or consort with such. Over the last two decades the two "new" infectious diseases (hepatitis C, HIV) weren't identified until well after large population infection. Anybody know anything about hepatitis D, E?

Also, the whole thing seems ridiculous on moral grounds. No stem cells but we can harvest organs from healthy adults?

cicerotully

“…the only real long-term and humane solution to the shortage of organs for transplant is figuring out how to stop so many organs from failing in the first place.”

while it would certainly be nice to live in a society of informed, responsible citizens that engage in healthy habits, that doesn't really address the immediate need. does this society strike you more as an "ounce of prevention" society or a "pound of cure" society?

one concern not mentioned here is that with the dramatic increase in cases of diabetes and kidney failure in recent years, many people are reluctant to donate their organs for fear they will need them in the future.

there are a number of people who have relatives/friends who need kidneys but their kidneys don't match enough factors for a match. i have heard of an incentive that is a sort of swap, where a relative donates a kidney in exchange for one that does meet enough factors to be a successful transplant...this could prove helpful once up-and-running, but i'm not sure about the incentives to get it started when a compatible kidney may not be available.
sorry for prattling on, but having a wife on dialysis and the transplant list this is a subject very near and dear to me.

Read more...

sasha

my problem with this is that it seems a step beyond simple renumeration and borders on being coercive. These prisoners will get a direct benefit from donating organs, so the concept of "paying for organs" is clearly at work here, but in the prison environment, I'm not really sure how much you can say the prisoners have free choice of whether or not to "sell". Basically the government says, "we're going to put you in a really crappy situation for an extended period of time, and the only way out of it is to pay a ridiculously high price." (the high price being the risks you incur by going through surgery and giving up an organ.) Or, you could look at it as the government saying, "your sentence is 10 years in prison, unless you don't (or can't) donate an organ, in which case you get an extra 10 years punishment." that seems to raise all sorts of fairness issues.

egretman

one concern not mentioned here is that with the dramatic increase in cases of diabetes and kidney failure in recent years...

Cure diabetes. Then the remaining 30,000 organs that are available will be enough. If you are not working to solve diabetes then you are just part of the problem.

JillEden

Relying on altruistic giving doesn't produce sufficient response to organ donation or other life sustaining gifts. If altruism was sufficient motivation for anything, charitable organizations wouldn't send address labels with direct mail solicitations. Communities must be judged on the treatment of their most vulnerable members and vulnerability is based on susceptibility to undue influence. Dangling liberty before a prisoner in exchange for bodily organs further dehumanizes him/her by turning them into a harvesting ground. Organ donation is a gift carrying with it profound emotional and physical risk. The keys to a successful increase in voluntary, knowing and unequivocal gifts of life are education, fear reduction and an increased sense of personal responsibility among all of society, including those incarcerated. Desperation is a great enemy of ethics, fairness and human decency.

Dave Undis

South Carolina's idea of giving prisoners reduced sentences for donating kidneys is the latest proposal to use incentives to get more organs for transplant operations. Relying on altruism has left us with an organ shortage that kills thousands every year and gets larger every day.

One incentive for organ donors is already in place – you can increase your chances of getting a transplant if you ever need one by agreeing to donate your organs when you die. This incentive is offered by LifeSharers, the national non-profit organ circle. Everyone is invited to join the organ circle, and there is no cost to join. Members agree to donate their organs when they die. They also agree to offer their organs first to fellow members, if any member is a suitable match, before making them available to non-members.

Membership in the organ circle is free at www.lifesharers.org or by calling 1-888-ORGAN88. LifeSharers has over 8,000 members. Everyone is welcome, there is no age limit, members can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

Read more...

bredbored

In the UK we have to opt in to organ donation when we die, and even that wish (I believe) can be overridden by our next of kin.

Why not pursue a statute where we automatically opt in to donation post mortem, unless we apply for opting out? Citizens then default to being altruistic. No doubt there are procedures which require live donors but there are plenty which don't, and requiring doctors to seek permission for donation from NoK at the time of death is unreasonable.

pkimelma

bredbored, you are right that an opt-out program would solve this problem quickly. But, it would likely end up in lawsuits almost immediately, and so would not work.
The US has an opt-in program, through the car license and "living will", but it has three problems: many people do not bother (do not care most likely), Hospitals often do not know you opted-in and so have to ask NoK anyway, some groups have religious or cultural issues that prevent them signing up.