In 2002, a California man who was in dire need of a heart transplant received the news that it was his turn. After waiting on the list for an extended period of time, he was the candidate to which the donated heart would go. The only thing potentially holding this man back from the transplant was the fact that he was currently serving a 14-year sentence in a California prison for robbery. Ultimately, his inmate status did not lead to him forfeiting the organ transplant he direly needed. The decision for an incarcerated individual to receive a precious organ through an expensive surgery caused an uproar among citizens. In recent years, there has been a push to remove prisoners from the waiting list for organ transplants, especially after cases like the one in California. Upset citizens view organs going to prisoners as a waste of a precious resource, and deem the inmates unworthy of such a drastic life-saving procedure. This view is understandable, but if the United States were to deny prisoners transplants, we would be thinking with our emotions when policies need to be based on facts and logic. It is for this reason that this paper will argue that the denial of organ transplants in prisoners is both unconstitutional and unethical.
Before looking at the policies and ethics behind organ transplants, specifically in prisoners, we must first address the history of organ transplants as a whole. In 1954, the world saw its first organ transplant performed by Dr. Joseph E. Murray, who was able to successfully transplant a kidney from one living brother into his identical twin (“History”,1). This singular surgery caused the field of medicine to be radically changed. Over the years, the practice of organ transplants has grown rapidly, with successful surgeries being done with, not only the kidneys, but hearts and lungs as well. Not only were there a variety of organs being transplanted, but “important medical breakthroughs such as tissue typing and immunosuppressant drugs [that allowed] for more organ transplants and a longer survival rate for recipients” were also being developed (“History”,1). In 1986, the United Network of Organ Sharing (UNOS) was awarded a government contract, therefore becoming responsible for all organ placements and allocation policies in the United States (“History”,1). UNOS has henceforth gone on to set the standard for organ donation, procurement, and allocation in the United States. The appointment of a singular organization helped to organize organ transplants across the United States, and helped to increase the prevalence of the practice. In the span of sixty short years, organ transplants have gone from an obscure medical dream to a very real, and very effective treatment in modern medicine. The history of organ transplantation is a rich and fast paced one, but we no longer face the question of how we manage to do the impossible and perform a transplant; now, we as society face the issue of who gets the valuable organs, and how to meet the increasing demand for one of society’s most precious resources.
The rise of success rates in organ transplants has led to a rise in demand for the procedure, which leaves America with a problem; “there continues to be a gap between supply and demand” (“Organ Procurement”,2). The issue the world faces, as a whole, is an organ shortage, and, “a shortage is equal to the difference between the quantity of a good demanded and the quantity of that good supplied.” (Beard et. al, 32). Essentially, we have too many people in need of organs, with too little organs viable for transplant. When saying there is a lack of organs, it may be more appropriate to state that there is a lack of organ donors. The reason the organ shortage is so important is due to the massive impact it has on people world-wide. “On average, 22 people die each day while waiting for a transplant” (“Organ Procurement”). Due to the lack of such a precious resource, organs, Americans are dying every day. The problem, however, is not one that can be easily fixed. In their book The Global Organ Shortage Economic Causes, Human Consequences, Policy Responses, authors Beard, Kaserman, and Osterkamp, propose that in order to help alleviate the organ shortage, there should be the ability to legally compensate donors for their organs (Beard et. al, xi). The authors, however, acknowledge that there is a “universally established rule that all organ donations must be altruistic and no compensation may be paid to the donor” (Beard et. al, xi). Until society, both nationally and globally, redefines the rules and stigmas regarding compensation in organ donation, we must abide by the rules in place. The rules are often made via either the government, or a government contracted organization. In the United States, the organization responsible for creating such policies is the United Network for Organ Sharing.
An example of an organization responsible for organ transplant related policies is UNOS, which is the non-profit company contracted by the US government. The United Network for Organ Sharing (UNOS) has been the official organization in charge of organ transplants and allocation in the United States since 1986. Over the years, UNOS has developed a specific protocol for all patients and physicians to follow to keep the system as fair and unbiased as possible. The UNOS website states that the current policy in place is as follows: first, the patient must receive a referral from their physician. Secondly, you must contact a transplant hospital, and then schedule an evaluation appointment to determine if you make a good transplant candidate. Then, you are added to the list, and the wait begins (“Matching”). UNOS describes how the system works on their website, “the UNOS computer generates a “match run,” a rank-order list of candidates to be offered each organ” (“Matching”). The choice of which patient makes the list and their position on the list is computer-generated to prevent any unfair advantages or biases. The current system UNOS uses is the need principle, and “the need principle is considered to be the “ideal” in medicine, as it abolishes discrimination and promotes charity, humanity, kindness and goodwill” (Cherkassky, 162). The need principle is derived from the Hippocratic Oath, which all physicians swear to uphold when they receive their white coats. The Hippocratic Oath states that physicians will do no harm, and to discriminate based on a patient’s past, be it criminal or not, would be to do just that.
The legal considerations on the fairness of organ allocation often fall in line with the medical considerations of the same issue, as is shown in the Constitution. The legal aspects of medical rights in prisoners are protected by the Eighth Amendment of the United States Constitution. When an individual commits a crime against society, they forfeit certain rights, such as the right to vote. There is, however, a great debate regarding what other rights they surrender and what rights tax-payer dollars should go towards maintaining. One of the rights that often comes into question is the right to medical care, or more specifically, what level of medical care prisoners have the right to. When viewing this question through the lens of the Constitution, it is important to look towards the Eighth Amendment, which states, “Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted” (Amendment 8). At the time the Constitution was written, cruel and unusual punishment meant, quite literally, cruel and unusual punishment. As is often the case, however, the interpretation of the Constitution evolves as society does, and that is where the Supreme Court comes into play. “Until the 1970s, a sentence to imprisonment deprived one not only of liberty but also one’s health at risk. Medical care was inadequately available and frequently primitive” (McDonald, 427). In 1976, the Estelle v. Gamble case, which changed the lives of prisoners forever, was brought before the Supreme Court. Estelle v. Gamble was the case of a prisoner suing for inadequate medical care (“Estelle v. Gamble”). The final ruling made by the Supreme Court stated, “deliberate indifference by prison personnel to a prisoner’s serious illness or injury constitutes cruel and unusual punishment contravening the Eighth Amendment” (“Estelle v Gamble”). The Supreme Court therefore reinterpreted the Eighth Amendment and clarified the rights afforded to prisoners, specifically regarding medical care. The Court cited it’s reasoning behind this verdict as, “the Eighth Amendment “must draw its meaning from the evolving standards of decency that mark the progress of maturing society” and that “the basic concept underlying the Eighth Amendment is nothing less than the dignity of man.”” (Posner, 1) . The Supreme Court’s role is to uphold the Constitution, and in this case, that meant protecting the medical rights of prisoners. In doing so, the Supreme Court made the denial of medical care a direct violation of the Constitution. The Eighth Amendment now stands to protect prisoners from denial of medical care based, not only on their status as a prisoner, but also from denial of care due to cost.
The Eighth Amendment serves as a means of protecting the medical rights of prisoners, not only through ensuring that they are available, but also through guaranteeing that they are not denied medical care due to cost. The Eighth Amendment, in its current interpretation, requires the government to provide prisoners with a variety of forms of medical care, which can often range from routine medical visits and checkups, to specialty care for chronic and terminal illnesses (Singh, 3). When an individual is imprisoned, they lose the ability to earn a significant income. It is for this reason that “the government cannot withhold necessary medical treatment because of the inmate’s inability to pay” (Wright, 1279). When the United States government removes an individual from the streets and places them in prison, they strip them of their ability to provide for themselves. Due to this, the government must provide for the needs of the prisoners. The American Board Association states in The Standards on the Treatment of Prisoners, that “health care should be based on the clinical judgments of qualified health care professionals, not on non-medical considerations such as cost and convenience” (153). It is the responsibility of the national, state, and local government to provide the funds for the maintenance of prisoners’ quality of life, and the prisons receive tax-payer dollars to do just this.
The legal implications of denying a prisoner adequate medical care do not only stem from the Constitution, but also from the Criminal Justice Standards on the Treatment of Prisoners. In 2010, the American Board Association House of Delegates published a resource on the expectation of the treatment of prisoners. Standard 23-6:1 states that “prisoners are provided necessary health care, including preventive, routine, urgent, and emergency care; such care is consistent with community health care standards” (152). The American Bar Association maintains that prisoners’ medical care should be consistent with what the medical standard is in a non-incarcerated society. This standard must be maintained, because “by using prison as a means of protecting the public, society creates an obligation to keep prisoners safe and treat them humanely” (Kahn, 2). If there is a denial of medical treatment a prisoner would receive if they were not incarcerated, there is an additional punishment for which they were not tried in a court of law placed upon their shoulders. “Laws and practices are unjust when they impose criminal liability or punishment beyond what the defendant deserves, even if such imposition is plausibly aimed at crime prevention or other utilitarian ends.” (Howe, 93). When an individual faces trial, they receive a specific sentence, typically a fine or a number of years in prison. This sentence does not include a denial of medical care, and, as previously stated, this is not a right forfeited by a prisoner upon their guilty verdict. In prison, inmates lose the autonomy of many their decisions. This is the price they must pay for their crimes against society, but that price should not cost them their life if that is not the sentence they received.
Justice is a value our country was built upon and is crucial to the American identity. It is a value we must continue to protect. Denying prisoners medical care would be to deny them of the justice they deserve. The Sixth Amendment states, “In all criminal prosecutions, the accused shall enjoy the right to a speedy and public trial, by an impartial jury of the state and district wherein the crime shall have been committed” (Amendment 6). It is not our role as average citizens to be the judge, jury, and executioner on the decision of whether or not someone lives. The Constitution guarantees the right to a fair and just trial, which we give prisoners with their original sentencing. In the article, “Should a Prisoner Be Placed on the Organ Transplant Waiting List?” Andrew Cameron et. al discuss a paper published by UNOS regarding criminal conviction, such as fines or incarceration. Cameron et. al argue that, when criminals are convicted, they should not be sentenced to additional punishment, such as being denied organ transplants (3). In the paper published by UNOS, which Cameron et. al reference, UNOS reasons that most criminals are not sentenced to death, but are expected to return to society and should be treated as others in society. UNOS’s paper concludes that justice dictates that a person’s status as a prisoner should not remove him or her from consideration for a transplant (Cameron et. al, 2). UNOS states that “Societies might even be judged by the degree of humanity and mercy they show their most vulnerable members” (Cameron et. al, 3). We as Americans pride ourselves on our strict moral code, and we deem ourselves as a nation with “liberty and justice for all,” as it says in the Pledge of Allegiance. We must maintain the values stated in the Pledge of Allegiance, because if we start to stray in one aspect of what liberty and justice mean, it will not be long until we start to slide down a slippery slope and lose focus on what our country truly values.
Even beyond the Constitution, medical ethics dictate that prisoners should not be denied medical care. The main argument against providing prisoners with organ transplants, is that they will not be able to use them to the fullest, or they will not be able to lead a meaningful life with them. Due to the variety of circumstances that lead to a prison sentence, it is difficult to define what makes a life meaningful. The opposition advocates for the best-bet principle to replace the current system in place to allocate organs for transplant. The best-bet principle is one that would focus more on giving the organ to the patient who would utilize it the best, versus the patient with the greatest need (Cherkassky, 158). The question raised by the best bet principle is, who has the right to decide whose life is meaningful, and whose is not? The University of Minnesota’s Department of Bioethics states:
The primary reasons for wanting to prevent individual worth from factoring into organ distribution include: a) the argument that individual worth does not determine medical need; b) the dilemma involved in deciding who will make decisions of who is worthy or not worthy to receive an organ, and; c) the slippery slope of determining an individual’s worth and whether or not it is fair to label someone worthy of a medical procedure. (UMN, 16)
If we start with denying prisoners organ transplants on the basis of their lives not being meaningful, a variety of other questions are raised. For example, would a past crime constitute an individual to be removed from the list? Many would argue that no, previous crimes shouldn’t affect a person’s chance, but then we must think of the fact that we incarcerate individuals not only to punish, but to rehabilitate as well. If the purpose of locking someone up is to rehabilitate, but we deny them the means to live out the rehabilitated life we have given them, what is the point? If we are condemning them to death with the denial of a life-saving procedure, is that not the same as awarding a death-sentence? “Any policy that would award lower priority to prisoners would be based on some sense that prisoners are less valuable members of society and would introduce the notion of social worth to the entire transplant system” (Kahn, 3). Many experts, such as those in the University of Minnesota’s Department of Bioethics, believe allowing bias based on criminal records would lead to discrimination based on age, mental health, and socioeconomic status (19). To deny transplants for non-medical research broaches a fine line, it has extreme potential for bias to infiltrate and corrupt the medical system.
The medical field is one full of complicated conversations. One of these happens to be whether or not a prisoner should be eligible to receive an organ transplant. The Constitution states in the Eighth Amendment that prisoners are protected from cruel and unusual punishment, and over the years, the Supreme Court has deemed the denial of medical care to be a violation of this amendment. Not only would the denial of medical care in prisoners be unconstitutional, it would be unethical. Medical care should be unbiased as it is a basic human right, and to begin discriminating on criminal history, or any form of non-medical factors, violates the basic principles behind medicine. America is a nation that values liberty and truth, and in protecting the rights of our most vulnerable, incarcerated individuals, as a nation we exemplify our core values.