The shortage of organs for transplant to those in need is significant and growing worse. One strategy for meeting the need for life-saving organs is to turn when possible to living donors. Since we have two kidneys, donating one has become a major source of transplants. In the United States, about a quarter of all kidneys transplanted come from living donors. As inspiring as this altruism is it has led to proposed organ donation legislation in Massachusetts that not only is lacking in respect for altruism but is unethical on its face.
The bill, cosponsored by Representatives Carlos González and Judith García, would allow incarcerated people to donate bone marrow or organs, such as a kidney or a liver lobe, in exchange for a one-year reduction in their sentence. This proposal violates a long-standing fundamental rule governing the nation’s organ donation system, where the exchange of organs for money or anything of significant value is prohibited. It also targets a group of vulnerable people who are unlikely to be able to resist an offer to get out of prison earlier.
The rationale for the no-sale rule is that those who would sell their organs are more likely to do so out of desperation, not choice. Asking for bodily organs in return for freedom is about as exploitative as a law can be.
Incarcerated people are not autonomous. They exist in an intrinsically coercive environment, where every aspect of their daily life is controlled and surveilled and every interaction with other human beings is monitored. They are stripped of normal clothing and forced to wear prison garb. They are ordered, not asked, to do just about everything. They work for pennies an hour. They are traumatized by the chaotic, violent living conditions. They are utterly vulnerable.
Kidney donation carries very small but very serious risks including infection, long-term failure of the remaining kidney, and death. If something goes wrong, prisoners frequently lack high-quality health care much less health insurance once they get out.
Compounding all of this is the fact that many of those in prison suffer with serious mental illness and addiction, are from lower socioeconomic and education strata, and are disproportionately people of color. Dangling a reduced sentence in exchange for a vital body part is a transaction, no different from offering a huge sum of money for a kidney.
The Massachusetts representatives twist the concept of autonomy. They claim to be protecting a prisoner’s right to choose but fail to recognize that this right was compromised when they were sentenced. Victims of crime expect confinement for offenders, not participation in an organ bazaar.
Incarcerated people, like anyone else, ought to be free to altruistically decide to help another by donating an organ or marrow. Despite the pressing need for these very scarce resources, extracting a pound of flesh for a price from some of the most desperate and vulnerable among us is ethically abhorrent.
Arthur Caplan is a professor at the New York University Grossman School of Medicine. Dominic Sisti is an associate professor of medical ethics and health policy at the University of Pennsylvania Perelman School of Medicine.