Should a Prisoner Be on the Waiting List of Organ Transplant? When both a prisoner and a non-criminal need an organ transplant, how can a doctor make the decision? Doctors have an ethical duty to save all patients. No matter what kind of patients they encounter, a cruel killer or an innocent victim, they should treat them in the same way. In many Hong Kong movies about gangsters, doctors save criminals by pure purpose of redemption and they are my idols. A doctor should focus on his duty, place the most deadly ill patients on the waiting list first and then try his best to care for other patients until the next opportunity.
When it comes to transplant, a prisoner is a good candidate because he meets all requirements. He is badly ill. His life is regulated by prison staff and is drug-, alcohol-free. He will be healthy again and prison staffs will not need to worry about his disease. But opponents focus on the background of patients and future benefits they will bring. These opponents are taxpayers and patients as well as their families and supporting networks. They do a lot for society and will do even more in the future while prisoners must stay in prison at great taxpayer cost.
Also prisoners have violated their obligations and have lost some human rights like freedom. And many prisoners have been alcoholics and drug addicts and have ruined their health. Therefore, they don’t deserve transplants. If they are granted a transplant, others’ opportunity will be taken. Possibly an important leader or a beloved family member dies. Society, families and friends will lose a lot. After I shallowly analyzed the transplant case, I became really confused because no matter what a doctor chooses, it seems half good, half bad.
So I had to ask a question, when a prisoner and a noncriminal patient need transplant, who should be placed on the organ transplant waiting list? But when I wanted to research the question, other questions came to me. Does the order on the waiting list really matter? And if it matters, why? Does UNOS have criteria to decide? With these questions, I searched the Internet and found an article called “Ethics of Organ transplantation” from University of Minnesota. It gave me a clue to find some data from the United Network for Organ Sharing website ww. unos. org. According to the website, there were still more than 117,000 candidates on the transplant waiting list until their last up-to-date report on February 22,2013. In 2012, there were 25,787 transplants performed for a sole year. The organs were taken from 12,874 donors both decreased and living (updated daily on www. unos. org). From these statistics, although 25,787 transplants seem like a large number, 117,000 people remain on the waiting list. The gap between need and provision is quite big and it is growing shown by the website.
Giving a transplant to a person means ignoring others’ pain and possibly leaving them to die. It is organ scarcity that makes ethical dilemmas arise(Center for Bioethics). Receivers win and failures must continue waiting until desperation. And I also found an article called “UNOS and the Waiting List”. It told me, “UNOS makes the rules about who can do transplants and how organs are to be allocated (given) to patients. ” And, “The match list is based on the number of antigens matching, the antibody levels of the recipient, and the length of time a recipient has been on the waiting list.
Children under 18 also get extra points. You could be listed a short time and come up on the match list due to antigen matching, or could wait for many years due to a high antibody level. ” (UC David Transplant Center) From these quotations, I thought the transplant list bases on the medical requirements rather than other aspects of patients. It seems humane and scientific. But in this case, if prisoners and non-criminal patients have the same level of antigen and antibody, the length of how long they have been put on the list still counts.
Even areas that don’t follow these rules like the California bay (UC David Transplant Center) also follow the convention—“first come, first serve”. The order really matters but UNOS doesn’t provide general criteria to make the list. Otherwise, the above scientific one only works out the list. They use the medical need to judge the eligibility of all patients. But why can’t doctors use medical need to measure to make this question simple? It seems that I returned back to my initial question, because if doctors can only focus on the medical need, ethic problems still remain unsolved and continue bothering them.
And there is also another question—Do prisoners share the same human rights as noncriminal people, especially in medical care area? To answer the question, my friend gave me a very supportive article about transplant for prisoners—“The Ethics of Organ Transplantation for Prisoners”. Its abstract gave me a clue, “While prisoners forfeit many freedoms, access to and the provision of adequate health care are guaranteed to them, and ought to include access to organ transplants. (Kahn, 365-6) In other words, prisoners have the rights for adequate medical care. The article also referred to “the U. S. Supreme Court ruled prisoners were entitled to receive adequate medical care” and the empowerment has taken place for about 40 years. (Kahn, 365-6) It proves that medical care for prisoners is protected by the US governments and relevant laws. After reading this, I got the same question as Kahn. What kind of medical care is “adequate”? Does it include organ transplants?
In Kahn’s mind, the basic medical services should be guaranteed and “we seem to treat transplantation as basic medical care for those who can access it, with the barriers to transplantation based mostly on its scarcity and cost, but not on viewing it as outside the delivery of basic care”(Kahn, 365-6). That is to say, we conventionally treat transplantation as a basic care. So prisoners should have the same human rights to have these ensured medical care. But I thought this logic lacked powerful proof. So I decided to search more information on this question.
When I used key words “medical care” and “prisoner” to search on the American Civil Liberty Union website (www. aclu. org), I found an article named “Know Your Rights”. The article actually told prisoners the obligations of prison staffs. According to it, “A prison official demonstrates ‘deliberate indifference’ if he or she recklessly disregards a substantial risk of harm to the prisoner. ” That is to say, prison officers must seriously care for prisoners’ illness. Of course, if a prisoner needs a transplant, there must be “a substantial risk of harm”(ACLU).
And if prison official must take care of it, laws must protect transplants for prisoners. In this way, prison want to put prisoners on the waiting list and both they and prisoners benefit. But it may seem unfair to law-abiding people and they must think so. It is easy to understand their concern. They follow laws, work hard and make contribution to society, while prisoners don’t need to do anything good and they even harm the society. Finally, law-abiding people have to pay tax for prisoners’ life and health care. So how much do taxpayers pay for prisoners? Does the money include health care?
Answers to the questions will give me the proof of their concern. When I searched in valley library webpage, I found a link called “Medically Necessary Organ Transplants for Prisoners: Who is Responsible for Payment? “. The article told me, “This is not to say that the prison authority must pay for the transplant using prison funds—it is free to obtain the money from other sources, including the inmate herself. If the only available option, however, is for the prison authorities to pay for the transplant, then they must do so…Evolving standards of decency thus require the government to make this level of care available to prisoners as well.
There is an obvious disparity between the level of care available to prisoners and that available to some groups of free citizens unable to afford adequate medical treatment…it is not sensible to lower the standard of care applied to prisoners to match the level of care available to the least well off members of society. A more equitable solution involves raising the standards of health care available to people presently unable to afford quality care, rather than viewing their lack of health care as a benchmark which can be used to limit the quality of care that prisoners receive. (Wright, 1251) There were two layers of meaning as far as I could figure out. First, governments have to pay transplants for prisoners if prisoners can’t pay by themselves. Actually, I think governments pay most times because transplants cost really too much. The article gave an example “in 1996, the estimated cost of a liver transplant was $314,500, with annual follow-up costs of $21,900” (Wright, 1251). Second, it is really unfair to these innocent law-abiding people and governments should focus on how to raise funds for these people. As far as I knew, American has 25 percent of the world’s inmates.
So governments need a lot to reach the objective. Ensuring medical care for prisoners involves the imparity for noncriminal people. For all the things I learned so far, the controversy about transplants for prisoner was pushed even further. So I had to ask, is there any other thing that matters in this issue? In Kahn’s article, post deeds and future benefits were post as an argument. Kahn thought, “The truth is that if social worth becomes a criterion for judging who gets transplants first—or maybe who gets them at all—then it is not only prisoners whose eligibility should be examined. (Kahn, 365-6) This is the part that I never thought before. People who are not imprisoned are not always innocents. Some of them may commit crimes but are not caught and they may have worse behaviors than the prisoners. In the most normal cases, businessmen who bring the society fortunes and progress may have to deal with frequent social activities involving alcohol, at least Chinese businessmen and officials are used to this convention, some of them may even become alcoholic. This is also a self-destruction behavior that should be counted.
Post deed seemed to be trivial so I wanted to find what prisoners could do for society. I believed prison industry could be a very important part to show prisoners’ contribution. A question came to me, how much do prison industries make in a year? So I tried to search on the Internet, then I found an article called “Cashing in on Cons”. It gave a round number about it—“annual revenue of $50 billion”(Talvi, 2005). And this is a very big number. But in the mean time, I found another article with a significantly contradict title “Prison Industry Stealing U.
S. Jobs”. This article asked a very profound question “with 8% unemployment why are prisoners working while citizens aren’t”(Johnson, 2012)? Actually this was not a question but an argument. So this part of research ended but I still couldn’t get a clue to solve the dilemma. So I began to think that even causes were helpless, maybe solutions given by some experts could help me figure the thread out. Then I found out an article called “Prison Inmates are Constitutionally Entitled to Organ Transplants – so Now what? (Douglas, 539-1229) In the conclusion part of it, the author addressed that “solutions targeting the scarcity of organs” and “the cost of providing organ transplants” were not workable for the controversial organ allocation and harvesting and the scarce donation with resulting large expense.
Meanwhile Douglas introduced the possible future research on “solutions aimed at reducing the number of the country’s elderly incarcerated” and that “the connection between the increase in elderly inmate populations and the advent of the public debate over prisoner organ transplants is well-established”. Douglas, 539-1229) Aging prisoner population intensified the scarcity of organs. Prison officers and noncriminal people share the same attitude on this issue. I also thought it would work someday but it must be very reasonable. After all these research I did in recent days, I finally found out what was really at stake for this organ transplant case. Rights, cost, habits, medical need and other aspects that matter to determine whether a prisoner or noncriminal person should be put on the organ transplant waiting list.
Either way doctors choose, there are always people gaining and others losing. When a prisoner was granted a transplant, especially for an elder prisoner, he would get health again and money came from taxpayers but innocent patients would possibly die. But when a prisoner was ignored and maybe died, the prison would be punished by humanity. But noncriminal people could survive and recover. But in either case, the governments lost. Losing humanity, violating laws or growing burden, drawing outcry, this is a question.
ACLU National Prison Project. “Know Your Rights”. American Civil Liberty Union. July 2012. http://www.aclu.org/files/assets/know_your_rights_–_medical_mental_health_and_dental_july_2012.pdf Center for bioethics. “Ethics of Organ Transplantation”. University of Minnesota. Feb 2004. http://www.ahc.umn.edu/img/assets/26104/Organ_Transplantation.pdf Douglas, Kate. “Prison Inmates are Constitutionally Entitled to Organ Transplants – so Now what?” Saint Louis University Law Journal 49 (2005): 539-1229. Print. Johnson, Keith.
“Prison Industry Stealing U.S. Jobs”. American Free Press. August 2012. http://americanfreepress.net/?p=5780 Kahn, Jeffrey. “The Ethics of Organ Transplantation for Prisoners.” Seminars in dialysis 16.5 (2003): 365-6. Print. Talvi, Silja. “Cashing in on Cons.” In these times. 4 Feb 2005: 16-19. Print. http://inthesetimes.com/article/1924 UC Davis Transplant Center .UNOS and the Waiting List, 13 Feb 2013. http://www.ucdmc.ucdavis.edu/transplant/learnabout/learn_unos_waitlist.html Wright, Jessica. “Medically Necessary Organ Transplants for Prisoners: Who is Responsible for Payment?” Boston College Law Review 39 (1998): 1251-. Print.