What is the value of a human organ? It’s a question that’s been on my mind since I heard about a disturbing proposed change to the law in Massachusetts that would allow incarcerated people to swap their body parts for reduced prison sentences.
That’s right. Prisoners who donate one of their organs or their bone marrow could be rewarded with anywhere between 60 and 365 days off their sentence if this bill were to pass.
One benefit of the bill, according to one of its cosponsors, is that it will broaden the pool of potential organ donors. It’s true that there is a dire shortage of organs. In the US alone, more than 100,000 people are waiting for a transplant, and 17 people per day die on the waiting list.
But laws like this one are not the right way of going about increasing organ donation. Let’s take a look at the many problems with this bill.
Undergoing surgery or other painful procedures to give a kidney, liver lobe, or bone marrow to save another person’s life is probably one of the most generous and selfless things any of us can do.
But these procedures aren’t without risks. Surgery of any kind has the potential to damage other organs or result in infections, for example. People who donate kidneys are more likely to end up needing dialysis or a donated kidney themselves in the future.
It is vitally important that living donors understand and accept these risks so their decision to donate is fully informed and free. Can someone who is suffering in prison, and desperate to get out, really give free and informed consent?
“This is being framed as an incentive,” says Jennifer Bell, a bioethicist at the University of Toronto. But would there be some degree of coercion involved? By definition, coercion would imply there’s some threat of harm influencing the person’s decision. There is no mention of that in the bill. But spending an extra year in prison might be harmful for some people, especially if there is a risk of violence, disease outbreak, or dangerously hot conditions.
People who are incarcerated might also not feel able to give a full and frank medical history, which plays an important part in helping to determine whether they might be suitable donors, says Peter Reese, a nephrologist at the University of Pennsylvania who evaluates potential kidney donors, and who has experience of working in a women’s prison.
Doctors routinely ask would-be donors about their health, well-being, and ability to look after themselves and whether they smoke or take recreational drugs. These factors will affect not only whether their organs are suitable for donation but how likely they are to recover well from the procedure.
“I would be worried that someone who is incarcerated might not feel comfortable giving me a full, transparent history,” says Reese. “It is difficult to assess someone’s lifestyle when they’re incarcerated and they can’t actually make decisions freely.”
There are other problems with the bill. Its apparent goal is to increase living organ donation from people who are in prison. We know full well that these people are a vulnerable group, much more likely to have been born into poverty or subjected to childhood abuse, for example. We also know that ethnic and racial minorities are overrepresented in prison populations. Just over 30% of US inmates are Hispanic, for example, and 38% are Black.
“It could be perceived … as harvesting organs from Black [people] to give to others,” says Bell. “There could be a question of exploitation.”
State Representative Carlos González, who is one of the bill’s cosponsors, sent me a statement arguing that “broadening the pool of potential donors is an effective way to increase the likelihood of Black and Latino family members and friends receiving life-saving treatment.”
It is true that people from racial and ethnic minority groups have an even harder time getting the organs they need. In 2020, for example, the number of transplants performed on white people was 47.6% of the number currently waiting. The figure was only 27.7% for Black people. But there are other ways to inform minority communities about organ donation and encourage informed decisions about it. And they shouldn’t involve trading organs for freedom.
Which brings us back to the first point. How much are our organs worth, and how is that decision made? Is a kidney worth a year of freedom? Is bone marrow worth less? “How do they decide the calculus here?” Bell wonders. “Is it really a fair exchange?”
Thankfully, even if the bill were to pass, it wouldn’t mean that such trades would ever take place. Every organ donation has to be approved by a medical and ethics team, which includes a person whose sole function is to advocate for the donor. It’s unlikely that everyone would be comfortable with this type of exchange, says Reese. I think that’s probably for the best.