Trendspotter: Prisoners, Professor Spark Organ Donor Debate

January 5, 2011

The debate over who gets the final decision for organ donation received some new fuel on the fire recently, thanks to a pair of Mississippi prison inmates and a Maryland college professor. Both examples raise the interesting question of who should decide donation and should there be any kind of payment in return, including one's freedom.

The debate over who gets the final decision for organ donation received some new fuel on the fire recently, thanks to a pair of Mississippi prison inmates and a Maryland college professor.

First, in Mississippi, we are faced with the question: Should a person get compensation for donating an organ or should the altruistic act be payment itself? Gov. Haley Barbour signed an order stating that Gladys Scott, 36, would donate her healthy kidney to sister, Jamie, 38, who is on dialysis. The catch? Both women have been imprisoned since 1994 for an armed robbery that netted them a combined $11.

Through Haley's agreement, the life sentences of both Scott sisters get suspended upon the donation. One the one hand, the move will save the state of Mississippi $200,000 annually in dialysis for Jamie, according to state officials, but on the other hand, it is essentially paying one person for a kidney and in this case, that compensation is freedom from prison.

Needless to say, medical ethicists had a field day with Barbour's order, despite the state's insistence that the deal was the Scott sisters' idea and did not come from its chief legislator.
Dr. William Hurlburt, a neurologist and former member of the President's Council on Ethics, told ABC News that the deal "was such a tricky medical realm with so much risk for abuse that we agreed organ donation must always remain altruistic."

Another called the donation, "absolutely a payment," and therefore a violation of the law.
An article in Forbes even suggests that in light of the Scott's deal, perhaps it is time to revisit cash payment in return for organs again to boost life-saving donations.

While the issue of prison inmates donating organs is not new - in fact, if you have some free time, read this interesting Esquire article about death row inmates and donations - the issue of a "Get Out of Jail Free" card for a piece of another's body is a new twist.

Barbour seems in no hurry to reverse his decision, despite the fact that we still don't know if Gladys will be a match for Alice, but that news will come later. The issue is the matter of the donation. If the sisters were not convicted felons, there would be no issue. The fact that Barbour is essentially making the decision here is what is driving the discord. Do we even know if Gladys offered Alice her healthy kidney for nothing first?

Another interesting case comes from St. Mary's College of Maryland, where philosophy professor Michael Taber assigned his class their final paper - worth 5 percent of their grade - to make the decision for him as to whether he should donate his kidney. Taber tells NPR that the exercise for his Altruism and Egoism class was to apply some of the issues they had been discussing that semester.

What's the bigger sacrifice, Taber posed to his class, donating a piece of one's person or a piece of one's wealth? Is it selfish to hold onto something another person needs just to survive?

In the end, the class decided that Taber should keep his kidney as it wasn't prudent for one person to make the call on another's internal organs. (Taber told his students prior to the assignment he would make the final call on his kidney despite their vote and at the same time, chided their paper's indecisiveness on the issue).

Neither NPR nor the Washington Post, which first carried Taber's tale, noted student consultation with someone awaiting a healthy kidney on a donor list, so we'll never know if that person would have had a greater impact on them than their willing professor.

So Taber's students say it is up to the person (the donator) to make a decision on organ donation. Gladys Scott agrees, and was able to leverage freedom for her and her sister as a result. Mississippi Gov. Haley Barbour says it can also be the state's decision, when it comes to those the state has stewardship over, given a willing participant and the potential to save hundreds of thousands of dollars on inmate healthcare.

The debate rages on. As physicians, where do you stand on the issue of donation decisions? Would you welcome a payment-for-organ donation system?