Prisoner Received Heart Transplant

A California prison inmate received a new heart earlier this month in a transplant operation that could end up costing taxpayers as much as $1 million, prison officials said Friday.

The operation appears to mark the most extreme application yet of a court mandate to give prisoners the same standard of medical care as the average law-abiding patient.

The operation was undertaken at Stanford Medical Center on Jan. 3 but not reported publicly until this week. State prison officials said they believe the operation was the first heart transplant performed on a prison inmate, although not the first organ transplant.

In 1995, a federal court ordered California to give a kidney transplant to a prison inmate whose request for one had been denied. Because of that case, correctional officials said they had no choice but to allow the inmate to undergo the heart transplant.

“This is all we can do under the law,” said Stephen Green, assistant secretary of the state Youth and Adult Correctional Agency. “We must follow the court’s mandate, and that’s what we’re doing.”

Russ Heimerich, a spokesman for the Department of Corrections, added: “We’re not insensitive to the larger issues here. There’s the whole question of how far should we go for inmate medical care. That’s not really a question for us to answer.”

It is, however, a question that officials are likely to confront more often. The number of inmates obtaining organ transplants will probably rise nationwide in coming years because of the large number of prisoners who have been diagnosed with hepatitis C and are likely to need new livers, said Scott Chavez, a spokesman for the National Commission on Correctional Health Care.

And although heart transplants are very expensive, it is far from unusual for inmates to cost taxpayers a small fortune in medical bills, prison officials said. Prisoners are typically far less healthy than the average person, with vastly higher rates of substance abuse, hepatitis and AIDS.

“To single out this guy as being expensive--well, a lot of inmates cost us a lot of money because they’re just not in good shape,” Heimerich said.

According to the United Network on Organ Sharing, the estimated first-year cost of a heart transplant is $209,100, with annual follow-up charges of $15,000. Green said the total amount associated with treating this inmate could climb to $1 million.

The 31-year-old inmate, whose name was withheld because of medical confidentiality rules, is serving a 14-year sentence for a 1996 robbery in Los Angeles, Green said. A two-time felon, the prisoner had been at the Salinas Valley State Prison in Soledad. He was transferred to the prison system’s medical unit in Vacaville last February after repeated hospitalizations.

Green said the man was suffering from heart disease caused by a viral infection and was ill before being sentenced to prison. Shortly before the transplant, he had been transferred to a local hospital in Vacaville and then to Stanford for treatment of congestive heart failure. He was being kept alive with a cardiac assistive device, a machine that causes the heart to beat mechanically.

The decision to perform the transplant was made by a committee of doctors at Stanford, not by the Department of Corrections, Green said.

News of the operation was first reported Friday in the Sacramento Bee.

Although heart transplants were once a highly experimental procedure, they have been considered more or less routine since the 1983 introduction of the immunosuppressant drug cyclosporine, the first medication to effectively block the body’s effort to reject transplanted tissues.

The primary barrier to the procedure now is a serious shortage of donor organs. According to the Scientific Registry of Transplant Recipients, there were 2,197 heart transplants in 2000, the last year for which there are complete data. On Jan. 4, one day after the inmate received his new heart, there were 4,119 patients on the waiting list for a donor heart, according to the United Network for Organ Sharing.

The criteria for who will receive a donor organ include the patient’s overall health other than his heart; whether the patient is likely to die without a transplant; and whether the patient is likely to be able to adhere to the lifestyle changes--including complex drug treatments and frequent examinations--required after a transplant.

Geographic proximity to a potential donor organ and immunological compatibility are also important considerations.

The criteria do not include whether a person is incarcerated. That is appropriate, said Renee C. Fox, a bioethicist at the University of Pennsylvania. Barring inmates from receiving heart transplants would create ethical problems, Fox said.

The moral standing of a transplant recipient is “ideally irrelevant,” she said. To argue otherwise would risk creating a system in which each potential recipient is graded according to his or her moral standing--a decision that most ethicists might argue is best left to God.

“Should merit be considered a criteria?” Fox asked. “Should organs go to people who are ‘good,’ who have lived good lives?”

In this case, said Green, the inmate was chosen over other potential recipients because the donor was nearby and the two were considered a good match. Like the recipient, the donor has not been identified.

Some prison systems have been accused of “dumping” inmates who require costly medical procedures, using “compassionate release” as a pretext for getting them off the prison budget. California officials say they do not use compassionate release that way, but frequently release prisoners who are believed to have less than a year to live.

The inmate who received the heart transplant had applied for compassionate release on that basis, but got the new heart before the request was considered, Heimerich said. Even with the new heart, the inmate might still be granted release, meaning he may still be considered terminally ill, the spokesman added.

About 86% of patients survive the first year after a heart transplant, with survival declining to about 70% after five years.

In 1976, the U.S. Supreme Court ruled that denial of decent medical care to prisoners violates the constitutional prohibition against cruel and unusual punishment. The 1995 federal court decision ordering a kidney transplant was based on that ruling.

Since 1976, prisoners in several states have received transplants of organs other than hearts. In one noted case, James Earl Ray, the man convicted of assassinating the Rev. Martin Luther King Jr., sought a liver transplant. Tennessee officials refused to grant him a furlough to obtain the operation, and he died a few months later.

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Times staff writer Thomas H. Maugh II contributed to this report.