Donating Organs to Inmates Targeted

Outraged that a prisoner received a taxpayer-funded heart transplant and later died, a state senator wants to give Californians the option of designating that their donated organs not go to patients behind bars.

Republican Sen. Jeff Denham, whose father died in November while waiting for a liver transplant, believes people have grown less willing to donate organs because they fear their body parts will wind up helping a convict.

“Donors want to know that their organs are going to save a sick child or productive member of our community,” said Denham, a freshman legislator from Salinas. Prisoners, he believes, should not enjoy the same right to donated organs as ill Californians who are not incarcerated.

Denham’s bill, SB 38, has yet to receive any legislative scrutiny. But officials with at least one federally designated organ procurement organization are strongly opposed, saying the measure’s intent violates the objective standards guiding who gets transplants in the United States.

“The organ allocation system is based solely on medical and scientific criteria -- not on which patient is the richest, the smartest or the most socially acceptable,” said Mary Wallace, spokeswoman for the California Transplant Donor Network.

Creating subjective standards for deciding who gets organs, she warned, would threaten the equitable nature of the process and “lead us down a very slippery slope.”

Senate leader John Burton (D-San Francisco) summed up his concerns this way: “Where do you draw the line? If it’s prisoners today, it might be people over 70 tomorrow, or blacks, or Jews or Catholics.”

Burton added that although many Californians “would not want Charlie Manson to get a transplant, they might feel differently about a 19-year-old kid in [prison] for petty theft with a prior.”

Despite such skepticism, Denham’s bill reflects a burst of public anger that followed the inmate’s state-funded transplant a year ago. The senator said he had reports of some Californians tearing up their organ donor cards in disgust, and Wallace confirmed that officials at the transplant network had received calls from some who were taking that step.

The unidentified inmate -- the first California convict to get a new heart and only the second given a transplant of any kind -- was serving a 14-year sentence for a Los Angeles robbery at the time of his surgery. Due to be paroled in 2008, he was suffering from a viral infection that led to a gradual degeneration of his heart muscle.

After he was struck with congestive heart failure, the inmate was taken to Stanford University Medical Center, where he was kept alive by a machine that made his heart keep pumping. Hospital officials determined that a transplant was medically necessary, and a Stanford ethics committee approved him for the surgery.

The patient had done fairly well after the transplant and was taking anti-rejection drugs, prison officials said. But by fall, he was ailing and it appeared his body was rejecting the organ. A corrections spokesman said he “was not a model patient,” suggesting he may not have been taking his post-surgery medication as directed.

The prisoner died Dec. 16 at Stanford, and corrections officials estimated the costs of his transplant and related care at $2 million, including $1 million for the surgery and $12,500 a day for his stay in the intensive care unit.

Officials said they were compelled to provide the transplant by court decisions concluding that denial of decent medical care to prisoners amounts to unconstitutional cruel and unusual punishment.

Denham called the inmate’s transplant outrageous, saying that taxpayers should not be forced to foot the bill for such expensive procedures for prisoners. His bill, however, is more narrowly drawn. It would simply allow motorists who fill out forms donating their organs or tissues to specify that no incarcerated person may benefit.

The senator said he was motivated in part by a personal experience -- the death of his father, John, in November at age 54. John Denham suffered from hepatitis C and was on a waiting list for a new liver for about a year, his son said.

“I want to make sure there are more organs available so people won’t lose someone like I did,” Denham said. “We can’t afford to have people tearing up their donor cards because they think a prisoner will benefit.”

Nationwide, about 80,000 people are on waiting lists for life-saving organ transplants. Wallace, of the transplant network, said very few of them are prisoners, although she could not provide precise figures because such lists are confidential.

Because of the organ shortage, a transplant candidate dies every 90 minutes in the United States -- a total of 6,124 in 2001. Among people who die under conditions that make them medically suitable to donate their organs, about one-third do so, Wallace said.

Denham said he hopes his bill will encourage more Californians to become organ donors.

But one medical ethicist called his approach inappropriate and warned against altering health policy in a piecemeal fashion.

“If we want to ration health care, we need to have a reasoned debate about it and decide, globally, who gets it and who doesn’t,” said David Goldstein, co-director of USC’s Pacific Center for Health Policy and Ethics.

“Until we do that, we shouldn’t take potshots at this person or that person. This is just emotional flailing by someone who happens to have a bully pulpit.”

If Denham’s bill became law, it would not be the first time a high-profile transplant had led to changes in organ donation. In 1996, the United Network for Organ Sharing declared that people suffering from long-term liver failure typical in alcoholics and drug addicts would no longer be at the top of the list for liver transplants.

That change came after Mickey Mantle and former “Dallas” star Larry Hagman received liver transplants.