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Advocacy Ethical Considerations Living Kidney Donor

Want Parole? Give Up a Kidney.

In short, the Scott sisters are serving life sentences for an $11 armed robbery. Civil rights groups have been fighting this unusually harsh sentence for 16 years. Now that one sister is on dialysis, the governor, the same dude who was all over the news for saying the Citizens Council wasn’t racist, has decided the sisters can be paroled if one gives the other a kidney.

1. While the sisters have compatible blood type, it hasn’t been determined that A. they are HLA/tissue matches and B. that the prospective donor can pass the evaluation.

2. What the hell happened to a living donor’s autonomy? Give up a kidney, or go back to jail… hmmm, let me think…..*

3. Liberty = valuable consideration, which is ILLEGAL in the U.S. (See NOTA 1984)

I could go on and on here, but other folks have done so already. Hence, it’s far less time consuming for to excerpt and link to their columns.

Practical Ethics’s Michelle Hutchinson’s take.

One of her commenters quipped:

In the case of the Scott sisters, the authorities wouldn’t benefit from the exchange; the sisters would. I’m not sure whether the deal is morally objectionable or not, but if it is, it’s not because of exploitation.

I disagree with Ernesto’s point that the state does not benefit from the kidney donation. As per CNN’s article, Jamie’s dialysis costs the Department of Corrections $110,000 per year. The entire tally of her medical treatment is unknown. By paroling these ladies, the DOC is no longer paying to feed, house and clothe them, but more so, they no longer have to foot the bill for Jamie’s medical costs.

Yes, Medicaid will most likely pay for Jamie’s transplant and subsequent treatment, but if all goes well, it will be less than keeping her in prison and on dialysis. Unless Gladys suffers complications from the procedure – and that is another issue unto itself, because 4.4 living kidney donors die each year in the US within 12 months of surgery (per OPTN) and many do experience surgical issues – the state will no longer financially support Gladys. That is surely a tremendous benefit to the state and DOC.

The Journal of Medical Ethics blog post. He concludes:

Medical rights and duties are one thing; liberty rights and duties another. It’s one thing to incentivise donation; mixing it with criminal justice decisions, though, is something else.

*Barbour has not said if he will send the sister back to prison if the kidney isn’t donated. He has said something along the lines of “We’ll cross that bridge when we come to it”.

4 replies on “Want Parole? Give Up a Kidney.”

The sister had already said she wanted to donate her kidney to her sister. Before the parole hearing. Now she could have just been saying that to help obtain early release? Who knows. But by being told she can have early release if she does in fact donate the kidney she promised she would, makes sense to me. Either she wants to donate or she does not. As far as whether she passes the evaluation tests or not we have not heard what would happen if she was truly willing to donate but does not pass evaluation. I would like to think she still gets her parole as her intentions were correct.

If she had no intention of donating but just said that to help her case, then she has the final decision, the coersion all from herself.

To me it is no different to the long discussions that have been had over when living donors should be paid. i.e. The state will give you money if you give your kidney!

It's quite illegal to pay someone for their organs, kidney or otherwise. So if you're saying parole = valuable consideration (which imo, it does) then it should be prohibited.

The issues are a bit more nuanced than your comment implies. Living donation is a precarious ethical position because it harms one person for the benefit of another. The medical community has justified this uneven exchange by emphasizing the living donor's autonomy/willingness. In other words, the living donor is given an 'out' at every juncture of the evalation process. Holding someone's freedom over their head negates this autonomy. In fact, even the possibility of losing one's freedom negates this autonomy.

Since the governor has not stipulated what (if anything) will happen to Gladys if she doesn't donate a kidney to her sister, the only ethical thing for any tranpslant program to do would be to refuse to consider Gladys as a living donor until those questions are satisfied. They don't do this, of course, because they are too profit and recipient-driven, but any other path puts their Hippocratic Oath toward Gladys into question.

My understanding was that the sister had already offered her kidney before any parole hearing took place. It could be that she was only saying that to help her parole case and if released would then not donate. So the judge is really calling her bluff … you said you would donate, now lets see if you will. I do agree that if she then refuses to donate she should be put back in jail. But if she sticks to what she said but the evaluation fails her, then not her fault and she should still be released. Another question to ask is had she not offered to donate a kidney, would her parole hearing have refused her parole and if so on what grounds?

Actually, none of those things matter at all. Allegedly, Gladys did offer to donate a kidney to her sister but was refused because she was a prisoner. This is because prisoners are considered a 'vulnerable' population, suseptible to coercion and exploitation. By making kidney donation a condition of her parole, the Governor (not the judge) has violated the entire ethical framework of the US transplant system. He coerced and exploited her.

In truth, what he did is a violation of federal law (NOTA 1984) but like any other criminal activity, unless the victim (Gladys) complains, there will be no challenge to the decision.

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