Transplants Bridge Divides

A 16 year old Pakistani girl received an urgent live donor liver transplant in India two months ago. Previously an Israeli suicide bombing victim donated a kidney to a Palestinian woman. Conversely, a Palestinian man's heart now circulates the blood through an Israeli man's body. All of these cases illustrate how organ transplantation can move individuals and their surrounding peoples to bridge epic political divides so that the right thing happens. Tragedy morphs into triumph.

Such beautiful selflessness is sometimes seen even within families suffering the serious pain of separation. When Richard Leakey, the renowned paleoanthropologist and conservationist needed a kidney transplant in 1979, his brother Philip donated an organ that then functioned for 26 years. Philip interrupted his own political campaign for the Kenyan parliament to undergo the procedure, indicating that, "There is a strong family bond" according to People magazine. Less emphasized than that act of heroism (every live donor is a true hero) was the fact that the two brothers barely spoke during 20 years despite the transplant, according to the Philadelphia Inquirer in 1995.

Behind closed doors, those of us privileged to work in this field often participate in similar stories in which an act of live or deceased organ donation and the subsequent transplant accomplish a connection that had seemed virtually unimaginable or reestablish a bond that had seemed unbreakable. These moments are spectacular even for we crusty old healthcare veterans - good exposed beneath tough outer human shells. Neither contrived nor fictitious, the moments are glorious.

Every plain vanilla case of donation and transplantation is glorious too. When reduced to the smallest scale, every live donor has accepted personal risk to save the life of another, regardless of who the donor is. Any deceased donor's organs and/or tissues have been gifted to save or better the lives of others, without qualification by demographics. Each recipient has gained a priceless opportunity to remodel or extend life without entitlement, no matter where the organ originated.

Failure to appreciate the magnificence of what is indeed now taken for granted is a mistake. If it takes "bridging" transplants to help  refocus on the amazing altruistic potential  that does lie inside us all, then more of these stories must be told. Perhaps some who would not otherwise have done so will be moved to register to become organ donors. After all, if Palestinians and Israelis, Pakistanis and Indians can help each other, can't we all do so? And again, let us not overshadow the everyday tales of donation and transplantation that are equally compelling if perhaps somewhat less dramatic.

Now the US Will Use Prisoners' Organs Too!

News stories of "donated" organs from executed Chinese prisoners being transplanted have horrified the transplant community because of concern about the lack of donor consent and other corollary ethical issues. Now comes news from the first of our fifty states to have torn down legal obstacles to the same practice. On March 28th, Utah's governor Gary Herbert signed legislation, H.B. 26, that expressly permits prisoners to make anatomical gifts if the inmate dies while in the custody of the Department of Corrections. Death row inmates are not excluded. With passage of the bill, the names of 247 inmates who expectantly signed organ donation documents have been added to the state donor registry according to JoNel Aleccia, writing for NBC news.

Pro arguments for the use of prisoners' organs include the desperate need for more organs to stem 18 deaths per day on the U.S. wait list for transplants. And why should commitment of a crime serious enough to land a person in jail necessarily imply an inability to give informed consent for organ (and tissue) donation? Should inmates really be denied the right to make one or more altruistic acts upon their death? Is the notion of reforming a human's ability to behave honorably a complete lost cause?

Con arguments abound as well. Today, we would consider any prisoners' organs to fall within the definition of "CDC high risk" because of the increased prevalence of HIV infection. Would a jury and judge feel more at ease sentencing a defendant to death knowing that organ donation was already checked off on the driver's license?

Reality can be unpleasant

Without absolute answers to any of these questions, a practical issue arises. Once an organ recovered from a Utah prisoner organ enters the national UNOS system, it will be allocated to a patient somewhere in the U.S. That patient may be located outside of the state of Utah. Similarly, tissue may be distributed throughout Utah, Idaho, Wyoming or Nevada, according to the Intermountain Donor Services 2012 Annual Report. The anonymity that is intrinsic to both organ and tissue donation systems assures that recipients will not be informed that their anatomic gifts were donated by a prisoner, regardless of their state of residence. Thus, passage of the Utah law implies that the entire U.S.  is now engaged in the practice of using organs from prisoners.

Reality can be unpleasant. The organ shortage is terrible. Commission of a crime serious enough to land a person in prison merits serious punishment. So long as transparency is retained within a system that requires informed consent of donors and recipients, this new law may be an important step forward for inmates and transplant candidates. Utah has dragged the entire U.S. into an ethically challenging arena. The implications must be clarified and openly acknowledged. Alternatives are not readily apparent, especially to those who can expect to die waiting for organs not otherwise available.