The barrier was the penal system. “As a rule, we are banned from live organ donation (even though an inmate in need of an organ is given equal priority on the waiting list as everyone else),” Ross wrote me some months later. Wisconsin’s department of corrections is not alone in imposing such a ban on prisoners; I have not been able to find any states that permit inmates to give a kidney to a stranger. This stance mirrors the policy of the Federal Bureau of Prisons, which forbids federal inmates to donate to a stranger. The Bureau does, however, allow live organ and bone marrow donation by federal inmates when the recipient is a parent, sibling, or biological child.
In my view, there is no compelling reason to bar all inmates, as a matter of policy, from making live donations to strangers. Bioethicists may contend that it is not ethical to allow prisoners to donate because incarceration is a coercive process that limits one's freedom to make a choice, but there are ways to make inmate donation safe and fair. For example, authorities would stipulate that the donation could not have bearing on parole, and the donor would be made fully aware that relinquishing an organ would do nothing to secure early release.
What’s more, a prospective donor would undergo rigorous informed consent regarding surgery and the risks of living with one kidney, as is required for any kidney donor. Medical and psychological testing would be performed, which is also standard. A several-month "cooling off" period before surgery should be a good gauge of an inmate’s commitment to donate. Likewise, review by a prison-appointed panel could determine the authenticity of his request as well as a test of whether his expectations are realistic. Annual medical checkups following transplant could be paid through a Medicaid voucher (which is not even a regular feature of standard donation on “the outside”).
Hepatitis and HIV occur at relatively high rates in the prison population, posing a risk of transmitting the diseases to non-infected recipients. But the solution is to test the inmate at initial screening—the standard procedure for any living donor—and then again at three weeks prior to surgery. He should be kept in medical isolation between the final test and the transplant date so he can’t become infected and pass on a newly acquired virus before it can be detected.
This strategy would provide as much, if not more, confidence in the safety of the transplant as is the case for standard transplants. Compare this to the procedure surrounding unplanned, deceased donors—often victims of gunshot wounds or car accidents—where there is pressure to obtain test results quickly, to rely on family members for donors’ health information, and to perform the transplant before the removed cadaver organ becomes damaged from sitting “on ice” too long.
The impact of donation, both living and deceased, by inmates would probably be modest—perhaps a few hundred organs per year at most. Realistically, many organs from inmates would not be acceptable due to infectious disease. (Though if HOPE passes, more HIV-positive organs will be eligible for transplantation to people who are already infected.)
But with roughly 117,000 people waiting for an organ, inmate donation would still be a most welcome contribution to public health. Besides saving lives—virtue enough—it could also help the cause of justice. “After how much we have taken from society,” Ross told me, “it’s unacceptable that society is denied the opportunity to receive something so valuable from us in return.”