Last month, the Senate Health, Education, Labor and Pensions Committee made life a little better for people awaiting an organ transplant. It passed the HIV Organ Policy Equity (HOPE) Act, legislation designed to end the federal ban on research into organ donations from deceased HIV-positive donors to HIV-positive recipients. It would permit the Secretary of Health and Human Services to sanction such transplant operations if the research establishes their safety.
“Those infected with HIV are now living much longer and, as a consequence, are suffering more kidney and liver failure,” said Sen. Tom Coburn, a physician and one of the bill’s co-sponsors. Advocates of the legislation, which has bipartisan support in the House, estimate that organs from deceased HIV-positive donors could each year save about 1,000 HIV-infected patients who suffer from liver and kidney failure.
The future beneficiaries of HOPE aren’t just the patients desperate for a new kidney, liver, or heart. The donors also benefit; they see value in leaving their organs to medicine. Giving the “gift of life,” the narrative long championed by the transplant community to encourage people to become donors, is an opportunity to perform the ultimate charitable act—saving the life of another. Through posthumous donation, some people see the chance to fulfill a moral obligation to help others or to make something life-affirming come from their death.
Another marked population—prison inmates—is also pushing to expand its opportunity to save lives. Last month, Utah state legislator Steve Eliason proposed a bill allowing prisoners to sign up to become donors if their death occurs while incarcerated.
Although there is currently no nationwide legal proscription against prisoners signing up to become posthumous donors, Eliason wanted the allowance enshrined in statute. "There are many inmates who are constantly looking to give back to society in any way they can," said Steven Gehrke of the Utah Department of Corrections, which supports Eliason’s effort. "They feel like sitting in prison doesn't really repay their debts." At least three other states—Arizona, Texas, and California—promote deceased donation among inmates.
But what about inmates who want to donate while they are still alive?
In December 2011, I received a letter from Shannon Ross, 29, at the Stanley Correctional Institution in Wisconsin. He is eight years into a 17-year sentence for reckless homicide. Ross, who had read an article I wrote about the country’s organ shortage, had a simple request:
"I am hoping you can give me some advice about my desire to get the state [of Wisconsin] to allow inmates to donate their organs—without compensation. … I am not simply looking to be humored as I try to make my time pass faster. I have been pursuing this objective for five years now."
Ross wanted to donate one of his kidneys to a stranger. And he wanted to do it now, given the odds that his organs would no longer be usable after he died.
Ross had done his homework. He pointed out that a patient who receives a kidney from a live donor instead of a cadaver can expect the organ to last several years longer. He knew that the operation he would undergo involved the surgeon making a few keyhole-size incisions in the abdomen and that the hospital stay is usually two days. Ross said this was not a decision he made lightly—surgery is not a trivial event—but stressed that he would want to donate even if the recovery period were more prolonged.