A Mass. bill would cut prison time for organ donations.

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https://www.boston.com/news/politics/2023/02/01/massachusetts-bill-prison-time-bone-marrow-organ-donations/

A Mass. bill would cut prison time for organ donations. An advocate is calling the measure ‘unethical and depraved.’

"To incentivize the selling of your body parts in exchange for the most precious commodity in the world ... was just so appalling.”

By Abby Patkin
February 1, 2023

Newly proposed legislation would allow incarcerated people in Massachusetts to trade one precious commodity, donated organs, for another: Time.

Under HD.3822, a bill filed in the State House last month, incarcerated individuals could shave two months to one year off of their prison sentence in exchange for bone marrow and organ donations.

State Rep. Carlos González, one of the legislators behind the bill, told Boston.com in an email that he was inspired in part by a close friend who requires dialysis three to four times a week while he awaits a kidney transplant.

“He’s a father of three children and is in stage 4 of kidney failure,” González said, adding, “I love my friend and I’m praying through this legislation that we can extend the chances of life for him and any other person in a similar life-or-death situation.”

González, a Springfield Democrat, noted that a number of comorbidities put people of color at risk for organ failure, pointing to higher risks of diabetes and heart disease among Hispanic and Black populations, and higher rates of chronic liver disease among Hispanic people. Broadening the pool of potential donors, he argues, is an effective way to increase the likelihood of those patients receiving critical care.

The bill would establish a bone marrow and organ donation program within the Massachusetts Department of Correction, to be administered by a committee that would include in its ranks MADOC representatives, a donation specialist, and an advocate for incarcerated individuals’ rights. Benefiting institutions would bear donation-related costs, and the Department of Correction wouldn’t profit from donations.

“We must provide every person who is incarcerated with the guidance of medical experts and advocates in order to ensure them the same rights and opportunities that every individual in Massachusetts has to save the life of their mother, father, brother, sister, child or friend,” González said.

He added: “In my view, there is no compelling reason to bar inmates from this. One of our goals is to provide information and education on the disproportionate number of Blacks and Latinos dying while waiting for donors.”

State Rep. Judith García, a Chelsea Democrat who submitted the bill alongside González, did not respond to multiple requests for comment. However, she shared an infographic on Twitter that stated the bill will “restore bodily autonomy to incarcerated folks by providing opportunity to donate organs and bone marrow” and “recognize incarcerated donors’ decisions by offering reduced sentence.”

Is the proposal ethical?

However, the proposal has raised eyebrows — and questions — among ethicists and advocates for incarcerated peoples’ rights.

“When I saw the bill, it just smacked as unethical and depraved. And the reason is because it is unethical to sell organs; it is unethical to incentivize the selling of organs for very, very good reasons,” said Michael Cox, executive director of the prison abolition organization Black and Pink Massachusetts, which supports LGBTQ+ and HIV+ people impacted by the criminal legal system.

He said the focus on incarcerated individuals was particularly shocking.
“They’re a marginalized group in society, highly stigmatized and extremely vulnerable,” Cox said in an interview. “And so to incentivize the selling of your body parts in exchange for the most precious commodity in the world — which is time on this earth, and your freedom — was just so appalling.”

Citing his own experience in the prison system, Cox explained that earning “good time,” or credit-based early release, is difficult to do, as the demand for applicable programming far outpaces availability.

“So that’s sort of why this bill is so criminal, because it’s such a big incentive for people who find it very difficult to earn even a single day,” he said.

The incentive also raises legal questions, as the National Organ Transplant Act prohibits the exchange of a donation for “valuable consideration.”

In 2007, South Carolina lawmakers considered a similar proposal that would have shaved up to 180 days off prison sentences in exchange for donations. However, critics debated the proposal’s legality, and South Carolina ultimately adopted a voluntary organ and tissue donation program that allows incarcerated individuals to donate without an incentive.

The Massachusetts bill’s proposed sentence reductions may confront the same issues, according to Dr. Robert Truog, director of Harvard Medical School’s Center for Bioethics.
“It does seem that there’s a quid pro quo here that [the incarcerated donors] are being rewarded with something — in this case, not money, but with time off of their sentence,” he said in an interview. “That does seem to me to not be compatible with how we think about organ donations, which are that they are given as a gift with no quid pro quo of any sort, whether money or otherwise.”

In 2014, the ethics committee at the United Network for Organ Sharing (UNOS), which manages the U.S. organ transplantation system, opined that “any law or proposal that allows a person to trade an organ for a reduction in sentence, particularly a sentence from death to life in prison, raises numerous issues.”

For example, the committee noted that if sentence reductions were to exclusively apply to donations that took place, and not offered donations, the policy would then discriminate against those found to be medically unsuitable for donation.

What’s next?

Cox said he doesn’t believe the bill will advance as-is, citing the abundance of progressive voices in the Legislature. He also cautioned against expending finite resources on this bill when there are so many others in need of attention, including a proposed jail and prison construction moratorium and the RIGHTS Act, a bill that would improve conditions of confinement for LGBTQ+ people.

Yet it’s early in the legislative session, and González noted that the proposed incentives are still up for debate.

“The same program could be established without a reduction in sentencing,” he said. “We are open to having discussions, throughout the course of the legislative session, on whether a sentence reduction component is appropriate.”

Allowing incarcerated individuals to donate without the expectation of a quid pro quo could make a difference, according to Truog.

Cox concurred.

“I met some of the nicest, kindest, most protective people I’ve ever met while I was incarcerated,” he said. “And yeah, I believe that some people who are incarcerated would choose to donate an organ or bone marrow to a dying child. I think that would be so meaningful to some incarcerated people, just like it is in the community.”

But, he added, “you just can’t incentivize it, because it just goes down a bad path.”

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https://www.wgbh.org/news/local-news/2023/02/02/a-bill-that-would-let-prisoners-trade-organs-for-a-reduced-sentence-faces-significant-blowback

A bill that would let prisoners trade organs for a reduced sentence faces significant blowback

By Sarah Betancourt
February 2, 2023

A new bill that would give Massachusetts prisoners an earlier release if they donate organs is mired in controversy as advocates raise concerns about ethics, and legislators urge understanding for their intentions.

It would allow people held in state prisons the ability to reduce their sentences between 60 days to a year, “on the condition that the incarcerated individual has donated bone marrow or organ(s).”

Prisoner advocates say that incarcerated individuals might feel pressured to trade their organs for free time. State Rep. Carlos González, one of the sponsors, told GBH News on Wednesday that is “far from the truth.” He said he has family members in prison, and is connected to a father of three hospitalized in a Massachusetts hospital suffering from stage-four kidney failure while waiting for a donor.

The idea, he said, is to broaden the pool of potential donors in an effective way to “increase the likelihood of Black and Latino family members and friends receiving life-saving treatment.” González, said this could benefit prisoners because it restores individual agency and decision-making.

“There is no law against prisoner organ donation,” he said. The committee in charge of proctoring the program, he said, would ensure the safety of every participant.

How it works

The legislation to “establish the Massachusetts incarcerated individual bone marrow and organ donation program” was filed by González of Springfield and Judith García of Chelsea in January. García didn’t respond to requests for comment, but posted on Twitter the bill will “restore bodily autonomy to incarcerated folks by providing opportunity to donate organs and bone marrow” and “recognize incarcerated donors’ decisions by offering reduced sentence.”

A program for donations would be established within the Massachusetts Department of Correction, and be run by a committee of five people, which include DOC leadership, an organ donor specialist, and two people from the Massachusetts District Attorney’s Association and a prisoners’ rights group. It would create eligibility standards and proctor the program. Costs related to the donations would be covered by “benefiting institutions of the program."
González said legislators are open to expanding the number and breadth of people on the committee.

There is a process in place which permits prisoners to donate organs, according to the Department of Correction, but the agency couldn’t provide details on how prisoners can currently donate organs. An agency spokesman said the department doesn’t comment on pending legislation.

“This bill basically establishes a committee with advocates, with advocates of our inmate population to establish the parameters, the guidelines, the clarity, the transparency, on a policy that is lacking within the department of corrections today,” said González.

The ethical questions

While there’s no evidence that prisoners are seeking to donate organs in droves, there are instances. In 2011, a 37-year-old man on Oregon's death row sought to posthumously donate his organs. He was told that the drugs in executions destroy organs, and argued in a New York Times op-ed that isn’t the case.

In July 2022, a Texas prisoner on death row sought to delay his execution so he could make a kidney donation. Utah became the first state to allow organ donation in 2013, if they die while incarcerated. Federal prisoners are allowed to donate organs to family members. It is unclear how state prisoners in Massachusetts are able to.

The need is certainly there. There are about 4,000 people waiting for organs in Massachusetts, according to the Health Resources and Services Administration.
Groups are decidedly against prisoners getting free time in exchange for their organs, and worry they’re vulnerable to influence in that decision.

Prisoners Legal Services said it’s in touch with the bill sponsors. Litigation director Jim Pingeon said that many Massachusetts prisoners wouldn’t meet medical eligibility for organ donation.

“We’re cognizant of the significant problem of racial inequity in our health system that has left BIPOC communities disproportionately impacted by organ and marrow shortages,” said Pingeon. “However, we are concerned regarding the potential for coercion and impact of inadequate medical care in carceral settings.”

The solution he said, must target underlying “structural problems leading to health disparities.” Hispanic men and women have chronic liver disease at twice the rate of the white population, and they're almost twice as likely to die from chronic liver disease. Gonzalez said it's comorbidities like this that are known to put people of color at risk for organ failures.

He also said its explicitly against the law to offer any “valuable consideration” or reward for organ donation.

The idea of prisoners having the right kind of autonomy to be able to make that kind of decision while being behind bars is also part of the ethical argument.

“Here they’re clearly trying to incentivize people by offering them sort of reduced sentences. That has historically been a problem because you have people who are in a context where they have reduced freedoms overall,” said Takunda Matose, a bioethicist at Loyola University Chicago who has worked in incarceration settings.

“There’s a history of concerns about how just when these kinds of programs have previously been attempted sometimes that included, some of the financial incentives, which I know are not included in this proposal," he said.

Organizations like Black and Pink Massachusetts are vocally against the bill. “We were shocked to see particularly the incentivisation provision to install a harvest organ harvesting program in the Department of Corrections,” said Michael Cox, executive director. "You can't essentially let people sell their organs for freedom,” he said.

The ethical arm of United Network for Organ Sharing —which runs the nation's organ transplant system —said in 2014 that “any law or proposal that allows a person to trade an organ for a reduction in sentence, particularly a sentence from death to life in prison, raises numerous issues.”

González said that sponsors are open to having discussions on whether a sentence reduction is appropriate and changing the bill’s language.

“The narrative being put out there, organ harvesting, trafficking, is so far from the truth,” he said.

Matose had a list of recommendations, including improving medical care at prisons that lack it, broadening committee membership to be less focused on prison staff, and tracking the racial demographics of people who are donating, and people who are recipients, to ensure equity.

The root cause of the bill’s creation, stemming racial inequities of organ donation recipients, is essential to address. ““More than two out of three white people find a bone marrow match, whereas most people of color have less than a 50 percent chance of finding a match. Those who require transplants are disproportionately people of color,” González, said.

The bill does not have a hearing scheduled yet. House Speaker Ron Mariano, a Democrat, cast doubts on its progress on Wednesday.

"It's the first I've ever heard of it ... first reaction is that some of these guys would give their legs to get out,” he said. “I don't know, it's kind of an extreme way to get your sentence reduced. I don't know if it makes much sense.”

Massachusetts could go the way of South Carolina. In 2007, lawmakers in there sought to reduce sentences by up to 180 days if a prisoner donated an organ. After blowback, the state created a voluntary organ and tissue donation program that allows prisoners to donate—without anything in exchange.

Katie Lannan contributed to this story.

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https://www.technologyreview.com/2023/02/03/1067768/massachusetts-bill-prisoners-swap-organs-freedom/

A Massachusetts bill could allow prisoners to swap their organs for their freedom
It’s a terrible idea.

By Jessica Hamzelouarchive page
February 3, 2023

This article is from The Checkup, MIT Technology Review's weekly biotech newsletter. To receive it in your inbox every Thursday, sign up here.

What is the value of a human organ? It’s a question that’s been on my mind since I heard about a disturbing proposed change to the law in Massachusetts that would allow incarcerated people to swap their body parts for reduced prison sentences.

That’s right. Prisoners who donate one of their organs or their bone marrow could be rewarded with anywhere between 60 and 365 days off their sentence if this bill were to pass.

One benefit of the bill, according to one of its cosponsors, is that it will broaden the pool of potential organ donors. It’s true that there is a dire shortage of organs. In the US alone, more than 100,000 people are waiting for a transplant, and 17 people per day die on the waiting list.

But laws like this one are not the right way of going about increasing organ donation. Let’s take a look at the many problems with this bill.

Undergoing surgery or other painful procedures to give a kidney, liver lobe, or bone marrow to save another person’s life is probably one of the most generous and selfless things any of us can do.

But these procedures aren’t without risks. Surgery of any kind has the potential to damage other organs or result in infections, for example. People who donate kidneys are more likely to end up needing dialysis or a donated kidney themselves in the future.
It is vitally important that living donors understand and accept these risks so their decision to donate is fully informed and free. Can someone who is suffering in prison, and desperate to get out, really give free and informed consent?

“This is being framed as an incentive,” says Jennifer Bell, a bioethicist at the University of Toronto. But would there be some degree of coercion involved? By definition, coercion would imply there’s some threat of harm influencing the person’s decision. There is no mention of that in the bill. But spending an extra year in prison might be harmful for some people, especially if there is a risk of violence, disease outbreak, or dangerously hot conditions.

People who are incarcerated might also not feel able to give a full and frank medical history, which plays an important part in helping to determine whether they might be suitable donors, says Peter Reese, a nephrologist at the University of Pennsylvania who evaluates potential kidney donors, and who has experience of working in a women’s prison.

Doctors routinely ask would-be donors about their health, well-being, and ability to look after themselves and whether they smoke or take recreational drugs. These factors will affect not only whether their organs are suitable for donation but how likely they are to recover well from the procedure.

“I would be worried that someone who is incarcerated might not feel comfortable giving me a full, transparent history,” says Reese. “It is difficult to assess someone’s lifestyle when they’re incarcerated and they can’t actually make decisions freely.”

There are other problems with the bill. Its apparent goal is to increase living organ donation from people who are in prison. We know full well that these people are a vulnerable group, much more likely to have been born into poverty or subjected to childhood abuse, for example. We also know that ethnic and racial minorities are overrepresented in prison populations. Just over 30% of US inmates are Hispanic, for example, and 38% are Black.

“It could be perceived … as harvesting organs from Black [people] to give to others,” says Bell. “There could be a question of exploitation.”

State Representative Carlos González, who is one of the bill’s cosponsors, sent me a statement arguing that “broadening the pool of potential donors is an effective way to increase the likelihood of Black and Latino family members and friends receiving life-saving treatment.”

It is true that people from racial and ethnic minority groups have an even harder time getting the organs they need. In 2020, for example, the number of transplants performed on white people was 47.6% of the number currently waiting. The figure was only 27.7% for Black people. But there are other ways to inform minority communities about organ donation and encourage informed decisions about it. And they shouldn’t involve trading organs for freedom.

Which brings us back to the first point. How much are our organs worth, and how is that decision made? Is a kidney worth a year of freedom? Is bone marrow worth less? “How do they decide the calculus here?” Bell wonders. “Is it really a fair exchange?”

Thankfully, even if the bill were to pass, it wouldn’t mean that such trades would ever take place. Every organ donation has to be approved by a medical and ethics team, which includes a person whose sole function is to advocate for the donor. It’s unlikely that everyone would be comfortable with this type of exchange, says Reese. I think that’s probably for the best.