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The Use of Prisoners as Sources of Organs-An Ethically Dubious Practice



The movement to try to close the ever-widening gap between demand and supply of organs has recently arrived at the prison gate. While there is enthusiasm for using executed prisoners as sources of organs, there are both practical barriers and moral concerns that make it unlikely that proposals to use prisoners will or should gain traction. Prisoners are generally not healthy enough to be a safe source of organs, execution makes the procurement of viable organs difficult, and organ donation post-execution ties the medical profession too closely to the act of execution.
The American Journal of Bioethics, 11(10): 1–5, 2011
Copyright c
Taylor & Francis Group, LLC
ISSN: 1526-5161 print / 1536-0075 online
DOI: 10.1080/15265161.2011.607397
Target Article
The Use of Prisoners as Sources of
Organs–An Ethically Dubious Practice
Arthur Caplan, University of Pennsylvania
The movement to try to close the ever-widening gap between demand and supply of organs has recently arrived at the prison gate. While there is enthusiasmfor
using executed prisoners as sources of organs, there are both practical barriers and moral concerns that make it unlikely that proposals to use prisoners will or should
gain traction. Prisoners are generally not healthy enough to be a safe source of organs, execution makes the procurement of viable organs difficult, and organ donation
post-execution ties the medical profession too closely to the act of execution.
Keywords: cadaver donation, compensation for donation, organ donation, prisoners, redemption, retribution
The push to find more organs to transplant has led to
some very novel ideas. Some cities have decided to send
out specially equipped “donor” ambulances to follow reg-
ular ambulances. When someone dies outside of a hos-
pital and is pronounced dead by the first ambulance
team, a second team can be called in from the trailing
donor ambulance, try to get consent from any available
family member to attach the corpse to life support, and
then transport the body back to a place capable of car-
rying out procurement. Initially this strategy will only
be used when a newly dead person is known to be an
organ donor by an advance directive or other means,
but the plan is to eventually extend the effort to all
newly deceased persons who die outside a hospital, us-
ing surrogate consent (New York Organ Donor Network
2010). Still others have proposed routinely offering kid-
ney donation to anyone undergoing elective surgery (Testa
et al. 2009). And some procurement teams argue that
advance directives regarding termination of life support
should never interfere with the possibility of donation (De-
Vita and Caplan 2007).
The movement to try to close the ever-widening gap be-
tween demand and supply of organs by creative strategies
has recently arrived at the prison gate. While there is some
enthusiasm for using prisoners as sources of organs, there
are both practical barriers and moral concerns that make it
likely that the use of prisoners will not contribute in any
significant way to relieving the problem of organ shortage.
Calls for the Use of Organs From Executed Prisoners
There has been a renewed interest in the use of organs from
death-row inmates, as reflected in an editorial in the New
York Ti m e s written by a death-row inmate, Christian Longo
Address correspondence to Arthur Caplan, Department of Medical Ethics, University of Pennsylvania, 3401 Market Street, Philadelphia,
PA 19104-3308, USA. E-mail:
(2011). He wrote that he was in prison in Oregon as a con-
sequence of having killed his wife and three children. He
said he had reached the point where he wished not to make
any further appeals of his conviction. What he hopes is that
after he is put to death he can donate his organs. But prison
authorities have rejected his request.
Longo says there are others on death row who want
to donate after execution. He has started a movement to
insure he and they have the chance to exercise what he
claims is his right to donate: “I am seeking nothing but the
right to determine what happens to my body once the state
has carried out its sentence” (Longo 2011).
Longo has attracted some support for his idea of us-
ing executed prisoners as sources of organs (Wood 2011).
Longo’s idea is not original. Efforts to obtain organs from
executed prisoners have attracted attention for many years
(Patton 1995; Bartz 2005).
Use of Living Prisoners as Organ Sources in Exchange
for Parole or Reduction in Sentence
In January 2011, Mississippi Governor Haley Barbour freed
two sisters from life sentences in jail for an $11 armed rob-
bery on the condition that one donate a kidney to the other.
Given the offer of parole, Gladys Scott agreed to be a donor
for her sister Jamie, who requires dialysis. Barbour was not
apparently convinced of the sisters’ innocence or merito-
rious conduct while serving their sentences in prison. He
said a key reason for his decision to order the sisters’ release
was that Jamie Scott’s kidney dialysis and treatment was a
financial burden on the state of Mississippi (Williams 2011).
In 2007 a state legislator in South Carolina proposed
a law to shorten prison sentences in exchange for kidney
or bone-marrow donation. State Senator Ralph Anderson
proposed bills that would release prisoners 60 days early
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for donating bone marrow and another that would give
good-behavior credit of up to 180 days to “any inmate
who performs a particularly meritorious or humanitarian
act,” which Anderson said would include living kidney
donation (O’Reilly 2007).
So, do either of these strategies to seek organs from
prisoners, dead or living, pass muster either practically or
The Number of Potential Organ Donors Is Very Small
The practice of capital punishment remains ethically con-
troversial. A tiny minority of the world’s nations still retain
this form of punishment. Some countries that permit cap-
ital punishment have not executed any prisoner for many
The majority of all executions in the world happen in
China, with approximately 5000 per year. Iran, with about
400 per year, is the second highest executioner. No other
countries regularly execute more than 100 people per year.
The only other countries that regularly execute more than
10 people per year are Iraq, Saudi Arabia, the United States,
and Yemen.
As of February 2011 there were 60 federal prison-
ers in the United States on death row (http://www. row-prisoners). Since
the reinstatement of the federal death penalty in 1988, 68
defendants have been sentenced to death. Three have been
executed. Six had their death sentence removed.
Thirty-four states permit the death penalty for nonfed-
eral crimes. In 2010, there were 46 executions, down from
a peak of 98 in 1999. That number may well decline in the
future due to problems raised concerning the manner in
which executions are currently conducted.
Many challenges and appeals have been mounted in re-
cent years to execution, protesting the mode of execution
used as cruel. This has led to court-ordered stays of all ex-
ecutions in some states. Other states may abandon capital
punishment in light of difficulties in obtaining drugs that
courts deem necessary for humane execution (Belluck 2011).
So the pool of potential candidates may grow even smaller
in the future.
Not only are the numbers of potential donors small, but
many prisoners would not be eligible to serve as donors
due to age, ill health, obesity, or communicable disease.
The average time between sentencing and any execution is
10.6 years (Baltimore Sun 2011). This means that executed
prisoners are often in their fifties or older, greatly reduc-
ing their potential to serve as sources of organs. Inmates
engage in drug-related and sexual risk behaviors, and the
transmission of HIV, hepatitis, and sexually transmitted
diseases occurs at high rates in correctional facilities. The
prevalence of HIV and other infectious diseases, whether
acquired prior to or during imprisonment, is much higher
among inmates than among those in the general commu-
nity. The burden of disease among inmates is also dispro-
portionately high (Hammett 2006; Kuehn 2010). Those in
prison for long periods of time are more likely to become
infected with communicable diseases that would either dis-
qualify them as donors or make their organs a high risk for
Even if one presumes the willingness of all those sen-
tenced to death in the United States to donate, the actual
number of executions diminishes the maximum pool of
possible donees to roughly 40 to 50 persons per year. That
number is declining. Presuming some of those on death row
would not be willing to be donors and that others would
be medically ineligible due to age or ill health, the use of
prisoners as cadaver organ donors cannot yield anything
more than a tiny number of organs for those in need.
Ethical opposition to capital punishment is strong and
further compromises proposals to use executed prisoners
as sources.
Efforts to abolish capital punishment remain vigorous in
the United States and around the world. In the United States,
fears of false conviction reinforce efforts to do away with
the death penalty. The Innocence Project reports 267 post-
conviction exonerations in the United States using DNA
evidence since 1989. Of these, 17 were prisoners on death
row ( on
PostConviction DNA Exonerations.php).
Critics of the practice may see linking organ procure-
ment to execution as increasing the image or social accept-
ability of capital punishment. The introduction of organ
procurement into executions also raises concerns that pros-
ecutors, judges, or juries may be more likely to insist on the
death penalty, knowing that lives might be saved.
Opponents of the use of executed prisoners are likely
to be very concerned about the impact of legalization in
the United States on other nations, since such a move may
make it more difficult to condemn controversial interna-
tional practices involving the execution of persons in order
to obtain their organs. Allegations persist of the involun-
tary and brutal execution and then immediate harvesting of
“prisoners” in China (Matas and Kilgour 2010).
Some of those executed may have been imprisoned for
religious or political activities (Matas and Kilgour 2010).
Any legitimation of the use of executed prisoners in the
United States may make it more difficult to protest cruel
and unjust execution practices in other nations.
Yet another moral problem confronting the use of exe-
cuted prisoners is the role that physicians and health care
workers ought play with respect to executions (Caplan
2007). Many maintain that physicians should play no role
whatsoever in the process, and some include in this even
the pronouncement of death at an execution. This is the
position of many national medical associations (American
College of Physicians [ACP] 1994; American Medical As-
sociation [AMA] 2010; World Medical Association [WMA]
2005). It is not clear whether the professional groups that
condemn physician or health care worker involvement with
executions would deem it ethical to be involved with organ
procurement after an execution has been completed. It is
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The Use of Prisoners as Sources of Organs
clear that they would not condone any change in the prac-
tice of execution in order to achieve procurement (ACP 1994;
AMA 2010; WMA 2005).
Putting aside the controversy over the morality of the
practice and the permissibility of health care workers in-
volvement with executions, the use of prisoners as cadaver
donors is made even more difficult by the complexity, practi-
cal and moral, of procurement in the setting of an execution.
Cadaver Donation Would Be Difficult to Achieve Using
Executed Prisoners
A large number of methods of execution including electro-
cution, hanging, and firing squad make organ procurement
impossible. However, nearly all executions in the United
States are by lethal injection.
Typically, three drugs are used in lethal injection:
sodium thiopental is used to induce unconsciousness;
pancuronium bromide (Pavulon) is used to cause muscle
paralysis and respiratory arrest; and these are followed by
potassium chloride to stop the heart. In the past 3 years, two
states have used a single-drug execution protocol using only
sodium thiopental. The only American company that made
this drug stopped manufacturing it due to its use in execu-
tions, leading to shortages that have delayed executions.
The primary obstacle to utilizing organs from executed
prisoners is that the prisoners do not die on life support.
This means that donation must be accomplished using
protocols developed from donation after cardiac determi-
nation of death without life support. Prisoners would be
treated as if they were controlled DCDD (donation after
cardiac determination of death) donors. This category
refers to patients in intensive care units with nonsurvivable
injuries who have treatment withdrawn and a transplant
team present to immediately try to retrieve organs after
monitored cardiac arrest has occurred.
Hearts cannot be used after a non-life-support death. If
the liver, kidneys, or lungs are felt to be suitable for trans-
plantation, the donor in a hospital setting is taken directly
to an operating room after cardiac arrest, and, after a wait-
ing period of up to 5 minutes depending on the protocol
in place at the hospital, a rapid retrieval operation is per-
formed. The outcomes for kidneys post DCDD procurement
seem comparable to those obtained from persons who die
on life support. Outcomes for livers and lungs are less cer-
Part of the problem in trying to carry out DCDD recov-
ery from executed prisoners is the extent to which the legal
and practical requirements of the execution would diminish
the likelihood of successful DCDD procurement. Executions
take place in prisons, not hospitals. Most executions involve
at least 10 to 15 minutes of examination prior to a final pro-
nouncement of death ( If the
usual DCDD protocols involving additional waiting time
post death to insure death has occurred were to be applied
and if, since most prisons lack a facility where DCDD pro-
curement could safely be done, bodies will likely have to
be moved to another location, the time involved could well
make DCDD procurement impossible. Given these practical
challenges, it is likely that only kidneys may be safely used.
This scenario also presumes medical teams would be
willing to be involved in the requisite proceedings. The
ethics of involvement in monitoring a patient post execu-
tion, the use of interventions to preserve organs either prior
to, during, or right after the execution, and participating in
the movement of the body from the execution chamber to a
surgical suite raise issues of complicity with the execution
that may violate professional norms. Moreover, the number
of physicians and nurses willing to be publicly associated
with these activities, given that executions are witnessed
events, is likely to prove extraordinarily small. Potential re-
cipients may not be willing to accept organs from executed
prisoners, knowing the risks involved (Halpern et al. 2008),
or simply out of ethical concerns that they do not want
organs from a person executed for terrible crimes.
Could Organ Removal Be Used as the Mode of
It might be possible to shift the location of executions into
hospitals or clinics in order to increase the chance of a suc-
cessful procurement of more organs. Prisoners might be
anesthetized and have their organs removed by a medical
team before they are dead. I have dubbed the notion of ex-
ecution by means of the removal of the heart or other vital
organs the “Mayan protocol” after the Mayan practice of
human sacrifice by removing a beating heart during cer-
tain religious rituals (Wood 2008). It is, however, morally
repugnant to involve physicians as executioners or to shift
the setting of punishment from prison to hospital. Involve-
ment in causing death in any way is a direct violation of
the “dead donor” rule, which has long been maintained as
a bright line between death and donation in order to insure
public trust and support for cadaver donation (DeVita and
Caplan 2007). This principle would even restrict efforts to
maximize the likelihood of procurement by the use of drugs
and cold perfusion as steps prior to execution.
Donation Undercuts the Morality of Execution
The point of capital punishment is to achieve retribution for
terrible crimes. It is also, proponents argue, a deterrent. If
either justification is to hold, then is organ donation likely
to be compatible with these reasons?
Retribution may be made far more difficult to achieve as
families and friends of victims watch as executed perpetra-
tors are lauded in their final days by possible recipients and
the media for their altruism in saving lives. Some may find
redemption acceptable (Wang and Wang 2010) if it saves
lives, but given the horrific nature of the crimes that lead to
execution, relatives and friends of victims are not likely to
be among them.
Consider Christian Longo, the prisoner behind the
movement to permit organ donation post-execution. What
were his specific crimes? He killed his wife MaryJane, 34,
and children Zachery, 4, Sadie, 3, and Madison, 2. Longo
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strangled MaryJane and Madison, stuffed their bodies in
suitcases, and threw them in a bay. Then he drove Zach-
ery and Sadie to a nearby bridge, tied rocks to their legs,
and tossed them into the water to drown. He said he did
it because his family was hindering his lifestyle. After the
murders he fled to Mexico, where he engaged in a variety
of cons and swindles until he was caught. In prison he has
made money by writing explicit sex letters to gay men, who
pay him for the raw prose (Smith 2011).
Longo now seeks redemption through being an organ
donor. If the moral basis for his execution is retribution
for his horrific acts, then how is any redemptive gesture
on his part consistent with the retributive intent of capital
execution (Hill 2009)?
social good is seen as issuing from the practice. While the
needs of those awaiting transplants are real, the aim of the
penal system is not to serve medical needs but to achieve
justice for those wronged and their families and friends,
as well as to deter future crimes. Mitigating the horror of
execution by permitting organ donation is not consistent
with the deterrent purpose of execution.
Giving the state a motivation to execute beyond
retribution or deterrence may be seen as inconsistent with
protecting prisoners’ rights. Creating the possibility of
organ donation may provide an incentive to prisoners or
their legal teams to prematurely abandon efforts to appeal
death-penalty decisions, particularly if prisoners believe
they may be able to expiate their crime and be remembered
in a positive manner as a result of donation.
Nor is it true, contrary to Longo’s claim (Longo 2011),
that being an organ donor is a right. Organ donation is a gift
that neither organ procurement agencies nor anyone else is
bound to accept. Even freed felons lose their right to vote, to
be a party in most lawsuits, to hold public office, and to bear
arms, and they suffer restrictions on travel overseas. Why
permit prisoners the chance to make posthumous gifts of
their bodies if their punishment is in part based on both ret-
ribution and their loss of standing within society (Hill 2009)?
The practical and ethical problems facing the use of ex-
ecuted prisoners as donors are overwhelming. Despite on-
going interest in their use, there is absolutely no possibility
of this strategy moving forward.
Practical Obstacles
In 2008 there were about one and a half million persons in
federal and state prisons and another 785,000 in local jails
in the United States at some point during the year (Sabol
2009). This large population might be available to provide
kidneys and perhaps portions of liver to those in need of
these types of transplants.
There are prisoners willing to consider donation, es-
pecially to family members. In the past a few prisoners
have done so. And prison officials in many states are
willing to consider these requests on a case-by-case basis
( home.htm).
The primary practical problem facing living prisoner
donation is the ill health and high rate of infectious disease
among prisoners (Hinkle 2002). In the case of the sisters
in Mississippi where the governor granted parole on con-
dition of sister-to-sister donation, no donation took place.
The would-be donor was too obese to be able to safely
donate. The risk factors for prisoners are significant enough
that they require special consent requirements to be used in
approaching potential recipients to inform them of the dan-
gers of accepting a kidney or lobe of liver from this source
(Singer et al. 2008; Halpern et al. 2008; Kucirka et al. 2009).
Ethical Concerns Over Use of Living Prisoners
The issue of living donation from prisoners is made morally
complex when various incentives or rewards such as pa-
role, reduction in sentence, or the extension of privileges
are associated with making an organ available. Federal
law prohibits making organs available for “valuable
consideration” (NOTA 1984). Arguably, giving a prisoner
parole or a reduction in sentence on condition of giving a
kidney to another is a form of valuable compensation. That
is how various national (UNOS [United Network for Organ
Sharing] Ethics Committee 2009) and international groups
(Zhiyong 2007) interpret policies that reward prisoners
who give up organs for rewards.
In addition to worries about compensation, the question
of free choice clouds the issue of prisoner consent (WMA
2005). Many maintain that prisoners cannot consent freely,
given the nature of the environment in which they live. The
vulnerability of prisoners in terms of coercion and manip-
ulation is explicitly acknowledged in their categorization
as a special population for whom informed consent may be
compromised in regulations governing prisoner participa-
tion in research (National Institutes of Health [NIH] 2011).
The ability to comprehend the facts about donation and to
make a voluntary choice must be carefully weighed on a
case-by-case basis if voluntary consent is to remain a key
component for obtaining organs from all living persons.
In most programs for living donors a donor advocate is
appointed, a psychological assessment is undertaken, and
the donee is made aware that he or she may change his
or her mind about donation at any time prior to the actual
act. These steps would have to be in place for a vulnerable
population such as prisoners, and those carrying them out
ought not have a connection to the corrections system, to
minimize any possibility of coercion or manipulation.
The arguments against allowing prisoners to donate
organs—kidney, liver, or bone marrow—while alive are not
as persuasive as the practical and ethical issues raised by ca-
daver donation from executed prisoners. Still, as the case in
Mississippi shows, a decision to commute a sentence condi-
tioned on making an organ available for reasons of cost may
well backfire. A high degree of ill health among prisoners,
alongside issues around the acceptability of compensation,
and the problematic nature of consent by those who are
incarcerated make this practice one that needs to be care-
fully regulated and assessed on a case-by-case basis. Direct
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promises of reward will have to be replaced by a willing-
ness to consider generous acts as a part of parole decisions
without any guarantees. As such, while lives may be saved,
living prisoners are not likely to provide a significant source
of organs for those in need.
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... Traditional questions of moral enhancement and violence have tended to center on three issues: (a) enhancing warfighters with beta-blockers to depress feelings of guilt and shame after killing in war [19,20], (b) accepting organ donations from prisoners [21], a practice explicitly prohibited by international human law [22], and (c medicalized punishment/ treatment to reduce prison terms, such as chemical castration [23]. By contrast, I focus on the ethics of neuroenhancements for prisoners of war (hereafter, 'POWs'). ...
... This is particularly true if, as was also stipulated, people with Moral Deficiency Disorder are actively posing serious unjust threats to others. 21 But then, not all reactivated unjust POWs suffer from lack of empathy. Many of them are likely deeply empathetic people who have false beliefs or harmful implicit attitudes about their participation in an unjust war. ...
... For instance, in cases where things are unequal, such as when just combatants place their lives on the line for nonliable civilians or when patients refuse consent and informed consent is necessary to render medical intervention morally permissible, their willingness to do so isn't medically indicated. 21 Cf. Thomsen [101], 208-211. ...
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... 83,84 This is primarily due to the belief that the inherently coercive circumstances in which condemned prisoners are held impairs their (or their families') capacity to give free and informed consent to donate organs upon death. 85 Chinese officials have alternately defended and criticized their own use of prisoners-often based on consent. As late as January 2015, the leader of the transplant sector, Dr. Huang Jiefu, told journalists: "I am not saying that I am against prisoners donating. ...
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The dead donor rule is fundamental to transplant ethics. The rule states that organ procurement must not commence until the donor is both dead and formally pronounced so, and by the same token, that procurement of organs must not cause the death of the donor. In a separate area of medical practice, there has been intense controversy around the participation of physicians in the execution of capital prisoners. These two apparently disparate topics converge in a unique case: the intimate involvement of transplant surgeons in China in the execution of prisoners via the procurement of organs. We use computational text analysis to conduct a forensic review of 2838 papers drawn from a dataset of 124 770 Chinese‐language transplant publications. Our algorithm searched for evidence of problematic declarations of brain death during organ procurement. We find evidence in 71 of these reports, spread nationwide, that brain death could not have properly been declared. In these cases, the removal of the heart during organ procurement must have been the proximate cause of the donor's death. Because these organ donors could only have been prisoners, our findings strongly suggest that physicians in the People's Republic of China have participated in executions by organ removal.
... Previous execution methods, such as a firing squad, diminished the transplantation success rate due to cell degeneration of the organs from severe blood loss. Under the clinical death of lethal injection, these problems do not exist (Caplan, 2011). As a result, lethal injection has become the primary enabler for harvesting superior quality organs from Chinese prisoners (Zou, 2012). ...
... This determination is even more difficult in cases where the prisoners might be suffering from a severe mental illness (e.g., schizophrenia and bipolar disorder). Even if a prisoner might not have a mental disorder, there is a higher likelihood of him/her being coerced and manipulated in the light of the hierarchical prison environment (Caplan, 2011;Macklin, 2018). ...
Although ethical and methodological challenges of conducting research with vulnerable populations are widely acknowledged, there are fewer discussions on the unique difficulties encountered by researchers while working with prisoners sentenced to death and their families. This paper presents the reflective accounts of two researchers’ fieldwork experience, highlighting the ethical concerns and methodological challenges encountered while conducting an interdisciplinary research project on the mental health of prisoners sentenced to death and their families in India. Specifically, we discuss challenges faced during sampling of participants (prisoners and families), obtaining informed consent, confidentiality and right to anonymity, role confusion and conflict of interest, potential risks and benefits to research participants, and personal biases of researchers. We also provide suggestions for future researchers who wish to conduct research in this area and for policy makers to work toward minimizing the stigmatization and oppression faced by this community. Implications for research, clinical work, education, and training of mental health professionals are discussed.
... In the past few years, the use of executed prisoners as a source of organ transplantation also has been a controversial issue in China. Proponents of organ procurement from executed prisoners argue that it could provide more transplantable organs whereas opponents argue that it is very likely to bring about judicial corruption or injustice (27). Reasons for supporting organ procurement from executed prisoners could be summarized in the following two points. ...
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In the past several decades, due to the severe shortage of transplantable organs, organ procurement from executed prisoners has been used to organ transplant, which goes against international ethics standards. In order to establish a transparent and equitable organ transplant program, China government has made a series of policy announcements concerning reducing dependence on procurement of organs from executed prisoners. As of 1, 2015, China phases out the use of executed prisoner organ and embark on its transplant reform. Since then, many effort have been made to meet the international ethics guidelines on organ transplant. In this study, we aim to elaborate on the status quo of organ procurement from executed prisoners from the perspective of ethics and law. Although China has made great progress in organ donation and transplantation, some western transplant surgeons or bioethicists still hold outdated views on organ donation and transplantation in China, which will not bring any benefits to its development and will alienate it from the international transplant community. We propose that both the international transplant society and Chinese transplant community within mutual cooperation and trust should jointly make efforts to advance the sustained and healthy development of organ donation and transplantation in China
... However, this has not always been, and still is not always, the case in research. A study published in early 2019 investigated questionable ethics in research on Chinese transplant recipients [6,32]. The authors request the immediate retraction of a large body of papers because of the poor ethical principles behind the studies (e.g., using organs from executed prisoners). ...
... At this point, it is important to take note of studies that argue against prisoner donation. Caplan (2011) 47 , for instance has suggested that in making prisoner donation plausiblethe ideal purpose of capital punishment is being averted which would be against the very idea of capital punishment. He argues that "permitting organ donation mitigates the horror and reduces the deterrent purpose of execution, and being an organ donor is a gift, not a right" 48 . ...
... However, this has not always been, and still is not always, the case in research. A study published in early 2019 investigated questionable ethics in research on Chinese transplant recipients [6,32]. The authors request the immediate retraction of a large body of papers because of the poor ethical principles behind the studies (e.g., using organs from executed prisoners). ...
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Background: Despite a long history, numerous laws and regulations, ethics remains an unnatural topic for many software engineering researchers. Poor research ethics may lead to mistrust of research results, lost funding and retraction of publications. A core principle for research ethics is confidentiality, and anonymization is a standard approach to guarantee it. Many guidelines for qualitative software engineering research, and for qualitative research in general, exist, but these do not penetrate how and why to anonymize interview data. Aims: In this paper we aim to identify ethical guidelines for software engineering interview studies involving industrial practitioners. Method: By learning from previous experiences and listening to the authority of existing guidelines in the more mature field of medicine as well as in software engineering, a comprehensive set of checklists for interview studies was distilled. Results: The elements of an interview study were identified and ethical considerations and recommendations for each step were produced, in particular with respect to anonymization. Important ethical principles are: consent, beneficence, confidentiality, scientific value, researcher skill, justice, respect for law, and ethical reviews. Conclusions: The most important contribution of this study is the set of checklists for ethical interview studies. Future work is needed to refine these guidelines with respect to legal aspects and ethical boards.
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This cross-sectional study collects data on US prison policies concerning organ donation by incarcerated individuals.
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We propose a new model for living organ donation that would invite elective laparoscopic cholecystectomy patients to become volunteer, unrelated living kidney donors. Such donors would be surgical patients first and living donors second, in contrast to the current system, which 'creates' a surgical patient by operating on a healthy individual. Elective surgery patients have accepted the risks of anesthesia and surgery for their own surgical needs but would face additional surgical risks when a donor nephrectomy is combined with their cholecystectomy procedure. Because these two procedures have never been performed together, the precise level of additional risk entailed in such a combined approach is unknown and will require further study. However, considering the large number of elective cholecystectomies performed each year in the United States, if as few as 5% of elective cholecystectomy patients agreed to also serve as living kidney donors, the number of living kidney donors would increase substantially. If this proposal is accepted by a minority of patients and surgeons, and proves safe and effective in a protocol study, it could be applied to other elective abdominal surgery procedures and used to obtain other abdominal donor organs (e.g. liver and intestinal segments) for transplantation.
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A new United Network for Organ Sharing (UNOS) policy mandates special informed consent (SIC) before transplanting organs from donors classified by the Public Health Service/Center for Disease Control (PHS/CDC) as high-risk donors (HRDs); however, concerns remain that this policy may cause suboptimal organ utilization. Currently, consent and disclosure policy is determined by individual centers or surgeons; as such, little is known about current practices. The goals of this study were to quantify consent and disclosure practices for HRDs in the United States, identify factors associated with SIC use and analyze associations between SIC use and HRD organ utilization. We surveyed 422 transplant surgeons about their use of HRD organs and their associated consent and disclosure practices. In total, 52.7% of surgeons use SIC, but there is a high variation in use within centers, between centers and by donor behavior. A defined HRD policy at a transplant center is strongly associated with SIC use at that center (OR = 4.68, p < 0.001 by multivariate hierarchical logistic regression). SIC use is associated with higher utilization of HRD livers (OR 3.37), and a trend toward higher utilization of HRD kidneys (OR 1.74) and pancreata (OR 1.28). We believe our findings support a formalized national policy and suggest that this policy will not result in decreased utilization.
Through a collection of new, previously unpublished essays, TheBlackwell Guide to Kant's Ethics addresses diverse topics crucial to our understanding of Kant's moral philosophy and its implications for the modern age. Provides a fresh perspective on themes in Kant's moral philosophy. Addresses systematically Kant's foundational work, Groundwork for the Metaphysics of Morals and his more specific treatment of justice and virtue in The Metaphysics of Morals. Includes essays by both established scholars and rising stars. Identifies common misperceptions of Kant's thought and challenges some prevailing interpretations. Shows how Kant developed and supplemented his earlier ethical thought with specific discussions of practical issues in law, international relations, personal relations, and self-regarding virtues and vices
A 5-year initiative will aim to help reduce the spread of HIV by seeking, testing, and treating prison and jail inmates. The nearly $50 million effort is being funded primarily by the National Institute on Drug Abuse, with additional funds provided by the National Institute of Mental Health and the National Institute of Allergy and Infectious Diseases. Rates of infection with HIV/AIDS are disproportionately higher among inmates of state and federal prisons and jails than in the general population. According to the Bureau of Justice Statistics, 1.5% of male inmates and 1.9% of female inmates were HIV positive or had a confirmed case of AIDS?about 3 to 4 times the prevalence in the general US population ( Yet many inmates go untested and untreated.
In the face of increasing calls for more transparency about and regulation of genetic testing in the United States, the National Institutes of Health (NIH) announced in March that it is creating a new voluntary genetic test registry that may soon help physicians and patients select and interpret genetic tests.Test makers can voluntarily submit information about the availability, validity, and clinical relevance of their products to the registry, which is expected to be available in 2011. The registry will be publicly searchable, allowing physicians and patients access to an array of information about genetic tests.
This article discusses the practice and development of organ donation by capital prisoners in China. It analyzes the issue of informed consent regarding organ donation from capital prisoners in light of Confucian ethics and expounds the point that under the influence of Confucianism, China is a country that attaches great importance to the role of the family in practicing informed consent in various areas, the area of organ donation from capital prisoners included. It argues that a proper form of organ donation from capital prisoners can be justified within the Confucian moral context in which the proper interests of capital prisoners and their families, the benefit of organ receptors, and a rightful order of society should all be appropriately considered. From the Confucian perspective, the act of donating organs from a capital prisoner must be decided by both the prisoner and his/her family (i.e., each side should hold a veto power), whereas such donation, in the proper circumstance protected by a rightful procedure, should be appreciated as a morally praiseworthy act of the prisoner who is willing to make the final effort to repent and correct his/her evil conduct and to leave something good to the world.
Recently, four organ recipients were infected with HIV through transplantation, raising questions about current serologic testing policies. Currently, the decision to use enzyme-linked immunosorbent assay or nucleic acid testing, an expensive and time-consuming method capable of detecting more recent infections, is left up to individual organ procurement organizations. The purpose of this review was to present estimates of the window period between infection and detection by enzyme-linked immunosorbent assay and nucleic acid testing for HIV, hepatitis B virus, and hepatitis C virus; and to evaluate the impact of those infections on posttransplant outcomes. Nucleic acid testing for HIV can detect infections 12-13 days earlier than enzyme-linked immunosorbent assay; in the case of hepatitis B virus, infections are detected 21.8-36 days earlier; and in the case of hepatitis C virus, infections are detected 26-60 days earlier. Studies indicate that it is possible to manage all three infections posttransplant. HIV/hepatitis C virus coinfections seem to present the greatest posttransplant management challenges due to drug toxicities. Nucleic acid testing can reduce the window period and thus increase the probability of detecting viral infections. HIV, hepatitis B virus, and hepatitis C virus positive organs may be appropriate for use in some situations; nucleic acid testing helps patients and physicians make informed decisions about their use.
This Note argues that prisoners, whether executed or living, should not become organ donors. The introduction acknowledges the shortage of transplantable organs in the United States and the steps that have been taken to ameliorate the crisis. Part I discusses the procurement of organs from executed prisoners, beginning with a brief examination of China, a country where this type of procurement is routinely practiced. Part I also examines organ procurement legislation pertaining to executed prisoners. Finally, Part I asserts the reasons that prisoners should not become donors, including the dead donor rule, the ban against physicians as executioners, the Oath of Hippocrates, the risk of transmissible diseases, and the negative perception that would result if organ procurement was tied to executions. Part II of this Note discusses prisoners donating their organs in return for mitigated sentences. Part II then argues that this practice should not be adopted because of the lack of informed consent and voluntary choice. Finally, Part III of this Note introduces potential solutions to the possibility of maintaining a voluntary system, moving to a presumed consent system, and using financial inducements to create a larger supply of transplantable organs.