Convicted Criminals and Transplant Evaluation
Reviewed in 2015
Ethics Committee Position Statement 1
Punitive attitudes that completely exclude those convicted of crimes from receiving medical treatment, including an organ transplant are not ethically legitimate. The more difficult question is whether one's status as a convicted criminal should be a factor in reaching a decision regarding who should be eligible to obtain an organ transplant. In other words, should convicted criminal status be considered in evaluating individuals for organ transplantation?
Another view argues that convicted criminal status should be irrelevant in the evaluation for candidacy as a potential transplant recipient. This position assumes that convicted criminals have been sentenced only to a specific punishment, i.e., incarceration, fines, or probation. However, the convicted criminal has not been sentenced by society to an additional punishment of an inability to receive consideration for medical services. This argument also emphasizes that criminals not sentenced to death are expected to return to society and be deemed worthy of equal treatment in the receipt of other items/services distributed by society.
The UNOS allocation system is based on the principles of equity and medical utility with the concept of justice applied to both access (consideration) as well as allocation (distribution). The UNOS Ethics Committee opines that absent any societal imperative, one's status as a prisoner should not preclude them from consideration for a transplant; such consideration does not guarantee transplantation. Acknowledged are medical and non-medical factors that may influence one's candidacy for transplant however prisoner status is not an absolute contraindication. Although one's status as a prisoner may evoke legitimate medical concerns (i.e., infectious diseases), as well as psychosocial issues (i.e., character disorders and substance abuse problems that may compromise compliance), judgments regarding these medical and non-medical factors are the purview of individual transplant teams. Consideration of prisoners as well as others for transplantation includes evaluation of medical and non-medical factors relative to their impact on transplant outcome. Screening for all potential recipients should be done at the candidacy stage and once listed, all candidates should be eligible for equitable allocation of organs.