Another organ dilemma so soon....

Nurses General Nursing

Published

http://www.msnbc.com/news/878794.asp

Convicted killer's transplant sparks ethical debate

Many argue inmate is not entitled to donated liver

YORK, Neb., Feb. 28- Farmer Calvin Stock's life was saved by a liver transplant three years ago, and he would hate to see anyone else lose their chance at survival because a convicted killer was ahead of them on the transplant list. But that's exactly what could happen because of a Nebraska inmate's conditional approval to be included on the list of 17,300 people nationwide waiting for new livers.

FORMER PROSTITUTE Carolyn Joy, convicted of murdering another prostitute in Omaha in 1983, admits her liver was ruined by almost daily heroin and alcohol abuse over nine years.

Stock, a 68-year-old retired Lexington farmer who believes strongly in organ donation after it saved his life, fears people will tear up their donor cards if they learn their organs may go to felons.

"It's just going to do great damage to the organ donation program as we know it," he said.

The woman, known as Mama Joy by other inmates at the Nebraska Correctional Center for Women, has been the focus of a heated medical ethics debate since Omaha television station KETV first reported Feb. 3 that she had been evaluated by doctors for a possible liver transplant.

Joy, 49-years-old and drug free for nearly 20 years, said she is not surprised that others object to her possibly getting a liver.

"I know how society is," Joy said. "It's like, 'Oh my gosh, she's a murderer and on top of that, she wants one of our organs? What makes her so special?"'

TAXPAYERS TO FOOT BILL

But the biggest complaint from the dozens of people who have called or e-mailed the Nebraska Health System in Omaha, where Joy would get the transplant, is that the state would have to pay for it, said Kolleen Thompson, manager of the hospital's Organ Recovery Services.

Taxpayers would pay up to $200,000 for Joy's transplant because of a 1976 U.S. Supreme Court ruling that prisoners have a constitutional right to equal medical care. The decision requires government entities to cover the medical costs of their inmates.

A 32-year-old California inmate last year is believed to be the nation's first prisoner to receive a heart transplant. The convicted robber died 11 months later. Dr. Alan Langnas, head of transplant surgery at the University of Nebraska Medical Center, said doctors are only considering the transplant from the standpoint of whether Joy is medically a good candidate.

"Whether or not she's a prisoner or not does not enter the equation," Langnas said. "Ethically as a physician, it's our responsibility to be advocates for whatever patients we are treating."

Dr. Lainie Friedman Ross with the MacLean Center for Clinical Medical Ethics at the University of Chicago, said people should receive transplants based on need, not social standards.

"I'm a workaholic, and when I get my first heart attack I'll say I've earned it but no one will keep me off a list for that," Ross said. "We don't blame the workaholic but we blame the alcoholic. ... Yeah, she belongs on the list like I belong on the list."

Bill Grimes, 76, received a heart transplant 15 years ago and helped start a support group for transplant recipients in central Nebraska called Seconds for Life.

"I just absolutely can't pass judgment on anybody," Grimes said. "I feel everybody should have the same chance I had."

SHE MADE HER CHOICE'

But many do not feel as charitable toward Joy and her situation.

"She made her choice. It sounds real cruel to say that, but nonetheless, we all have choices in our life," said Stock. Whether Joy gets a liver will depend on her. Doctors have told the 5-foot-10, 195-pound woman that she must lose 30 pounds and get her diabetes under control before they will put her on a transplant list. She's already lost 70 pounds the last two years, some because of illness.

She's given herself until mid-April to meet both goals. Once the weather warms up, she plans to restart her exercise regime of eight laps around the prison courtyard twice a day.

"The doctors that I've seen said that I need to get busy and start doing what I'm supposed to or else I won't make it to see my liver come in," said Joy, who wears stocking caps to hide her thinning auburn hair.

Joy says she doesn't know if she deserves a liver. She believes she has paid her debt to society and answers only to her family and God. But she says she has trouble sleeping when she thinks about all the other people who need livers

"I want a chance just like they do," she said.

She said if she were to get a new liver and be paroled at her next hearing in 2006, she would take her 3-year-old grandson to the movies and looks forward to watching him grow into a young man.

Joy said she would consider passing up a liver to allow someone in a more dire situation to get one, especially if the person immediately behind her on the transplant list was a young mother.

"I'd step back and let that lady have the liver because she has a child," Joy said. "She has a life."

She also has made peace with the possibility she may not get the transplant and soon die.

"I'm not going to blame nobody," she said.

© 2003 Associated Press

Originally posted by Brownms46

But I don't think anyone here, said anything about it not being anyone's choice, or that anyone would be wrong for not donating their organs.

No, nobody said anything to that fact. I just saw a trend in the way the posts were going and figured I would try to redirect it away from a "who's right, who's wrong" kind of arguement before it ever got that far.

Everything expressed in this thread is the opinion of the person posting it and sometimes it is hard to not criticize them because you don't agree. Not placing blame on anyone or even saying that is what would have happened.

Leigh

Specializes in LDRP; Education.

Great posts, Leigh and sbic56. You truly "get it." I would hate to see someone like Sleepyeyes made to feel bad because of her choice.

Thanks for standing up for that.

I have read several times that the 2nd donation for Jessica was "directed". If we can direct who our organs go to couldn't we direct who they DON'T go to? Just wondering.

My mother who was a long time alcoholic who had liver cirrhosis was told by her doctor she should go on the transplant list. When my mother told me this I told her that in no way would I support her getting a liver transplant as she had never shown me in 10 years that she was serious about sobriety. If she had pursued this I would have done all I could to keep a liver from being wasted on her. Yes, I loved my mother, most of the time, but once an alcoholic always an alcoholic. What other posters said about the prisoner being sober for 20 years is true. If she did get parole would she stay sober? Not in my experience. I guess I am jaded.

O.k, I'm chiming in WAY late on this one, but I agree with those who don't think death row inmates should get organ transplants. If they got transplants, they'd do what? Stay on death row? Although that seems "par for the course" as far as a return for our tax dollars, I'm against it.

I'm personally not thrilled to be paying for ANYTHING for prisoners - cable, electricity, uniforms, hot water, heat and A/C, 3 meals a day, beds, health care. They've done WHAT to deserve being given all this for FREE???

I will remain an organ donor, but I pray that my organs will be given to someone who can and will make a contribution to society, not suck more tax dollars out of those who have already been bled dry.

Specializes in Everything except surgery.
Originally posted by nurseleigh

No, nobody said anything to that fact. I just saw a trend in the way the posts were going and figured I would try to redirect it away from a "who's right, who's wrong" kind of arguement before it ever got that far.

Everything expressed in this thread is the opinion of the person posting it and sometimes it is hard to not criticize them because you don't agree. Not placing blame on anyone or even saying that is what would have happened.

Leigh

Well I missed that trend...because I thought we were in the last several post debating about prisoners. Not whether you should or shouldn't donate...and so totally missed the agruement part.

Oh well...people do read things differently...and that is a known fact. Glad that is straightened out in some people's minds.:cool:

OK, working in the ICU, I have to wonder how much people really know about liver transplants.

Majority of reasons are alcohol abuse, drug abuse, suicide attempts.

For the small population of "OTHER" hepatitis, congenital abnoms. ect.

Look at your transplant lists for diagnosis..... these are the majority. Have a patient on his SECOND liver transplant..... drank his origional and the first transplant away.

We are doing transplants on those that theoretically "chose" to kill thier own livers.

Yep, potentially volitile post, yet true.

BUT, because any of these people lost thier liver, even with their own doing, shoul it negate them from a transplant? Not according to transplant criteria, as long as they have proved compliance with med regime and have cleared through repeated drug testing and psyc. testing.

Is this that different from a criminal who has learned the proverbial "error of their ways" ?

Leaves alot to ponder as to who should really be at the top of the list, and who is to determine the criteria. Tough choices, which is why I remain jaded to the process, yet void of an opinion,.

Because I worry if it was me on the list I would feel very hateful to those of the majority that killed their own liver and they are "UP" first, yet they would want to live..... same as me.

"quote from sjoe"

Unfortunately, IMHO, the US Supreme Court has ruled that anyone held against their will by a government agency ( in a jail, prison, on a psych hold, etc.) is ENTITLED to taxpayer-provided health care. Taxpayers have NO choice in the matter unless and until that ruling is overturned.

konni writes: "Even children on Medicaid can't get organ transplants paid for by the state. They have to raise money from private donors. If the children who are being cared for with state money can't get an organ transplant paid for by the state, why should prisoners? "

A simple solution. All the child has to do is commit a serious crime, be convicted, and sentenced to an extended incarceration (no probations or acquittals will do it).

I can attest to this first hand. Some years. ago I wanted assistance for my son. The state told me I made to much money to qualify, but suggested a solution.

They told me to have my son commit a crime then the state would pay for whatever he needed.....INCREDIBLE BUT TRUE

I'm not sure I want to be an organ doner. It just doesn't seem fair that good people have to pay for their organs, but prisoners who have committed a crime against society can receive organs free of charge. They get a better deal than those of us who pay ALOT of money for health insurance which doesn't even cover organ transplants. We work hard to pay our taxes so that we can..... pay for prisoners organ transplants. The message here is: (sung to the tune of "We Are The World") "We Are the Suckers!" Are we crazy doing this for our prisoners, our dregs of society? Yes we are! People need to come together and get serious about stuff like this. Write to your congressmen and let them know that we aren't going to take this kind of abuse anymore as American citizens. Providing a cell, food and a bed for them is one thing, but organs? It's a kick in the azz to us taxpayers. The kicker is they've probably never paid one cent in taxes in their entire lives! Prisoners are the leaches of society...they feed off the American taxpayer, but they never seem to get full. It's not fair, it's not ethical and it's just plain wrong! The line must be drawn somewhere. Let them pay for their new organs if they want them and then let's see how many of them receive organs. You and I shouldn't have to pay for them, but we do and that should be a crime in itself! Is someone getting rich off of this stupidity???

Originally posted by Nurse Hag

Well I for one would like to have Semstr come to nebraska and foot part of the bill for her getting this surgery. I do agree she probably will not make the changes to be put on the list but, on the off chance she does I do not want to pay for it or the follow up care. I feel my tax dollars can go for better things. I wish our Govenor would step in and say no but that would be like keeping up with issues in this state other than the ones he creates. STOP THE INSANITY!!!!!

Nurse Hag, thanke you very much for your invitation, but I prefer to live where I live now.

and yes, I am paying a lot of taxes already, for prisoners getting medical help too.

and I have no problem with that. After all, they are human beings too.

Sorry, guys, but reading a lot of posts here, makes me feel rather uncomfortable.

Thank you semstr for presenting your opinion in a mature way. That's why we're all here....to disagree! :D

I understand your perspective, even though I don't agree.

Kristy

I work in a jail and have for going on 9 years now. I see inmates come and go on a VERY regular basis. As has been said before, she has stayed sober for 20 years because she IS in jail. What would make her stay sober if she was released??

We deal with constant non-compliance. We get them well, they get released, they do something wrong again, back to us in need of care again, we get them well again, etc. etc.

Even if they passed all the criteria to go on a transplant list, would they remain compliant if released from jail or prison? If there wasn't a nurse there every day to give them their anti-rejection medications would they remember to take them or even bother to go and get the RX filled??

Who would pay for the medications once they were released from prison? Would it be covered under medicaid or medicare? If not and they couldn't afford the medication would their body go into rejection and the transplant be for not anyway?

Just wondering. :rolleyes:

Again, my posts were not intended to make people feel bad

that is why I used the phrase "those who had already decided"....

:cool:

here is a list of what is usable

*Organs: heart, kidneys, pancreas, lungs, liver, and intestines

*Tissue: cornea, skin, bone marrow, heart valves, and connective tissue

*Bone marrow

http://www.organdonor.gov/default.htm

I remember the days special "God" boards would decide who was worthwhile to be eligible for the limited renal dialysis which was available.

Our technology is always pushing at our ethics.

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