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 Tilleycs

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 agree with part of this. I don't think that prisoners deserve cable, or a fitness center that probably rivals any that I would have to pay dearly to use. But a lot of the rest of that is basic necessities of life. Food, water, clothing, a bed.

I mean, really, how humane would it be to deny them those things?

Leigh

Specializes in LTC,Hospice/palliative care,acute care.
Originally posted by nurseleigh

I agree with part of this. I don't think that prisoners deserve cable, or a fitness center that probably rivals any that I would have to pay dearly to use. But a lot of the rest of that is basic necessities of life. Food, water, clothing, a bed.

I mean, really, how humane would it be to deny them those things?

Leigh

Let me ask you this-how humane is it for someone to break in my house and steal my silver,jewelry and electronics and maybe vandalize it and kick my dog on the way out? Or knock and old lady down and steal her purse? Or rape someone?How humane is it to murder someone during robbery or a drug deal? Basic needs-nothing else-and bring back those chain gangs.overcrowed? Erect some tents...Plenty of people in the US-adults and children-live in worse conditions...If prison was truly HARD time the rate of recidivism might just drop
Specializes in LTC, Alzheimers, hospice.

This woman killed someone ending their life why oh why should she get a second chance by getting this liver transplant. She did not give her victim a second chance & who's to say if she gets paroled she would not go back to drinking & murdering again. Yes prisoners are entittled to medical care, but it should be basic nothing extraordinary to prolong their life.

I've got to agree. Basic care. Food, shelter, water, and freedom from torture. And let them work for their room and board. Right now too many prisoners have it way better than a lot of hard working folks out there. There have been cases where prisoners have sued because they got apple juice instead of orange juice. An absolute waste of tax dollars.

Specializes in LDRP; Education.

Yikes, even I agree. Basic food and clothing. No TV. Maybe some donated books. Exercise can be accomplished by pounding rocks or making license plates or other manual labor. Heck, we had a correctional facility that used to farm the fields for their own food and aside from the building, were totally self-sufficient. Not anymore, unfortunately.

Specializes in Obstetrics, M/S, Psych.
Heck, we had a correctional facility that used to farm the fields for their own food and aside from the building, were totally self-sufficient. Not anymore, unfortunately.

Now, that, I like. Tending these farms gave a sense of accomplishment, responsibility and built esteem. And, asside from perhaps death row inmates, aren't we supposed to be in the business of rehabilitation? I saw a piece on inmates training therapy dogs awhile back. Great program. These felons were able to know what it was like to be needed, trusted and they gave back to the community from which they were previously a problem in the process.

I saw a similar piece; it was amazing how some of the most hardened criminals were able to develop a bond with their dog, and know what it's like to feel needed/loved.

It was really touching...these dogs just giving these guys unconditional love. It might have been the first time any of those men ever got that. But this is the perfect kind of thing for an inmate; it gives him something constructive to do for society, and it gives the inmate a feeling of being needed/loved.

Originally posted by nurseleigh

I agree with part of this. I don't think that prisoners deserve cable, or a fitness center that probably rivals any that I would have to pay dearly to use. But a lot of the rest of that is basic necessities of life. Food, water, clothing, a bed.

I mean, really, how humane would it be to deny them those things?

To clarify, I'm not against them getting food, beds, or basic medical care - I'm against them getting it for FREE (i.e., you and I having to pay for it). I think they should have to work (either at the prison, on a road crew, or off-site on work release) and EARN it.

Specializes in ICU/Telemetry/Med-Surg/Case Mgmt.

As an active supporter of organ donation, I hate to see all the negative posts.

I hope the issue of the prisoners getting an organ is not the only reason for changing some of your minds about organ donation.

Last summer our family was proud to represent our state as a donor family at the National Transplant Games in Orlando, FL.

It was awesome!! Seeing happy and healthy recipients participating in activities that would make it hard to believe all that they had been through.

There are many happy stories of organ donation. Our is one of them. Please read the story of our daughter's donation at http://www.clainescorner.com

Maybe it will give a positve aspect to the donation idea. The press certainly needs that right now!!

Karen:)

Karen (donormom!), thank you for bringing your own personal story to share and for bringing life and joy into this discussion.

Organ donation is a profoundly unselfish gift and the most giving thing that a human can do for another human. Having lost, very recently, a good friend to complications from a transplant and as a nurse who works with post-op thoracic transplant patients, I can assure you that I love what I do and so does every person on our unit that I come into contact with, from the housekeepers to the physicians. Each and every single person including the donor and the recipient and all the families involved are unique individuals. I think I can speak for my team when I say we know and admire the life changing circumstances that surround organ donation and tranplantation, and we care.

Your children are beautiful! :)

Just wanted to add a little bit here -- I lurk more than post but I always appreciate the wide variety of folks and thoughts on here. :^)

I'm in Tranplant ICU (liver/kidney/pancreas). More of our liver patients are Hep C than ETOH, but many suffer from both. Patients are required to be "dry" for at least 6 months, more often a year. They pass an extended evaluation process that includes a social worker's estimation of their psychologic state/social resources and support. Most people can and DO stay sober before and after transplant! (Not all -- I've been at the bedsides of two men who started drinking again after their liver transplants. They both died. I assure you, *neither* would have been re-evaluated for another transplant.)

Deciding when to transplant is a fine line -- the patient must be sick enough to need it urgently, and yet healthy enough to survive the surgery and recover. Likely, both Mickey Mantle and Erma Bombeck were too close to the edge of their illness when they got their transplants. But that's not just celebs... it happens on a daily basis with us "regular" folks too.

Personally, I don't care who gets my organs when I don't need them anymore. My husband has instructions to "part me out". I've shared the sorrow of too many families waiting on the organ that didn't come in time.

(That said, I do respect others' choices! :)

{{{donormom}}} Thanks for sharing your story. Lovely little 'claine! :)

Specializes in ICU/Telemetry/Med-Surg/Case Mgmt.

Thank you Sally and Tephra for taking time to look at our website. I would love to work with transplants, but it won't happen any time soon because our small hospital doesn't handle transplants.

I am thrilled to say that we have recently had several organ recoveries at our facility. Usually we transfer anything that might be a candidate, so they can get the advantage of specialists before donation is considered an option.

Like you, I do respect others' choices, but do want to make sure they have enough info to make informed decisions!

Karen

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