Prisoners as organ donors: is it worth the effort? Is it ethical?

Prisoners have generally been excluded from donation because of ethical and infectious disease concerns. We propose a plan, which would address both concerns and examine the potential impact. Interested inmates would approach the prison's medical team expressing interest in living donation (LD). Principle steps in the process are (1) consent to evaluation and a two-step surgical consent. (2) Nucleic acid amplification testing (NAAT). A standard LD workup would be initiated. If the results were acceptable, the inmate would sign the first surgical consent. NAAT for human immunodeficiency virus (HIV) and hepatits B and C virus would be performed 3 weeks apart. Assuming acceptable results, prisoner and family would sign the second consent, and the inmate would be scheduled for LD surgery. The inmate would be in medical isolation until the time of donation. NAAT testing has enabled the window period to be small enough to allow close observation and monitoring of the prisoner, enabling safe donation. The paternalistic protection of prisoners would ensure that experiments were not performed. This plan would allow prisoners the ability to participate in opportunities provided noninmate people. There are currently 2.2 million inmates; the incidence of HIV is 1.8%, decreasing the potential pool to 2.1 million. A donation rate of 1% could provide 21,000 kidneys. Advances in medical technology and the acknowledgment that prisoners can consent to complex but standard medical procedures have opened up a potential pool of organ donors that could dramatically impact the organ shortage.

2007: the year of regulatory change.

INTRODUCTION: The two countries that performed the most organ transplants in 2006, the United States and China, initiated significant regulatory changes in 2007 that continue into 2008 and likely several more years. The purpose of this article is to highlight the reasons behind the regulatory initiatives, document the new regulations, and assess the impact thus far. METHODS: Review of US and Chinese governmental regulations emphasizing the underlying principles and impact. RESULTS: We evaluated the changes with respect to equity and transparency; understanding transplant policy; field strength; and informed consent. We found a number of similarities between the US and Chinese regulatory changes. The changes in the United States introduced new members into the team (independent donor advocates) and improved documentation, while China began the process of regulation by defining the process and identifying practices that are not allowed. CONCLUSIONS: We found a number of similarities between the regulatory changes in the United States and China. Both countries have made significant progress in attempting to improve the process for both donors and recipients. The United States is a more mature system, while China is attempting to move toward an international standard. In the short term, there may be decreased overall access to transplantation while transplant centers and policies adjust to the new regulations in both countries.

The market of human organs: a window into a poorly understood global business.

The global demand for human organs has set the stage for an exploding and poorly understood global business in human organs. Whenever there is demand for a product, the opportunity for business arises. The form that a business takes is dependent on a complex network of inputs and outputs, each affecting the others. Historically, the details of any specific market are drastically underestimated. Nowhere is this truer than in the market of human organs. The drivers, which propel the "goods" of human organs, form a flourishing business. Critical analysis is essential to understanding of the supply and demand sides and to determine the role of government in regulating the industry. Governmental groups have dismissed formation of a regulated market for organ sales. The concept is nonetheless a topic of active discussion, motivated by the suffering of patients in need of organs and exploitation of the victims of human trafficking. Ethical principles have been invoked on each side of the ensuing debate. Theory in the absence of sufficient data is shaky ground for enactment of new policy. The Aristotelian concept of "practical wisdom" and the pragmatism of William James illuminate the importance of scientific investigation as guide to policy formation. How will stakeholders benefit or lose? What impact might be anticipated in regard to organized medicine's social contract? What can we learn about cross-cultural differences and their effect on the global landscape?

Expanding kidney paired donation through participation by compatible pairs.

In kidney paired donation (KPD), incompatible pairs exchange kidneys so that each recipient receives a compatible organ. This modality is underutilized partly because of the difficulty of finding a suitable match among incompatible pairs. Alternatively, recipients with compatible donors might enter KPD arrangements in order to be matched with a donor predicted to give greater allograft durability or for other altruistic reasons. Using simulated donors and recipients, we investigated the impact of allowing recipients and their compatible donors to participate in KPD. For KPD programs of any size, the participation of compatible donor/recipient pairs nearly doubled the match rate for incompatible pairs (28.2% to 64.5% for single-center program, 37.4% to 75.4% for national program). Legal, logistical, and governmental controversies have hampered the expansion of KPD in the United States by delaying the creation of a national program. The inclusion of compatible pairs into small single-center pools could achieve match rates that would surpass that which could be realized by a national list made up of only incompatible pairs. This new paradigm of KPD can immediately be instituted at the single-center level, while the greatest gains will be achieved by incorporating compatible pairs into a national program.