A California prison inmate serving 14 years for robbery received a heart transplant earlier this month, renewing a debate about who deserves to get desperately needed organs.
The taxpayer-supported transplant, expected to cost $1 million with follow-up care, occurred as 500 Californians waited for hearts. The operation saved the 31-year-old inmate from dying of a viral heart condition, said Russ Heimerich, spokesman for the California Department of Corrections.
Citing two court rulings in favor of inmate care, Heimerich said, "Our hands are pretty much tied. It's not a question for this department to decide."
He pointed to a 1976 U.S. Supreme Court ruling declaring it "cruel and unusual punishment" to withhold necessary medical care from inmates. And he noted that in 1995 a federal court ordered prison officials to give a kidney transplant to an inmate whose request had been denied.
Prison system officials and spokesmen for an organ-sharing network confirm that numerous inmates nationwide have received kidney transplants. And, they say, such taxpayer-financed transplants are likely to increase as the prison population ages.
But the California case could be the first case of an inmate receiving a heart, an organ sought by 4,000 Americans.
"Anecdotally, I've not heard of any other case of an inmate receiving a heart transplant," said Joel Newman, spokesman for the Virginia-based United Network for Organ Sharing, which maintains the nation's waiting list for organs.
The level of debate in California has risen as news of the heart transplant has spread.
"You have to wonder if a law-abiding, taxpaying citizen drew one last breath while Jailhouse Joe was getting a second wind," wrote Los Angeles Times columnist Steve Lopez.
Conservative radio talk show host Mark Williams in Sacramento said that two callers who were on transplant waiting lists "were absolutely besides themselves."
But the UNOS has an ethics policy that puts prison inmates on equal footing with others. In California, Heimerich said, that could include death row prisoners.
Dr. Lawrence Schneiderman, medical professor at the University of California, San Diego, disagrees with that interpretation, saying people convicted of murder or other "heinous" crimes shouldn't get transplant benefits from a society they violated.
But in this case, the professor said, "It's reasonable to think the benefit we are giving him will be experienced by him with plenty of life left. Medically, we have no reason to deny him. Socially, he violated society, but not so severely that he gives up his right to experience medical care."
Besides, he added, "Doctors in medical practice don't have a right to make social decisions. If it's a limited resource, our choice should be who will it help the most."
Arthur Caplan, a University of Pennsylvania medical ethicist and author of the book, "Ethics and Organ Transplants," says it's up to state lawmakers to change the law if citizns don't want prisoners to get organs.
Other high-profile transplants have resulted in changes in the organ waiting list. In 1996, UNOS declared that people suffering from long-term liver failure of the kind often seen in alcoholics and drug addicts would no longer be at the top of the list for liver transplants.
The change followed debate that was raised when Mickey Mantle and TV star Larry Hagman received transplants.
In the California case, the inmate received the heart at Stanford University Medical Center on Jan. 3 after an ethics committee there approved him and put him on the waiting list, Heimerich said. "From there on, it's strictly a medical decision. It was always a medical decision."
Department policy forbids identifying inmates while discussing their medical conditions, he said. But the inmate's crimes involved a 1996 robbery in Los Angeles County, eight months after he was released from prison for burglary, Heimerich. He is not eligible for parole until 2008.
The patient is currently in satisfactory condition at a prison medical facility near San Francisco.
As for the cost of the transplant, Heimerich noted that inmates are typically less healthy than the average person due to "poor lifestyle choices."
The state's most recent annual medical bill for 156,000 inmates was $663 million, he said.
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