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Live Liver Donor Case on Death Row Raises Questions

Gregory Scott Johnson was killed by the State of Indiana at 12:01 a.m., May 25, 2005. He died with liver intact, and all his organs remained that way following declaration of death. The would-be organ donor was not permitted to give.

Johnson, 40, was a death row inmate scheduled to die by lethal injection. His 48-year-old sister, Deborah Otis, had been diagnosed with liver failure (nonalcoholic cirrhosis) and was expected to die without an organ transplant. <?xml:namespace prefix = o ns = “urn:schemas-microsoft-com:office:office” />
 
Little brother said that big sister could have a part of his liver—or the whole organ, for that matter—for transplantation. “Chances are I’m not going to be needing it very long,” he said.
 
<?xml:namespace prefix = st1 ns = “urn:schemas-microsoft-com:office:smarttags” />Greg Johnson had been convicted of murder, a particularly heinous crime in which an elderly Indiana woman was slain in 1985. In interviews, Johnson said he would like a chance “to give a life in exchange for the one he took” and “to leave something positive to the society in which he has wreaked so much havoc.”
 
A temporary stay of execution would be required if organ donation and transplantation were to occur, raising the ethical question: Should a death-row live donation be allowed?
 
Many other questions are also raised by this case—questions that pertain to medical, legal, logistical, economical, political and social dimensions of living-donor organ transplantation. All of these affect the question of “ought” or “ought not.”
 
Some issues raised were distinctive to this potential donor’s prisoner status, and some others arose uniquely because of his placement on Indiana’s execution docket.
 
Medical assessments would need to be made to ascertain whether a transplant would be in the sister’s best interests? A liver transplant is not like changing out a carburetor. Would the known risks to both donor and recipient outweigh the potential benefits to the recipient alone?
 
Was the prisoner healthy enough to donate? Obesity and hepatitis B reportedly were concerns of physicians at Indiana University Hospital’s transplant center. Would the donor have suffered inordinate harms? And was his liver healthy or damaged? Incarcerated donors are classified as “high risk” by transplant clinicians, and are rarely used.
 
Life-style questions are raised. Had he engaged in high risk behaviors so as to contract and transmit deadly diseases? Would the organ be of a quality sufficient to transplant?
 
Many medical questions need to be answered before an ethically fitting response could be ascertained in any living donor situation, and especially one involving an inmate.
 
Legality is also a subset of the ethical (rather than synonymous, as sometimes is thought). Are there legal hindrances to a death row donation?
 
The only known illegality arises as an unlikely hypothetical option. If a living donor were allowed to give up the whole liver (or any unpaired organ) rather than just a lobe, the altruistic act would result in death. We don’t practice that sort of live donation, of course; but this donor was going to die regardless. Why not save the state the bother and expense of lethal injection?
 
One reason is that fatal procurement of the condemned’s organ would place a surgeon in the role of state executioner; so that unethical scenario was not apt to unfold. It would have also been illegal, since Indiana law permits execution by means of chemical injection only.
 
It might have been possible for the executed to become a deceased donor of organs, but we haven’t much experience in such practices. Stories have circulated about Chinese procurements following death by firing squad in that nation, but potassium chloride is a different matter. Would lethal injection render donor organs wholly unusable? We don’t really know.
 
Logistically and economically, a death row donation could be a nightmare. Not many dying prisoners receive an organ transplant for similar reasons. While the medical costs of donation might be picked up by the recipient’s insurer (if there is one), who pays for round-the-clock hospital bedside guard duty?
 
What other security measures might be required and at what cost to the transplant program? What arrangements would be made for the prisoner’s post-operative care, for regular follow-up visits from prison to the clinic? What institution would want to deal with the news media interest in covering such a sensational case?
 
And in the case of a death row donor who has exhausted all appeals, what sense would it make for society to spend tens of thousands of dollars on recuperation costs? Greg Johnson’s attorney, Michelle Kraus, had been quoted as saying that her client would require a stay of execution up to two months after surgery, at which time he should once again have been “healthy enough to be put to death.”
 
The moral contradictions and absurdities associated with state-sponsored killing are highlighted each time a condemned prisoner raises the question of organ donation. It becomes a political question then; and on those grounds alone, we are hesitant to accept an inmate’s offer.
 
Primary social and ethical principles that thwart most prisoner organ donations are those of voluntariness and altruism. On these are built the whole enterprise of donation and transplantation of human body parts.
 
Inmates are wards of the state, inherently vulnerable to manipulation and conscription. How well can we ensure informed and free consent to donor surgery?
 
Prisoners often are perceived to be master manipulators, also. Might the incarcerated “donor” have ulterior motives, expect favors or some type of compensation, a pardon perhaps, or parole or clemency, or even just a temporary stay of execution?
 
Can we ensure altruism? Need we?
 
Mr. Johnson’s unsuccessful ethical argument for granting his dying request and for accepting his offer of a liver donation seemed simple and to the point. Before dying, Gregory wanted to do something positive with his life and to give his sick sister what she needs to live.
 
If only giving were so simple as that.
 
Tarris Rosell is a program associate at the Center for Practical Bioethics in Kansas City, Mo., and associate professor of pastoral theology in ethics and ministry praxis at Central Baptist Theological Seminary in Kansas City, Kan.