After reading the story of a 10-year-old boy with a fatal muscle-wasting disease in the Deseret News on Feb. 20, Marco Guizar sent the newspaper a letter.
"I am a healthy 37-year-old male and am currently in the Davis County Correctional Facility," said the letter. "If this little boy can be saved by a heart donation, I would like to offer my heart to him."
Guizar is being held without bail for allegedly shooting at a truck on Legacy Highway and exchanging fire with police officers. Charged with aggravated attempted murder and assault, he faces 15-20 years in prison.
"I am a registered donor and believe I have every right to donate my organs to whomever I choose, and I can't think of any worthier cause or individual," wrote Guizar. "I have made a mess of my life but what I can do is offer to make someone's life better and make someone's family happy."
Such a donation is illegal, and Guizar is unlikely to be a match for a 10-year-old. But according to the National Organ Donor Registry, 117,784 people are waiting for an organ in the U.S. Eighteen die each day while waiting. Almost 2 million people are incarcerated in prisons across the nation, and dozens are executed each year — a largely untapped population, some say, of potential donors.
There are significant legal and ethical hurdles, but inmates, states and families are still asking: why not let prisoners donate organs?
Signing up in the Southwest
The Maricopa County, Ariz., Sheriff's Office complex is one of the largest jail systems in the country. With an average daily inmate population of 7,700 and constant turnover, arrests and subsequent bookings are frequent. The county has an unusual addition to the booking process, however — one that's been in place since 2007.
"Whenever an inmate is booked into jail, they're given an opportunity to register as an organ donor," said Lt. Chris Luginbuhl. Somewhere between frisking and fingerprinting, those who opt in are given access to the state donor registry site, and then the criminal justice system process continues as usual.
As of Jan. 28 of this year, the office has registered 14,124 inmates for the state organ donor program. Those booked into the county jail are pre-sentence and pre-trial detainees or sentenced to a year or less. If they're released, they are no longer considered by the organ registry to be at high risk for health complications — and remain on the state organ donor registry.
Similar measures are taking off elsewhere. Texas and California allow for deceased donation from their inmates, and in January, state legislation passed unanimously in Utah that allows prisoners to voluntarily sign up for the donor registry, a move that was applauded by organ donation advocacy groups.
There are more than 100 million registered organ donors in the U.S., and the incarcerated population of 2 million may add only a drop to the bucket. However, for those in need of an organ, all it takes is one.
"Any way we can possibly expand the donor pool, we're in favor of," says Alex McDonald, director of public education for Intermountain Donor Services, which serves Utah, southeastern Idaho and western Wyoming. McDonald said that in a period of six weeks, 237 inmates have already registered to be organ donors in the state of Utah.
If an inmate dies and his or her organs are transferrable, those on the waiting list are informed of the incarceration status of the donor and asked if they want to accept an organ.
"If they have a patient that's not terribly ill, they might say, 'Well, we're going to hold off until a non-prisoner organ comes along,’ ” says McDonald. "Whereas, a (more ill) patient might be willing to take that chance."
Disease, free choice and stigma
Not everyone is enthusiastic about prisoners becoming donors. Inmates have a higher rate of diseases and infections that could make transplantation dangerous or impossible, such as HIV and hepatitis. Organs and tissues are tested before transplantation, but bacterial infections and unknown disease are still a risk.
Considered a "high-risk" population, the incarcerated can donate living tissue or organs (such as kidneys or bone marrow) to immediate family members only. Most states do not allow deceased donation for inmates.
Greater still are ethical concerns. The United Network for Organ Sharing views policies that reduce sentences or give parole in exchange for donation as "valuable compensation," rendering them unethical. And while prisoners can receive organs and are placed on the national waiting list, donation is different.
"Many maintain that prisoners cannot consent freely, given the nature of the environment in which they live," wrote Arthur Caplan of the University of Pennsylvania for the American Journal of Bioethics in 2011. He argues that prisoners aren't allowed to participate in medical research for the same reason.
"The ability to comprehend the facts about donation and to make a voluntary choice must be carefully weighed," wrote Caplan. It's too difficult to ensure the decision isn't a compromised one — for prisoners, true informed consent isn't possible.
Some recipients are also reluctant to accept life from those that once took it.
Wesley Hill, a Salt Lake City resident who received a heart transplant with only days to spare, said as long as the organs and tissues are healthy, he doesn't see why inmates shouldn't be able to donate. But his concern grows with the length of the rap sheet — could he accept a heart from a murderer? Hill says he'd be opposed to receiving an organ from someone on death row, but the decision is tough.
"It's just so hard. You're on your deathbed. How desperate are you?" Hill says. "If they had nothing else, I'd think twice about it."
More need, more executions?
After nine months of living with a painful cracked cornea in his right eye, Kay Wells was delighted when his doctor informed him he had a donor. Kay received his first cornea transplant the morning of Jan. 17, 1977 — two hours after convicted murderer Gary Gilmore was executed by firing squad.
After surgery, he scarcely batted an eye when the National Inquirer tracked him down and told him it was Gilmore's.
"(The reporter) asked me if my attitude toward life had changed with a killer's eye," recalls Wells, now 63. "I said, 'Yeah, I really hate reporters now.’ ”
Jokes aside, after the paper confronted him, Wells confirmed with his eye doctor, opthalmologist Oliver Richards Jr., that he did indeed have Gilmore's cornea. With several patients in need of cornea transplants, Richards told Wells he had visited the Utah State Prison and asked Gilmore to consider donation. The prisoner, who had pleaded for the death penalty, agreed.
Richards has since died, so there's no way to confirm the story. But true or not, years later, Wells has no qualms about having possibly received a "killer's eye" and remains firmly pro-donation.
"I was just grateful I was able to get the cornea," Wells said. "I think we need as many organs as we can get. I'll give ’em anything they want, and I'll support anyone that does, whether they're a man on the side of the street or a man in prison."
While only 1 to 2 percent of deaths allow for organ donation, state executions, which occur under highly controlled circumstances, could provide a unique opportunity for transplantation. Execution practices in the U.S. today preclude organ or tissue donation, but death row inmate Christian Longo made a stir in 2011 with a letter to the New York Times requesting to donate his organs after execution.
"If I donated all of my organs today, I could clear nearly one percent of my state’s organ waiting list," wrote Longo. "I am 37 years old and healthy; throwing my organs away after I am executed is nothing but a waste."
Longo also founded the organization Gifts of Anatomical Value From Everyone to encourage tissue, organ and blood donation from populations not currently accepted, such as prisoners and gay men.
However, in a nation that remains on the fence about the death penalty, it's a fine line between "wasteful" and "cruel and unusual." The few methods of execution deemed to be constitutional don't lend themselves to donation.
"It's a very narrow set of circumstances where someone has the potential to be an organ donor," says McDonald. "Something like a lethal injection or firing squad would preclude that."
Death row donorship also compounds the ethical questions of prison organ donation. China, with the highest capital punishment rate in the world (around 5,000 are executed each year), currently has no national organ donor registry because all needed organs and tissues are supplied by executed prisoners. The controversial system is due to be phased out this year.
While the U.S. has far fewer executions than China (there were 43 in the U.S. in 2012), death row donations raise concerns that the justice system could be compromised or the need for organs could influence verdicts.
"Any legitimation of the use of executed prisoners in the U.S. may make it more difficult to protest cruel and unjust execution practices in other nations," argued Caplan. He said ethicists object to a practice that makes the death penalty more palatable and acceptable. "Prosecutors, judges or juries may be more likely to insist on the death penalty, knowing that lives might be saved."
Mitchell Jones, the 10-year-old boy in Utah, has since quietly passed away. And Guizar still thinks allowing prisoners to donate, especially to children, is "something that should be looked into."
"I've got kids myself, grandkids," Guizar told the Deseret News in an interview. "I'm almost 40. I should be able to decide if I live or die, if I can help someone."
A registered organ donor before his arrest, he said many of his fellow prisoners feel similarly. Organ donation could mean redemption, he said.
"There are bad people in prison, but there are good people too, especially when it comes to helping kids," Guizar said. "We're just sitting here in a warehouse wasting our lives."