Shortages of kidneys, lungs and livers for sick and dying patients have prompted discussion of several solutions. These include the standard donation after brain death, but also donation after cardiac death, shared organ exchanges and a market in organs. Now an article in an Australian publication, Internal Medicine Journal suggests that another promising source should be investigated: organs from executed prisoners.

Although this is common in China, where at least 5,000 organs are obtained each year, including up to 90% of transplanted kidneys, and permissible in Singapore, in other countries it is a taboo topic. In 2006, for instance, two Australian hospitals refused to train Chinese transplant surgeons because they feared that the doctors might transplant organs from Falun Gong prisoners. But even in countries where capital punishment is banned, the debate is still relevant, as Chinese hospitals market transplant surgery overseas.  

Is this taboo sensible? The authors – a lawyer and a bioethicist and two doctors from Monash University – have their doubts. In pondering the question, they contend, it is important to avoid “paternalistic positions” and to recognise “cross-cultural differences”. Although altruistic donation is clearly best, there is no “in-principle problem” with allowing donations for personal gain, either for a prisoner or his family. Even selling organs for profit “is not an argument per se against obtaining organs in this way” – just a reminder of the importance of transparency in striking deals.

The authors fall short of endorsing trafficking in the organs of executed prisoners, but they do point out that it would increase the availability of organs, that it would be an opportunity for prisoners to express remorse, and would decrease the burden of donating in countries like Australia. ~ Internal Medicine Journal, January