For the last decade, the number of people who require an organ transplant grossly outpaces the number of organ donations. Many proposals have been offered as a potential solution to this problem, including replacing the current opt-in system with a standardized opt-out program. Other proposals include expanding the living donor pool to previously restricted populations, like people currently incarcerated. Prisoners, particularly those facing the death penalty, may consider donating an organ in exchange for a reduced sentences. Is this coercion? Does it create perverse incentives for incarcerated individuals? Is this substantively different than reducing a sentence for typical reasons, like “good behavior”? Does the State have a duty to reduce a person's sentence because he or she has donated an organ? Some prisoners deeply committed to reconciliation, responsibility, and transformation may find fulfillment in donating an organ, even deferring a reduced sentence to remove any hint of coercion. Others, eager to reduce their sentences, might be tempted by a perverse incentive structure. Should evaluating potential living donors who are incarcerated require a greater standard of rigor to determine the “proper” motivations for donating? Or should the potential for coercion prevent incarcerated individuals from donating altogether?
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