Death of inmate who received heart transplant renews debate over organ allocation policies.

Almost a year after he caused a major furor by receiving a heart transplant, a California inmate died when his body rejected the organ. The 32-year-old prisoner, whose name was never released, died on December 18 at Stanford University Medical Center where he had been on life support since November 30.

The prisoner, who received his life saving heart transplant on January 3, 2002, was a two-time felon who entered the California prison system in 1997. He is believed to be the first state prison inmate in the US to receive a heart transplant.

Russ Heimerich, a spokesperson for the Department of Corrections told the press that reports from inside the prison indicated the prisoner "was not a model patient," and did not strictly adhere to his immunosuppressive regimen.

State officials estimated the cost of keeping the prisoner alive was at least $1.25 million, including the $12,500 a day it cost to keep him at the Stanford University Medical Center after his heart began rejecting.

The inmate's death reignited the debate over whether there are limits to the types of care that should be given to ailing prisoners.

Following the transplant last January, Heimerich defended the transplant by explaining the department had lost several lawsuits over inmate care. "We don't have a policy per se," he said. "We have a requirement, based in law and in losing many, many lawsuits, to provide necessary care to inmates." (Transplant News, January 31, 2002)

Heimerich cited a 1976 US Supreme Court ruling declaring it "cruel and unusual punishment" to withhold necessary medical care from inmates and a 1995 federal court decision ordering prison officials to give a kidney transplant to an inmate whose request initially had been denied.

The United Network for Organ Sharing (UNOS) policy says that excluding an inmate from receiving a life saving transplant is not "ethically legitimate."

"The National Organ Transplant Act specifies that the Organ Procurement and Transplantation Network establish 'medical criteria' for organ allocation," said Anne Paschke, a UNOS spokesperson. "It's been UNOS' position that 'social criteria' per se be excluded from medical criteria and therefore are not permitted in consideration of organ allocation."

For more information visit the OPTN/UNOS Web sites: www.unos.org or www.optn.org or contact the UNOS news bureau - [phone].