Only 40% of US prisons have accessible organ donation policies, a new study finds. These policies vary and have unclear ethical implications.

Yoshiko Iwai, MS, of the University of North Carolina School of Medicine at Chapel Hill, and colleagues attempted to analyze donor and organ transplant rates along with prison policies, but in many cases necessary data were not collected or reported. In their review of information from 53 state prisons, the Washington, DC prison, the Federal Bureau of Prisons, and Immigration and Customs Enforcement, only 21 (40%) had available organ donation policies. Fifteen systems permitted living donation and 13 permitted registering for deceased donation, the investigators reported in JAMA Network Open. Twelve systems limited donation to relatives, including some further restricting donation to immediate family members. Family notification was codified in Iowa, New York, and Washington only. In some systems, the warden had to authorize donation.

Among 27 states with capital punishment, 10 had donation policies, the investigators reported. Arizona and Nevada excluded organ procurement from individuals facing execution. The investigators highlighted that ethical implications around organ and tissue donation following executions are not well-defined in department of corrections policy.

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A new Massachusetts proposal would allow prisoners to donate bone marrow or organs in exchange for shorter sentences.

“It is essential that organizations like the United Network for Organ Sharing develop clear guidelines that ensure ethical practices that do not result in exploitation, and advocate for community carceral parity,” according to Iwai’s team.


Iwai Y, Forrest Behne M, Long JM, Brinkley-Rubinstein L. US prison policies on organ donation for individuals who are incarcerated. JAMA Netw Open. Published online March 8, 2023. doi:10.1001/jamanetworkopen.2023.2047