As jubilant supporters await the release of Gladys and Jamie Scott, who brokered a bargain with Mississippi Gov. Haley Barbour to get early prison release by undergoing an organ transplant, medical ethicists are crying foul.
Ethicists say suspending a prison sentence on the condition that one sister give the other a kidney is a "quid pro quo" and threatens the ethical underpinnings of living donation laws.
Dr. William Hurlburt, a Stanford neurologist who sat on the President's Council on Ethics, said the news was troubling.
"We pondered over and over this issue and came to the conclusion that it was such a tricky medical realm with so much risk for abuse that we agreed organ donation must always remain altruistic," he said.
On Thursday, the governor signed an order that suspended the Scott sisters' life sentences as long as Gladys, 36, who is healthy, donates her kidney to Jamie, 38, who has been on dialysis. The women have been imprisoned for the past 16 years on charges of masterminding an armed robbery.
"As soon as the governor began throwing around commutation -- getting out of her prison sentence -- he began to undercut the ethical framework," said Dr. Art Caplan, director of the Center for Bioethics at the University of Pennsylvania. "He has now put the sisters' donation in jeopardy because the parole is absolutely a payment, which is against the law. It would be considered pressure or coercion."
The Scotts' reprieve came just one day after the death of the first living kidney donor, Ronald Herrick, who gave the organ to his ailing twin brother in 1954. At the time, the notion of living donation was controversial and the ethical guidelines that evolved from that case illustrate why the governor has set a dangerous precedent, say critics.
Herrick, a retired math teacher who died at age 79 in Maine on Wednesday, was recognized as the world's first successful organ donor. His brother was kept alive for eight years and the lead surgeon, Dr. Joseph Murray, went on to win a Nobel Prize. Herrick was only 23 when he donated his kidney.
At the time, many opposed organ transplantation, particularly the Catholic Church, equating it with the desecration of a body. Some medical experts argued it was unethical to operate on a healthy person and put them at risk, saying it contradicted the Hippocratic Oath to "keep [patients] from harm."
"People said you cannot harm someone solely for the benefit of the life of another," said Caplan. "It has to be voluntary, altruistic. And if people do this, they have to really understand and make sure it's informed choice -- no pressure, no coercion and no reward."
The philosophical battle resulted in the legal and ethical guidelines that govern organ donation today. Restrictions were placed on those in mental institutions and child donors because they are not deemed competent to give informed consent and an irrevocable decision that might harm them.
Barbour, who is a Republican in his second term and a possible presidential candidate, said the parole board agreed with the indefinite suspension of the Scott sisters' sentences, which is different from a pardon or commutation because it comes with conditions.