Release to heal

2010-09-10 00:00

FEW public statements have proved as divisive as the “shoot to kill” injunction issued to police officers by top cop General Bheki Cele last August. Decried as symptomatic of the militarisation of South African society or lauded as the most appropriate way for the police to respond to ever-increasing crime rates and criminality in equal measure, it seems to typify the culture of violence which seems to pervade so many aspects of South African society.

In a society where citizens are subject to daily anxiety wrought by crime, one can easily understand the emotional appeal of this controversial statement. Low rates of genuine rehabilitation of inmates, as evidenced by high recid­ivism rates among former inmates, and the increasing financial costs incurred in the incarceration of prisoners all contribute to the general perception that the societal costs of imprisoning repeat offenders far exceeds the potential societal benefits of attempting to rehabilitate them. In such a situation, a policy that sought to address this perceived inequality might go some way towards altering the public’s perception of former inmates.

Since Organ Donor Month has just passed, I would like to argue the case for a system that might do so by addressing another apparently insurmountable societal problem: the shortage of organs available for transplant. The proposed solution entails offering reduced sentences to prisoners in return for them donating their organs for transplant purposes.

This may seem a macabre suggestion at first glance but there are likely to be many advantages to such a system for all parties involved. Moreover, as recent exposés attest, illegal organ markets are a reality in much of the world, including South Africa. Tellingly, participation in these markets and calls for their legalisation are likely to grow as the demand for organs for transplant increases.

Giving prisoners the opportunity to donate their organs should increase the number of organs available for transplant. For intended recipients, this increases the probability of their finding a suitable organ and reduces the time taken to do so. As a result, their health outcomes are likely to improve.

For the state, reducing the time patients spend on transplant waiting lists reduces the costs of maintaining them until transplants become available, allowing healthcare resources to be freed up to be used to address other pressing health-care needs.

Prisoners are also likely to benefit from this scheme. At its most mercenary, it provides an early escape from a system, the effects of which persist long after release. More generously, their participation might alter their own and others’ perceptions of themselves, thereby facilitating their acceptance and reintegration back into society. What better way of demonstrating true remorse and genuine reform to a wary society?

How would such a system work in practice? While the finer details can be worked out later, some guiding principles can be expanded upon. Under the scheme, incarcerated and awaiting-sentencing prisoners could be given the opportunity to volunteer to participate. Clearly, not all prisoners would be eligible to do so. Certain criteria would have to be applied to determine the eligibility of prisoners who volunteer. If donors and recipients are matched and agree to the transplant, donors would be monitored in prison hospitals for a specified period post-operation before release. Release need not be contingent upon the health outcomes of organ recipients. Upon release, there might even be scope for the state to assist volunteer donors by offering them a small stipend to facilitate their reintegration into their families and seeking employment.

A key feature of any organs market is the desperation of those seeking organs and usually, the preferential treatment afforded to the financially better off. In order to mitigate this, it is proposed that the state alone be responsible for the allocation of organs. The prioritisation of individual transplants could depend on current Health Department criteria and an added proviso, that victims of violent crime or their immediate descendants in the case of their (the victim’s) murder be afforded priority on transplant waiting lists.

Arguably, the potential negative health outcomes associated with illegal donations from live donors are reduced under this system. Since prisoners are the responsibility of the state, donors’ health can be carefully monitored post-surgery, even after parole and release. Doing so ensures that ex-inmates are in contact with the authorities. Hopefully, greater contact with authorities would reduce the likelihood of parolees re-engaging in criminal activities and so contribute to lowering re-incarceration rates.

In summary, a system which offers prisoners reduced sentences in exchange for their agreeing to donate an organ could offer a mutually beneficial solution to all parties involved. If implemented, it might literally increase the amount and quality of time available to both prisoners and patients. More importantly, might a “Release to heal” policy send the sort of reconciliatory message that is so desperately needed in as fearful and divided a society as South Africa?

• Gerard Boyce is a PhD student in the School of Economics and Finance at the University of KwaZulu-Natal.

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