In 1984, the U.S. Congress granted Federal courts the authority to reduce sentences for "extraordinary and compelling" circumstances, after taking into account public safety and the purposes of punishment. The U.S. Sentencing Commission is responsible for describing what those circumstances might be. Prisoners cannot apply directly to the courts for a sentence reduction due to extraordinary and compelling circumstances. By law, only the Federal Bureau of Prisons (BOP) has the authority to file a motion with a court in requesting judicial consideration for early release. Although the BOP does not keep records on how many prisoners have asked the BOP to make "compassionate release" motions on their behalf, since 1992, the annual average number of prisoners who have received "compassionate release" has been less than two dozen. BOP has limited the grounds for such release to when the prisoner is expected to die within a year or is profoundly and irremediably incapacitated. It has rejected the broader range of medical and non-medical circumstances that the Sentencing Commission has cited as warranting consideration for "compassionate release." "Compassionate release" might not be so rare if the courts were able to review BOP decisions that decline early release; however, the U.S. Department of Justice has persuaded most courts that they lack the authority to review the BOP's refusal to bring a motion for sentence reduction. Recommendations for action are addressed to the BOP, the U.S. Department of Justice, and the U.S. Congress. This study's methodology is described.