SHOULD BONE MARROW DONORS BE COMPENSATED

TOPIC: Should bone marrow donors be compensated?

You should read and cite the following articles by Rowe and Petersdorf.

Pro: Jeff Rowes, Senior attorney, Institute for Justice. Written for CQ Researcher, April 2011

Last April, 11-year-old Arya Majumder lost his fight against leukemia. A year earlier, he endured a risky bone marrow transplant using a donor who was only a partial genetic match. It was his only option. And last October, Penny Lindenberg, a married mother of three, died of leukemia despite having three known matched donors. None of the three matches would agree to donate.

Identifying more potential donors, and making sure they donate when asked, is a public-health crisis. Every year, the federal government spends tens of millions of dollars on programs that match about 5,000 patients with strangers — and thousands of people still die every year for want of a donor.

In 2009, the California nonprofit MoreMarrowDonors.org proposed a low-cost way to increase the number of donors: Compensate them. MoreMarrowDonors.org wants to operate a pilot program to determine if strategic financial incentives, such as a $3,000 scholarship, can make a difference, especially for minorities, who face the longest odds in finding a matching marrow donor. The funding for the scholarships will come from charitable giving — not the patients — so there is no danger that incentives will aid only the “rich.”

The hope is that, as with most things, financial incentives matter, and compensating donors will create more of them.

Unfortunately, offering a scholarship to a marrow donor is a federal crime under the National Organ Transplant Act (NOTA). Even modest compensation can land everyone — donor, patient, doctors, nurses — in prison for up to five years.

This makes no sense. NOTA forbids the sale of solid organs like kidneys because kidneys do not grow back when they are donated. Congress was concerned that people would undergo invasive kidney surgery and suffer the permanent loss of an organ out of financial desperation.

Whatever one thinks of those concerns, they are irrelevant to marrow donation. Marrow cells are just immature blood cells, and Congress specifically exempted blood from NOTA. Marrow cells are completely renewable, and marrow donation often uses procedures that are roughly the same as those used for blood donation (where compensation is perfectly legal).

Innovations in health care depend on an open mind and the freedom to put new ideas into action. That is why the Institute for Justice, a nonprofit, public-interest law firm, represents MoreMarrowDonors.org, cancer patients, their families and a renowned physician in a major constitutional challenge to NOTA. Trying to save lives without harming anyone should not be a felony.

Work Cited

Rowes, Jeff. “Should bone marrow donors be compensated?: Pro.” “Organ donations: Can the growing demands for organs be met?” By Barbara Mantel. CQ Researcher 21 (2011): 337-360. CQ Researcher. Web. 6 September 2012.

Con: Effie Petersdorf, Past President, World Marrow Donor Program. Written for CQ Researcher, April 2011

Last year, 12,250 people worldwide received a marrow transplant from an unrelated donor, 45.5 percent of whom received their donation from someone listed on a registry in another country. To maximize the opportunity to find the best available donor, individual donor registries collaborate internationally through the World Marrow Donor Association. The association develops and promotes international standards to ensure donor and patient safety.

The WMDA has consistently maintained a policy against compensating donors because such payment raises both safety and ethical concerns. It recently published its perspective in the medical journal, Blood.

The donation of cells must be safe for both the patient and donor. If the donated cells are tainted by transmittable disease, a donation may do more harm than good. To assure safety, the donor is asked to provide a behavioral history that may reveal potential areas of concern. While modern testing techniques can detect most transmissible diseases, a recent case of the transfer of HIV from a living kidney donor to a recipient shows that testing is not perfect.

Furthermore, while the risk of serious injury to the donor is low, the possibility of harm increases for a donor with certain health conditions. A complete health history is needed to identify when a donor may be at greater risk.

In both these instances, the promise of compensation may cause the donor to be less forthcoming, placing either the patient or the donor at unnecessary risk.

Today, every registry covers the donor’s out-of-pocket expenses but the potential for compensation beyond reimbursement creates the possibility of negotiation between the donor and patient. It is argued that this could be controlled by offering limited forms of compensation, but what if the donor does not want the specific form of compensation offered or demands greater value? By creating the potential of compensation in the first instance, the best intended system will quickly be undermined by a donor in the unique position of being the only match.

More donors are needed, but it is the lack of resources to cover the costs of adding donors that limits our efforts, not the failure to pay donors. Compensation will not address this issue but would place the United States out of step with the rest of the world, to the detriment of the patients in search of a donor.

Work Cited

Petersdorf, Effie. “Should bone marrow donors be compensated?: Con.” “Organ donations: Can the growing demands for organs be met?” By Barbara Mantel. CQ Researcher 21 (2011): 337-360. CQ Researcher. Web. 6 September 2012
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