Should Donors Get Paid For Bone Marrow?

A group of parents and advocates are suing to change a 1984 law that prohibits compensating donors for bone marrow. Would the ability to pay for marrow be a boon for sick people, a step down a slippery ethical slope — or both?

According to the AP, the group MoreMarrowDonors.org, along with leukemia patients and parents of sick (or deceased) children, is suing the US government to strike down the law — their appeal reached California’s Ninth Circuit this week. They say 1984’s National Organ Transplant Act, which outlaws payment for organ donations, shouldn’t apply to bone marrow. Their argument: organs like kidney’s are non-renewable, but bone marrow naturally replenishes itself, like blood or sperm. And since paying for blood or sperm is legal, barring payment for bone marrow violates the Constitution’s equal protection clause.

Parents of children who needed transplants are making an impassioned case for changing the law. Says Kumud Majumder, whose son died of leukemia, “From American dream, I am in a living nightmare. If we had a perfect match, maybe I’d still have my son living and standing next to me.” Government attorney Helen Gilbert, however, says that the ban is necessary, and prevents people from “extorting” money from sick people by selling their marrow to the highest bidder. And while MoreMarrowDonors and its co-plaintiffs are specifically hoping to avoid comparisons with organ donation, the debate really is a wider one — how can we best help sick people without creating a scary Never Let Me Go scenario?

A few years ago, William Saletan said the answer was “flooding the market with free organs.” He added, “If you haven’t filled out a donor card, do it now. Because if the dying can’t get organs from the dead, they’ll buy them from the living.” He’s right — consider registering as an organ donor. Or join the national bone marrow registry — MoreMarrowDonors is correct that bone marrow isn’t an organ and grows back. It can also often be donated non-surgically. But so far, efforts to get more people to donate haven’t come close to filling the need — especially for African-American patients.

In a Times op-ed last year, the lawyers for MoreMarrowDonors wrote, “Marrow donation would, and should, remain anonymous — and there should be no negotiation with donors. There would be no buyers or sellers, no possibility of market-like transactions.” If that’s true, there seems no reason not to treat marrow the way we treat blood and sperm. It’s hard to see organs ever being handled in this way — hard to imagine a scenario where payment for, say, kidneys didn’t prey upon those desperate for cash. And yet organ donations to strangers have happened — perhaps they would happen more if some compensation were involved. As far as how to engineer this compensation so it doesn’t turn into exploitation — maybe it’s impossible, but maybe a regulated, fair system for compensating bone marrow donors could show us the way.

Suit Challenges Ban On Paying Bone Marrow Donors [AP, via SF Gate]
Is Law Criminalizing Payment For Bone Marrow Constitutional? [WSJ]