Michael Boo is the chief strategy officer for the National Marrow Donor Program.
A 30-year-old federal law bans people from accepting compensation for donating body parts for transplantation, including solid organs and bone marrow. But the U.S. Ninth Circuit Court of Appeals recently created an exception, ruling that people who donate marrow stem cells from their bloodstream can receive payment. The ruling doesn't cover the more traditional method, in which marrow is extracted directly from a donor's hip bone. Compensation is still prohibited for that collection method.
Beyond the misguided view that providing payment will motivate more people to join the registry as potential marrow donors, this ruling could have disastrous consequences for patients worldwide.
Those who lobbied the court for the exception argue that compensation will encourage more people to donate marrow, thus increasing access to this lifesaving treatment for patients with leukemia, lymphoma, sickle-cell disease, and other critical conditions.
But there is no lack of volunteers. More than 9.5 million members are listed on the National Marrow Donor Program's Be The Match Registry—as well as 9 million more potential donors on international registries. And hundreds of thousands of potential donors are added to the registry each year. They are proof that people don't need financial incentive to save a life.
Instead of paying donors, funds could be better spent covering the $100 cost for the necessary genetic testing required to add each new person to the registry. More money also is needed to help patients, especially the uninsured, afford the transplants they so desperately need.
The current law, the National Organ Transplant Act, is designed to protect the safety of both patients and donors. Donors motivated by personal gain may be less likely to reveal medical details and personal activities that would exclude them as safe donors. A donor's complete and accurate health history ensures that the person is healthy enough to donate, and guards the transplant recipient from risk of infectious diseases and other complications.
In fact, this concern is the very reason why virtually none of the blood banks in America pay blood donors for blood intended for clinical use.
The court placed patients at further risk by allowing compensation for one method of donation, but not the other. Both methods are very much in use today. Some patients, including children, fare better with stem cells that come from the traditional extraction method. Compensating people only for the newer method, called peripheral blood stem cell donation, a less invasive procedure that removes stem cells from the donor's blood, may prompt donors to choose the procedure that pays, rather than what is best for the patient.
Compensating donors in the United States would restrict Americans' access to the global pool of potential donors. That's because the United States would no longer conform to international standards. Considering that more than half of the transplants facilitated by the National Marrow Donor Program in 2011 involved either an international donor or patient, the consequences could be severe. The NMDP's partners in 35 countries are vital to maintaining patients' access to donors across the world.
Decades of experience and research show an altruistic donor system is far superior to one motivated by financial incentives. Overturning the current federal law to allow compensation of marrow donors carries serious risks.