Give These Donors a Bone

April 1, 2010

EVERY year, more than 100,000 Americans discover that they have often life-threatening blood and bone-marrow diseases like leukemia. For many, the only hope is a transplant of blood-producing marrow cells.

Finding someone to donate the marrow is challenging, though, because the cells must be a near-perfect genetic match with the patient’s own cells, and those are hard to find. Even siblings have compatible marrow cells only 30 percent of the time. Most patients must search nationally and internationally for potential donors.

Only 7 in 10 Caucasian patients who need a donor find one. For African-Americans, the odds are longer still; only one in four do. Tens of thousands of Americans have died for lack of a donor.

It would make sense to encourage donation by offering potential donors an incentive—a gift to a favorite charity, for example, or a scholarship. But federal law forbids doctors, nurses or dying patients to offer any incentives. The intent of the 1984 law, the National Organ Transplant Act, was to prevent the sale of human kidneys for transplant, out of concern that a market in organs could tempt people to risk their health for money by making an irreversible decision to be a donor.

But with marrow donation this is not an issue. Unlike organs, marrow cells—basically, immature blood cells—are renewable. The body grows fresh ones quickly enough to replace those extracted for transplant in about a month. And donating marrow cells is now very safe—in most cases, it’s simply a matter of drawing blood from the donor’s arm and running it through a machine that skims off the marrow cells. Well under half of donations are conducted the old way, by harvesting marrow cells from the donor’s hip.

Interestingly, Congress didn’t bar compensation for all human donors. In writing the 1984 law, it excluded renewable cells like blood or sperm from the payment prohibition, even as it inexplicably included bone marrow.

We have filed in federal district court a constitutional challenge to the marrow prohibition, because we want to set up a pilot program to ascertain the extent to which certain strategic incentives—a $3,000 scholarship, a housing allowance, a charitable gift—could increase marrow-cell donations.

If our suit is successful and incentives are allowed, it would not create a freewheeling market in bone marrow donation. Marrow donation would, and should, remain anonymous—and there would be no negotiation with donors. There would be no buyers or sellers, no possibility of market-like transactions.

But people who provide life-giving marrow cells could, in good conscience, get something in return for helping save a life.

John Wagner is a professor of pediatrics and the director of the blood and marrow transplant program at the University of Minnesota.

Jeff Rowes is an IJ senior attorney.

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