Archive | December, 2011

Should Bone Marrow Donors Bring Home The Bacon?

8 Dec

By now you’ve all heard about it, I’m sure.

Last week a federal court decided that (some) bone marrow donors should be compensated. Since 1984, it has been illegal in the U.S. to pay for organ donations, bone marrow included.

After much reading and thought, and after hearing why Be The Match opposes the decision, and after talking to my own doctors, I’ve come to think compensation may not be such a good idea. Allow me to put on my Washington, DC heels and tell you why I’m leaning that way.

The rationale in 1984 was that although bone marrow naturally regenerates (unlike other organs like kidneys), compensation was prohibited because the extraction method used at the time was painful and risky for the donor. It was feared that compensation would lead poor people to disproportionately undergo the procedure to earn money. 

But today, about two-thirds of bone marrow transplants aren’t really bone marrow transplants at all, at least for the donor. It’s more like a long blood donation (with five days of pre-donation injections). The process collects stem cells instead of bone marrow through a procedure called apheresis. Blood is extracted from one arm, goes through a machine that sorts the stem cells from the more mature blood cells, and the mature cells go back into the donor’s other arm. (check out the video from Be The Match)

The court decided that because this process is much less “risky” than traditional bone marrow harvesting and because blood stem cells are a blood product, compensation should be allowed.

Sounds great, right?

Not so fast. The court ruled that compensation should be allowed only for stem cells, not for traditional bone marrow.

Donors have the ultimate say in which method they will undergo, but doctors recommend to the donor their preference. Many doctors, including mine at Mayo Clinic, recommend the traditional way. My donor abided. Anecdotally my doctors have found that although transplants using stem cells engraft faster, they are more susceptible to graft-versus-host-disease. This can be a debilitating, expensive, miserable side effect – deadly in the worst cases.

But what donor would elect to have the non-compensated procedure vs. one that compensates?

There is no definitive research on which procedure produces the best results, but a long-awaited, multi-year study is due next week at the American Society of Hematology Annual Meeting. Until that study is published, I don’t think we should favor one procedure over the other based on monetary incentives for the donor.

Supporters of the court decision argue that compensation – $3,000 – $5,000 has been proposed – would incentivize more people to join the Registry.

Maybe it would. But would these new potential donors – many of whom may join when in a tough financial situation – donate 5 or 10 years later when their bank accounts are in better straits? Without altruism as their primary motivation, would they be willing to later donate uncompensated white blood cells if the patient’s transplant was unsuccessful? 

Moreover, multiple studies on blood and organ donation have shown that introducing financial incentives can “crowd out” donors who would otherwise give out of a sense of moral obligation or altruism. In an NPR story this week, a caller who had donated bone marrow said it would be “unconscionable” if he had taken money for his donation.  

But at the same time, I can’t forget that 3,000 people die every year because they can’t find a bone marrow donor. I can’t believe that statistic isn’t enough to drive everyone to register. Maybe payment would chisel down that number.

Be The Match has said they won’t change their policy against compensation (read why in their statement). As the world’s largest registry of potential adult bone marrow donors, I’m not sure how the new law would be implemented without them on board. The decision may still go to the Supreme Court. 

Maybe I live in a world too familiar with helpful people, good luck, and easy genes. But with the procedural split in how donors would be compensated, I’m just not sure compensation is in the best interest of the patient, which should be the ultimate concern. Perhaps the answer is more communication, more public awareness that a “bone marrow transplant” is not the same today as it was in 1984, especially for the donor.

Both types of donation procedures have become less risky, less painful. I’ve heard this from many donors, including my own. She said in her last letter to me, “Really, it wasn’t that painful at all. Just a little sore afterwards. I don’t know what the big deal is.”

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