Should We Pay Bone Marrow Donors?

Wanting to write about something different this time…

Every now and then the general press reminds us about an ongoing controversy: should donors of bone marrow—or, more precisely, the early blood cells that are found in bone marrow and are highly useful in certain medical treatments for serious illness—be paid for their donation?

It’s a tricky area. Marrow cells are more like whole blood, plasma, or sperm, in that they are renewable, than they are like organs (your kidneys, heart, or liver) which are not. Agree or no, some blood, plasma, and sperm donors (and, indeed, egg donors) are paid for their trouble. In the U.S., the FDA regulates what’s done with the harvested tissue or cells, and mandates (in the case of blood) that, if a donor was paid, the harvested material is labeled to that effect. The one-day surgical procedure of repeatedly sticking a big needle into the hip bone to get bone marrow is increasingly being replaced by a 5-6 hour process of, as it were, filtering the desired cells out of a person’s blood, and re-circulating that blood back into the person. More is involved, and there are side effects (rarely severe). Still, while the procedure may not be “entirely benign” (to crib from the Perri Klass title), it’s hardly draconian.

Of course, transfusion and transplantation medicine suffer from donor shortages.

And consider that healthy volunteers for studies of experimental drugs are routinely compensated—sometimes to the tune of a few thousand dollars to be in a one- to two-month clinical trial—to cover not just time and inconvenience, but also to recognize that they are voluntarily placing themselves at some degree of risk. IRBs are charged with certifying that those risks are minimized, but they aren’t zero, and some of these volunteers make a living at it as “professional” research subjects.

When it comes to compensation, I’m inclined to think of marrow and blood donors as more akin to those drug-study volunteers than to organ donors. (I do recall that all analogies are flawed, so I don’t mean to press this one TOO far.)

It seems to me that it’s not unethical on its face to compensate marrow donors beyond, say, reimbursing travel expenses. The clearest ethical issues seem to be related to undue influence—would payment prompt someone to take foolish risks, would the profit motive (wherever it sits) swamp any regulatory efforts to be sure that the specimens obtained are safe to use in someone else, would the disadvantaged be preyed upon? These could, in principal, be addressed. Still, there’s significant risk on all three counts. Add to that the objection of the Bone Marrow Registry program—that non-volunteer donors would be more likely to withhold medical information about themselves that would otherwise evade testing but put a recipient at risk—and there are plenty of reasons, on grounds of benefit/risk or justice, not to pay marrow donors.

Beyond that, I am uncomfortable with the underlying perspective that seems to treat the body as a source of something not just to be used, but to be bought and sold. It’s a little disingenuous to be too dogmatic about that, because there are costs to an all-volunteer program. (Those costs might be unfairly shifted in a pay-to-donate approach, say, if a marrow program had to come up with the money to pay the donors.) Still, I think that, on these grounds alone, I prefer the all-volunteer approach.

Primum non nocere. I would not encourage anyone (e.g., a cash-poor seminary student) to donate marrow as a money-making proposition. (Indeed, I wouldn’t encourage anyone to be a healthy drug-study volunteer.) And we need to draw the line somewhere. If we pay for marrow, where does it end? Can we be sure we won’t be pushing to pay for kidneys?

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