A Court Allows Payment for Bone Marrow. Should People Be Able to Sell Their Parts?

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Ed Reschke / Getty Images

A color-enhanced photograph of spongy (Cancellous) bone— red bone marrow fills the space.

How much would it take for you to consider selling your bone marrow? A U.S. appeals court puts the price at about $3,000 in a ruling that now makes it legal to pay donors for their bone-marrow tissue.

The court’s decision may well help thousands of sick patients who need bone-marrow transplants to survive, but it also begs the question, What other body parts might next be up for sale?

The ruling came about at the end of 2011, in a decision to an October 2009 lawsuit brought by a group of cancer patients, parents and bone-marrow-donation advocates against the government over the federal law banning the buying and selling of bodily organs. The plaintiffs were led by Doreen Flynn, who has three daughters who suffer from Fanconi anemia, a blood disorder that requires bone-marrow transplants to treat. Flynn and the other plaintiffs said that too many such patients die waiting for transplants and argued that we should be allowed to pay people to donate their marrow as a way of ensuring a more reliable supply. The U.S. Court of Appeals for the Ninth Circuit agreed.

(MORE: Facebook Now Lets Organ Donors Tell Their Friends)

At the core of the plaintiffs’ argument was the National Organ Transplantation Act (NOTA), which since 1984 has forbid the buying and selling of human organs, including bone marrow. But new developments in bone-marrow extraction have made marrow donation not much different from donating blood: traditionally, bone-marrow donation required anesthesia and long needles to extract the marrow from the hip bones of donors. Now, a technique called peripheral apheresis allows doctors to extract blood stem cells directly from the blood, instead of the bone — patients first take a drug that pulls stem cells from the bone and into the blood — meaning that the marrow cells should be considered a fluid like blood, rather than an organ, the plaintiffs argued. NOTA doesn’t prohibit payments for blood or other fluids, such as plasma or semen.

U.S. Attorney General Eric Holder decided not to ask the Supreme Court to review the appellate court’s decision, which would have been the next step in overturning it. That means the ruling stands — and that people can now be paid up to $3,000 for their marrow, as long as it is collected by apheresis. In a concession to the spirit of NOTA, however, the compensation can’t be in cash; it needs to be in the form of a voucher that can be applied to things such as scholarships, education, housing or a donation to a charity.

While the decision applies only to the nine states covered by the Ninth Circuit court, and only to bone marrow obtained through apheresis, it does raise bigger questions about how we will look at organ donation in the future. With about 114,000 people waiting for organs in the U.S. alone on any given day, and only 3,300 donors, the urgent medical need runs up against moral standards of the value of human life. Once we start paying for the parts we need, though, how far do we go? “We don’t allow people to buy and sell human beings, that’s slavery,” says Dr. Robert Klitzman, director of the bioethics program at Columbia University. “Should we allow people to buy and sell human body parts?”

(MORE: Where Do (Some) Babies Come From? In Washington, a New Law Bans Anonymous Sperm and Egg Donors)

Of course, certain body parts are already up for sale. Aside from sperm and plasma, donors can also be paid for their eggs and hair. But by expanding that list, the court’s ruling reopens the long-standing ethical debate over the commercialization of human tissues. For now, legally “sellable” human body parts aren’t ones that could be used to cure fatal diseases, which prevents a market frenzy. But if the bone-marrow case starts changing that — and experts say it could — it might jump-start a dangerous trend in which lower-income groups were disproportionately targeted or incentivized to give up their marrow and people with rarer blood types demanded more money for their valuable cells.

Still, the benefits of compensating people for providing cells like bone marrow — which the body replaces and which involves a relatively safe extraction — may be wide-reaching, as Flynn and the plaintiffs argue. “In some sense, this is a policy experiment, and it could potentially be groundbreaking,” says Jeffrey Kahn, professor of bioethics and public policy at the Johns Hopkins Berman Institute of Bioethics. “If we compensate donors who give by apheresis and more people end up receiving [blood-] stem-cell transplants, maybe we should think about this for other kinds of donations.”

Already, he points out, there is international trade for other organs. Websites allow people to find matching donors for kidneys, for example (people are born with two kidneys, but can live with one), and U.S. patients travel to developing nations to obtain transplants. There isn’t supposed to be compensation, but it’s hard to regulate such exchanges.

(MORE: Britain Lifts Ban on Gay Men Donating Blood. Could the U.S. Be Far Behind?)

Nevertheless, selling tissues or organs may not be the logical first step in addressing the disconnect between supply and demand. Klitzman notes that there are other changes we can make to U.S. organ-donation policy that might improve giving rates. In Spain, for example, all citizens are organ donors by default; those who don’t wish to participate must opt out. In the U.S., in contrast, people must voluntarily opt in to give, which could be a deterrent.

Even within such systems, there are incentives that can entice donors. In Israel, for example, family members of donors are given priority on the waiting list of organs should they need one. “To me, it’s not clear that the current decision means we should overturn NOTA,” says Klitzman. “I personally think we should have the debate about whether there are creative ways of enhancing donation of organs.” Certainly, if the goal is to improve the supply of much needed tissues without toeing an ethically troublesome line, those options are probably worth pursuing.

Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.

55 comments
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ChloeRyan
ChloeRyan

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chadbag
chadbag

Anyone who thinks you shouldn't be able to sell your own body parts is mentally defective.  Our bodies belong to us and to us alone and we should have absolute control and supremacy over our bodies.   Interesting that many of the people opposed to people selling their own body parts are in favor of abortion and other harms against others in the name of controlling your own body...

Mike Hansen
Mike Hansen

You can murder a child in the womb... How is this even close to that type of evil?

adamrussell
adamrussell

Wait till someone offers to purchase stem cells and see how this blows up.

mememe27
mememe27

this is the 21st century, it is all about me... me, me, me.... i should never have to do, think, or just be without being monetarily compensated.  helping someone else is not about them, it is about me and i should get money for it because i am such a great person for helping them.  i am the most important person on this planet and you should be grateful (by paying me) that i even deigned to help you.

protank
protank

I will sell my 9" d!ck for 5 million.....cash!

protank
protank

with Obamacare, there will be lots of 'parts' available

adamrussell
adamrussell

Step 1: You may sell optional body parts to patients needing transplants.

Step 2: You may sell optional body parts to a medical corporation for resale to clients needing transplants.

Step 3: You can sell any and all of your body parts before you pass on, with the understanding that the buyer (medical corp) may collect when you die.

Step 4: You can sell your children's body parts before they are born.

Step 5: They own you.

Ishmale Whale
Ishmale Whale

I don't see a problem with payment. I donate blood regularly. I have been in states where you get paid for it, and in others where you don't. I still donate regardless and am coming up on the 15 gallon mark. If I volunteer to donate, say one of my kidneys, I should be able to be paid if I want that. The risks, pain, and lost work time effects my financial standing. Some who would freely donate won't because they can't afford the lost income, and because of that, a match may die. Payment would make up for that and possibly lead to a life saving match. Living liver lobe  donations are very risky, expensive, and requires a lot of time to recover before returning to work.

ArmyBrat66
ArmyBrat66

If a price is put on body parts, the problem arises when people are murdered to scavenge their bodies' parts.  Supply and demand.  Call it human rustling - if there is a demand, somebody will stoop to any level to get what they want.  We should steer clear of this quicksand pit at all costs.

bobthebobthe
bobthebobthe

since the ussc decided there is some 'right' that allows 50% of the population to engage in certain elective medical acts, under the guise of the government not interfering with one's own body, why is it that we are not able to sell parts of our bodies should we decide them excess to our current needs? or rent out our bodies for that matter? get your rosary off my bone marrow (not as catchy I'll admit)

Tatiana Covington
Tatiana Covington

Far better to learn how to grow new organs and tissues from one's own tissues! This is not Science Fiction any more. It is actually being done at the Wake Forest Institute of Regenerative Medicine.

That gets rid of all shortages, tissue-matching problems, and hitch-hiking infections for good.

Mike Carter
Mike Carter

Whatever happened to getting laws changed properly? You know, through the constitutionally mandated process.

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Gin Heedneeds

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Robert Lawton
Robert Lawton

I'd like to know when Americans who lived/served in the military in Europe during the '80s will finally be allowed to donate blood. Has there been a single case of "mad-cow" among service men and women from this time period? 

daveundis
daveundis

As the death toll from the organ shortage mounts, public opinion will eventually support financial incentives for organ donation in the United States. Changes in public policy will then follow.

In the mean time, there is an already-legal way to put a big dent in the organ shortage -- allocate donated organs first to people who have agreed to donate their own organs when they die. UNOS, which manages the national organ allocation system, has the power to make this simple policy change. No legislative action is required.

Americans who want to donate their organs to other registered organ donors don't have to wait for UNOS to act. They can join LifeSharers, a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. Non-donors should go to the back of the waiting list as long as there is a shortage of organs. Everyone can offer to donate their organs when they die, no matter what their medical condition or history is.

David J. Undis

Executive Director

LifeSharers

daveundis
daveundis

As the death toll from the organ shortage mounts, public opinion will eventually support financial incentives for organ donation in the United States. Changes in public policy will then follow.

In the mean time, there is an already-legal way to put a big dent in the organ shortage -- allocate donated organs first to people who have agreed to donate their own organs when they die. UNOS, which manages the national organ allocation system, has the power to make this simple policy change. No legislative action is required.

Americans who want to donate their organs to other registered organ donors don't have to wait for UNOS to act. They can join LifeSharers, a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. Non-donors should go to the back of the waiting list as long as there is a shortage of organs. Everyone can offer to donate their organs when they die, no matter what their medical condition or history is.

David J. Undis

Executive Director

LifeSharers

Kimsbenn
Kimsbenn

The court was smart to state the compensation must be non monetary as there may be a rush to a payday. While many people may be helped perhaps a larger number would be hurt. There is always a "businessman" ready to capitalize on a situation and a large pool of people to exploit. In China recently a 17 year old sold a kidney for an iPad without his parents knowledge. Only when their were complications did they find out. There are so many things wrong with this scenario that will surely happen if there is a monetary gain to be had and too many people exploit who lack the understanding or are in a desperate financial situation to have adequately thought through the consequences.

TheMuthaShip
TheMuthaShip

Author: Please review "begs the question."  It's not what you think it is.

f_galton
f_galton

I have a third ball I would like to sell.

Talendria
Talendria

There's something vaguely disturbing about commodifying human body parts while the bearer is still alive.

Moochie2012
Moochie2012

Absolutely ridiculous debate.  Of course we should be allowed to sell our body parts.  They're ours, signed, sealed amp; delivered.  In Belgium, people are automatically donors and only exempted if they have opted out in writing.  Same should be here, in my opinion.  It's the ultimate recycling and the way for us to advance medically.  I've told my family to harvest every single thing they can for the good of someone else's life when I die.  My stepson died in 1988 and donated his organs.  His gorgeous blue eyes are now a part of a wonderful man who carries my son with him every day.   If we're fortunate enough to be a match for someone who needs it while we're still living, we will bond with that person forever.  Quite a nice thought, that.

Lachlan Wells
Lachlan Wells

No mention of Iran in this article? They have a market for kidneys and NO WAITING LISTS! Check it out.

dymb
dymb

Harvesting bone marrow is not exactly a pleasant procedure to undergo.  As contrast, blood donation is quick, simple, and any blood you donate WILL save someone's life.  Bone marrow however, is difficult to match.  Typically, if you receive a call from the NMDP, National Marrow Donor Program, saying that you are a match for a patient, you are the ONLY match for the patient.  Marrow drives registering potential donors can register hundreds of people without finding a match for a specific patient. 

Where a paid donor system has been proven to be an ineffective means to collect a safe and reliable blood supply, perhaps paying marrow donors is exactly what is needed. 

Additionally, it's not as though blood is free for patients. One unit of red cells can cost over $400 and many surgeries require quite a few units, up to even 100. Even if you donate the blood for free, it doesn't mean that there are no costs associated with the collection, "production", testing, and distribution of blood components.

If it were you in need of a marrow transplant to return to health would you and your loved ones not do everything possible to make that happen?

aaronscc
aaronscc

Big difference between donating something that is 100% replenished like blood, platelets or bone marrow and surgically removing organs that may have some redundancy like a kidney.

Why restrict selling the former?

Hoping that the $3k can be supplemented by travel, hospitalization, loss of a couple of days of work and other incidental costs.

Samian
Samian

Why $3,000?  Why not let the market forces set supply and demand?

I read somewhere that roughly 90% of Caucasians seeking a bone marrow transplant find a match whereas less than 50% of South Asians (e.g., Indians, Pakistanis, Bangladeshis) do.

Hence, the demand for South Asian bone marrow matches presumably would be much higher than other racial groups' bone marrow.

Why put a set price on something that has variable monetary value?

max4374
max4374

Would bringing up "A Modest Proposal" be too much of a hyperbole? Muscle tissue after all IS a body part.  And used for food....could(?) be argued that it is used to supplant one's need for longevity.  Nah, too far fetched.  It could never, ever happen!...

Barakot Barakat
Barakot Barakat

isn't blood donation tissue donation ? same thing here.

ArmyBrat66
ArmyBrat66

Our people have grown too lazy and selfish to wait that long.

Karabis
Karabis

Which is why the organizations doing the procedures would be ethically obligated to careful screening and full disclosure of information. Today in America, there are young women who donate their eggs to pay for college expenses. I have friends who have done it. Potential donors are carefully screened, and then have to undergo a rigorous schedule of hormone injections for several weeks, and then an in-patient procedure. Egg donation can pay very well, yet do you see droves of co-eds lining up for egg harvesting? No, you don't. The application process and the physical demands are enough to dissuade an awful lot of people.

Also, keep in mind the litigious climate of medical practice in the US. It has forced physicians to strictly adhere to ethical an safe practices, and so they have heavy motivation not to put a patient in harm's way. There is no way any American 17 year old could sell a kidney here, the laws protecting patients from from malpractice are just way too strong.

aaronscc
aaronscc

 Bone marrow - 100% replenished.  Kidney... not.  Big diff.

aaronscc
aaronscc

Unlike other organs, bone marrow donation isn't a zero-sum commodity where the recipient would have it and the donor would lose it.  The donor totally regenerates his/her own bone marrow again.

I cannot regrow my second kidney again.

There should be little moral squeamishness about bone marrow donation.  It wouldn't diminish me in the least and I could still live a full life.

A $3000 price would probably result in a vast new pool of donors.  The good potential far outweighs the bad.

Reserve the arguments about zero-sum organ donation for another conversation.  THIS article is about bone marrow.

Perhaps by starting with paid bone marrow donors, we'll learn more about what might transpire in a free country concerning the donation of other organs.

BTW, we already allow paid surrogate motherhood.  Is that not rent-a-womb?  http://www.thesurrogacysource....

Nonymous666
Nonymous666

"

His gorgeous blue eyes are now a part of a wonderful man who carries my son with him every day"

Umm, eye transplants are not possible.  What was harvested was just the cornea which is transparent.

Samian
Samian

I strongly disagree. If I got into a car accident and died, I wouldn't want my family members to collect my body and find out its stripped of all its organs. The government has no presumptive right over my body. The mere thought sounds downright dystopian. Thank goodness I don't live in Europe!

oObubbIegirIOo
oObubbIegirIOo

Actually, majority of bone marrow donation procedures no longer requires drilling into the backbone to harvest the marrow.

In the past 5 years or so, donation is done in a non-surgical procedure done in an outpatient clinic called peripheral blood stem cell (PBSC). Donors receive daily injections of a drug called filgrastim for five days, to increase the number of blood-forming cells in the bloodstream. Then, through a process called apheresis, a donor's blood is removed through a needle in one arm and passed through a machine that separates out the blood-forming cells. The remaining blood is returned to the donor through the other arm.....similar to a blood donation. The donor would eventually regenerate the stem cells after a number of weeks.

As a minority who was waiting for a bone marrow match and constantly being told that the odds were against me, I am in full support of any measures that would add more donors to the registry. 

dymb
dymb

The reason that paid donation isn't efficient for the donation of blood components or whole blood is that the tendency for potential donors to lie about their health history in order to get paid rises drastically.  It increases the risk to donors mainly through a risk of having a reaction, but it mostly compromises patients by creating a much larger pool of blood that needs to undergo much more extensive and expensive testing.  This creates an unsafe and unsustainable blood supply.  Besides that, it isn't as necessary.  If your blood type, for instance, is O neg your red cells are suitable to transfuse almost any patient.  If you're AB neg your plasma is suitable to transfuse almost any patient, and platelets are type irrelevant.  Not so simple with organs or marrow.

Karabis
Karabis

Because accessibility to medical treatments should not in any way result in discrimination based on race or ethnic background, nor does someone with an "uncommon" form of a particular tissue have less of ara right to live than someone who can easily find a match. This isn't like buying a car or some other luxury good that it optional in life. Letting the market set prices for optional procedures like hair transplants or liposuction is fine, but when it's a matter of health, life, or death, procedure costs should be the same for everyone.

JackBeHumble
JackBeHumble

I think the point behind a set price is to prevent one matching family from outbidding another in a direct financial contest.  Are you promoting the idea that the wealthier person should get priority?

dymb
dymb

 sigh.  No.  They are incredibly different things.  All of them.

Jennifer Donehoo
Jennifer Donehoo

 Okay, yes, they really don't transplant whole eyeballs.  However, my stepmom died young in a car accident, and since they did an autopsy, one of the only things they could donate were her retinas.  She helped two people regain sight in their eyes with her retinas.  I'm thinking this is what they meant.  And to the person who didn't want their family to collect their body with no organs in it - Why?  What in the world are you or your family gonna do with them after you're dead??  I would be happy to donate everything I could when I die to help others, because I don't need them after I'm dead.

Michael Jorden
Michael Jorden

Whether you're correct isn't at issue, but what a hurtful thing to say to someone who lost their child and clearly took some comfort in what they believed about the eye transplant.  

Do you think before you talk, or just blurt out whatever you want regardless of others? 

dymb
dymb

Yeah, i had kind of missed that part about the new method of apheresis collection. Should at least help with registration. Good to hear.

Jennifer Donehoo
Jennifer Donehoo

 I get seriously ill when I donate.  Like, I throw up and I'm sick in bed for 2-3 days.  I'm O positive.  If they paid me for my illness, I'd donate.

Karabis
Karabis

Lab testing of the sample, possibly coupled with genetic screening, would largely solve that problem. Besides, what's to stop unpaid donors from lying, or from plain not knowing some elements of their own health history? If people want to receive cash for their tissues, then simply make some or all screening tests at the donor's expense. Fear of spending money on tests only to get rejected would dissuade an awful lot of dishonest donors. It would help prevent lower-income groups from being exploited, as was one potential ethical issue raised in the article.

aaronscc
aaronscc

I've got years of donating platelets and blood.  I'm O+.  Given that I won't get paid in cash, I could still greatly use some kind of compensation for a more serious effort.   I'd donate a couple of times a year. 

Perhaps somehow establishing a continuous history of healthy donations could be a prerequisite?

I'd even take delayed payment, a year later, to confirm that all was good and not risking anyone's health.

Struggling just to afford repairing my car at the moment.

Samian
Samian

1) The mere necessity of the donor being the same race as the recipient obviates the possibility of a race-blind discussion. In other words, race matters because the donor in question was selected on race-based screening. 

2) Food is a necessity for life. Clothing is assumed to be a necessity for life. Can I go into grocery stores and Walmart to demand free food and clothes? No.

3) If I have the product (i.e., my own bone marrow), I should have the right to sell it at a price I want.

This $3,000-limit means nothing. I could just as easily find another country that doesn't have such a limit and tell the prospective recipient, "Let's discuss the terms of a settlement in Country X.  Otherwise, I'll bid you a good afternoon and be on my way."

Samian
Samian

Well, if it's my bone marrow, and I can sell it, why shouldn't I sell it for more than $3,000 if someone can bid much more than that for it?

calivianya
calivianya

You can always donate plasma. That can also help save people's lives, and where I live the first donation in a week nabs you $20 and the second donation in a week nabs you $25. You can make over $200/month donating plasma. I need to sign up to do that myself...