Bone Marrow Bounty Hunters

by on October 11, 2011 at 1:41 pm in Current Affairs, Law, Medicine | Permalink

Amit Gupta has leukemia and needs to find a  bone-marrow transplant. Gupta is the founder of the do-it-yourself photography site Photojojo and the collaborative-working community Jelly and many of his high-tech friends have jumped to his aid including Seth Godin. Here’s Virginia Postrel:

[Godin offered] to pay $10,000 to anyone who became a match for Gupta and made the stem-cell donation, or to give the money to that person’s favorite charity. The offer, he says, was “a chance to say to my readers, ‘Hey, I care about this. A lot. Money where my mouth is.’”

He picked $10,000 because, he says, it’s “enough money to matter to both the giver and the recipient, without being enough money to sue over, cheat over or corrupt.”

Gupta’s friend Michael Galpert, one of the co-founders of the photo-editing site Aviary.com, quickly matched Godin’s offer. “I would do anything that could contribute to helping save his life,” he says.

With $20,000 at stake, the cause did indeed take on new urgency….There was only one problem. The offer was illegal.

Paying a marrow donor is currently illegal under the same law that makes paying organ donors illegal, despite the fact that marrow donation (technically blood stem cells from marrow) is much more like blood donation or egg donation than donating a kidney. (To avoid the law Godin has modified his offer.) Fortunately, the law might be overturned.

In February, the 9th U.S. Circuit Court of Appeals heard arguments in a lawsuit challenging the constitutionality of the ban on valuable consideration for bone-marrow donations. The suit was brought by the Institute for Justice, a libertarian public-interest law firm, on behalf of plaintiffs who include patients, parents of sick children, a doctor who does bone- marrow transplants and a charity that would like to offer incentives, such as scholarships, to encourage more donations.

The lawsuit argues that since marrow cell transplants aren’t significantly different from blood transfusions, the federal government has no “rational basis” for outlawing the kind of compensation that is perfectly legal not only for blood but also for other regenerating tissues, such as hair and sperm, not to mention eggs, which don’t regenerate. This disparate treatment of essentially similar processes, it maintains, violates the Constitution’s guarantee of equal protection. A decision could come down any day.

Greg October 11, 2011 at 1:47 pm

I received payment for bone marrow when I was in college. Perhaps the laws didn’t apply because it was a small amount of marrow donated for research purposes.

(For the record: totally not worth it. If I had a time machine, I’d let my 19-year-old self know that there are easier ways to make $100 than letting someone shove a needle through your pelvic bone.)

Andrew' October 11, 2011 at 2:53 pm

Underpaid so some guy could write a paper is way better than using it to save a life.

Virginia Postrel October 11, 2011 at 2:52 pm

The donation process, at least for transplants, has changed since you were in college. 70% are done in a way similar to blood donation, as explained in my article.

paa October 11, 2011 at 3:47 pm

Could you just structure the payment as a “finders fee” for the service of successfully finding you a match? No reason why the finder couldn’t also be the donor, and then collect, no?

Silas Barta October 11, 2011 at 4:10 pm

No, they’re a little to clever (or evil) for that.

Old oncologist October 11, 2011 at 4:57 pm

There are currently about 9 million donors in international marrow donor registries. Ethnicity, which correlates with transplantation cell types, is a factor. The registries are full of northern Europeans. I had a patient of German ancestry that found 37 matches for his transplant.
The blood banking community has been leery about paying for donors for a long time for fear that profit-driven donors might not be as safe as pure altruistic donors. After the AIDS epidemic first hit, there was a push to use family donors rather than strangers. The Puget Sound blood bank studied the people who came forth to donate for a relative (presumably not motivated by pure altruism) and the stranger donors in its panel. The relatives had three times the level of Hepatitis virus antibodies as the volunteer donors.
In brief, for most people there are plenty of donors. I can’t imagine that there are not a lot of Guptas in the registries.
There are reasons to suspect paid donors. Some things are worth more than money can pay, and money can cheapen those things.
I do encourage all to register as a potential donor

Andrew' October 12, 2011 at 7:41 am

You encourage all how?

Anyway, you are mainly talking about the transition. Besides, wouldn’t the most altruistic be the lowest offer? I don’t understand why this behaves differently from nearly everything else unless it is true that someone being paid will quash someone else’s altruistic motivation. I’m not sure that happens.

albatross October 11, 2011 at 5:39 pm

Old oncologist:

If I’m understanding correctly, your concern here is that the paid donors will also bring stuff we don’t yet know to test for along, at least at higher rates than the background for the population. This is an interesting problem, which is very different from the usual reasons given for not paying donors (which always seem to me to resolve down to a yuck factor for selling body parts, and a fear that the short-sighted or desperate will end up selling off a bunch of their organs to get a quick buck. In this case, it’s more that the kind of person who wants a quick buck badly enough to do this will also have done a lot of other stuff you’d rather your potential organ/marrow/plasma donor hadn’t done.

Are there parallel situations in other places besides organ/tissue/blood donations? The only one that comes to mind is the difference between people who will sleep with you voluntarily and the ones whom you have to pay to sleep with you–the volunteers are almost certainly a lot less likely to expose you to something nasty than the ones you have to pay.

The general pattern seems really odd, though–the kind of person willing to volunteer to do X tends on average to be a better candidate to do it than the kind of person you have to pay to do X.

Rich P October 13, 2011 at 10:31 am

Albatross:

I don’t think your parallel with prostitution holds up well. If you meet someone at a bar for a one-night stand and they don’t require you to wear a condom, it is imprudent to assume that you are a unique case. It is safer and more reasonable to assume that you are not the only person they have brought home, and you are not the only one who didn’t have to use a condom.

At least the professionals are going to make the request.

Mogden October 11, 2011 at 5:48 pm

Silly people. Don’t you know that the value of a human life is incalculable? That is why we will shoot you or lock you up if you try to pay with dirty money to save someone.

Old oncologist October 11, 2011 at 6:11 pm

If we pay for blood/bone marrow donations to increase the donor pool, will payment increase the number of clean-cut altruists or increase the number of meth users that come forward?
You tell me.
In my location the predominant group of blood donors are firefighters who are healthy, can see where the stuff ends up, and are not paid for it. Strangely enough, people leading Hep C lifestyles are not lining up to donate. Would paying people change this?

John Thacker October 11, 2011 at 6:54 pm

I hear all you’re saying, but it’s simply not convincing. The risks you outline don’t outweigh the rewards. I think on net you’re still advocating more people dying.

The odd thing to me about your comparison to blood donors is that paying for blood is already legal. You seem to indicate that blood banks make a distinction between paid and volunteer blood; why couldn’t bone marrow be treated the same?

bunker brown October 12, 2011 at 2:04 pm

I lead a very healthy lifestyle but I can’t be bothered to donate. Throw in a few bucks and I will go.

Mogden October 11, 2011 at 6:24 pm

I think it would be fine to label the donor products with whether they were paid for or not. That way the recipient could decide if it is worth the additional risk.

Personally if it was a meth head’s bone marrow or nothing, I’d take it.

gcochran October 11, 2011 at 9:58 pm

In reality this story is much crazier than you know. Typically, donor centers CHARGE donors. When I signed up, they wanted to charge me $70 for the privilege of someday (if I matched) having a needle stuck in my pelvic bone. But as they were quick to explain, I only had to pay if I was white. As it turned out, they also waived the fee for people who threatened them.

Andrew' October 12, 2011 at 7:42 am

Makes sense if you want the violently altruistic.

efficiency r us October 12, 2011 at 12:49 pm

Who doesn’t, really?

Jehu October 14, 2011 at 1:25 am

Perhaps they’re just really into altruistic punishment?

Old Biology Professor October 12, 2011 at 8:54 am

You couldn’t find a better organization to make a donation to than the Institute for Justice. Visit http://www.ij.org and see. They are also on Facebook. Start with a small $10 donation if you want, just to get their message feed. You’ll be impressed with how they fight for clients who are being abused by governments.

E Pons October 15, 2011 at 1:16 pm

Legalizing “incentives” to acquire more bone marrow donors may have some substantial downfalls- such as the possible depletion of a healthier and totally altruistic donor pool, as Old Oncologist has mentioned- but I believe that the benefits of implementing such a system would outweigh the cons. The article notes that the lawsuit against the illegality of paying a marrow donor consists of groups directly associated with patients who are undoubtedly struggling to find these donors. Because bone marrow is regenerative (like sperm) and the need for transplants is high, I don’t see why the movement for legalizing incentives for donors would be overturned.

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