Blowback: Pay bone-marrow donors? Give it a shot
John Wagner is a professor at the University of Minnesota Department of Pediatrics, where he directs the Blood and Marrow Transplant Program. He is a plaintiff in the lawsuit challenging the federal ban on compensating bone-marrow donors. For more information, visit ij.org/BoneMarrow. If you also have a bone to pick regarding a recent Times article, editorial or Op-Ed and would like to participate in Blowback, here are our FAQs and submission policy.
The Times' March 1 editorial suggests that a proposal to provide modest compensation to bone-marrow donors carries too many risks without promising enough benefits to implement even on a trial basis. Rather than disregard the proposal outright, I think it is important to consider all the options.
As a bone-marrow transplant specialist who is continuously faced with finding suitable donors for many children with deadly illnesses such as relapsed leukemia, my task is to leave no stone unturned. All too often, donors back out or are not available at the time they are needed. Unless recent updates suggest otherwise, prior reports from marrow donor registries have documented a 30% attrition rate, a persistent problem despite intensive efforts in donor education and awareness.
It is bad enough to have patients who lack a matched donor, but even worse is when a matched donor is identified but then backs out. I have a list of patients who have experienced this problem; some were left without good alternatives.
Let me be clear: I do not know if our compensation proposal will solve the problem of donors backing out altogether or not being available at the time patients needs them. But if alternative strategies have so far failed to solve this important and costly problem, I believe we need to consider other options.
The way the proposed program would work is simple: Potential marrow donors would sign up with a nonprofit group, MoreMarrowDonors.org, at the time they register. Then, if called on to donate because the tissue type matches a patient's (which could be months or years after registering, if ever), the donor would be entitled to either a $3,000 college scholarship, a $3,000 housing allowance or a $3,000 payment to the charity of his or her choice as compensation.
The hope is that these modest payments would encourage more people to sign up and follow through with the marrow collection at the time requested should a patient need their lifesaving marrow. The funds for the compensation would come from charitable giving. Wealth or influence wouldn't matter, as we "choose" the donor on the basis of genetic type, rather than the donor "choosing" simply to make a random donation for money.
Of course, we need to consider all risks, but I think this proposal addresses The Times' concerns. The editorial, for example, suggests that financial incentives might encourage people to conceal their health histories. While a possible risk, it is likely a low one. First, the vast majority who sign up are doing so for altruistic reasons. And again, we call on them because they happen to match children or adults with life-threatening diseases. Of course we want them to be honest, but we also presume that every donor may not even be aware of possible prior exposure to infectious diseases. Every donor is extensively tested.
Importantly, patients and their families are made aware of the risks of bone-marrow transplantation, including the risk of diseases passed through the donated cells. While it is our aim to keep those risks as low as possible, there are others that need to be considered as well -- such as the risk of no donor at all, delayed donation or the use of an alternate donor who is less well matched.
Now, federal law prevents us from considering the option of compensation, which promises to at least reduce the number of donors -- currently about one-third -- who aren't available when we need them. As an advocate for our patients, I believe we should consider all options for overcoming this major obstacle, which all donor registries have tried unsuccessfully to address for decades.
When the ban was proposed, lawmakers didn't consider the fact that we actually choose the donor, that the "organ" -- bone marrow -- regenerates itself, or the relative ease of extraction. Comparing this to selling a kidney is foolish.
Obviously, what we are proposing represents a change from the status quo, and I understand that new ideas will always face resistance. But compensating marrow donors has the potential to save lives while doing no harm. We ought to see, under medically supervised conditions, if it will work. Our patients, quite literally, cannot afford to wait.
-- John Wagner, MD