HEALTH CARE/Joan Retsinas

Bone Marrow Transplant and the Market

In a perfect world we would be loving, generous, magnanimous – those Sunday School virtues. We know the “shoulds.” But we often eschew them. As Portia cautioned, “if to do were as easy as to know what were good to do…” In a decidedly imperfect world, our baser natures often trump our better ones.

Consider organ donations. Kidneys, livers, lungs – all are scarce relative to demand. In a perfect world, we would all sign on the dotted line, offering our innards to people who need them. But most of us demur, and patients linger on waiting lists, hoping to move up the list before they die, or grow too sick to benefit.

The market presents one solution: why not pay for organs? Other nations do it. But we Americans have shied from that solution. We proffer a host of reasons, starting with patient safety: those organs do not regenerate, and donors may be compromising their own lives.

Until recently, bone marrow transplants fell into the category of “organ” donations and, consequently, subject to the rules spelled out in the 1984 National Organ Transplant Act: no payment, simply magnanimous donations. Extracting marrow from bone is a major procedure, and while marrow cells do regenerate, the aspiration is painful, and risky.

But technology has given a new procedure: apheresis. Today in two-thirds of cases physicians harvest bone marrow cells from blood. The marrow donor is in effect donating plasma.

Since people can sell their blood – indeed, people can also sell their sperm and eggs – technology pushed the question: can we pay for bone marrow obtained through apheresis? A distraught mother with three children born with Franconia anemia, who might need bone marrow transplants, joined with a clinician and a group MoreMarrowDonors, org, to call the question. Initially, the donor would receive $3,000, either as a scholarship or a housing stipend. The traditional network for organ donation objected. The case went to court. A lower court ruled against the group: this payment was against the rules. The newer method did not matter.

But in December a three-person appeals court ruled unanimously to allow payment for marrow given through this procedure, not the traditional aspiration one. In fact, payment could be just that, payment, with no scholarship attached.

The Department of Justice has joined with a coalition of professional groups to appeal. They argue that payment will encourage unhealthy people to donate; they argue that payment will skew the procedure towards apheresis, not aspiration; they argue that payment will stifle the altruistic urge behind donation. Yet presumably clinicians can screen out unhealthy marrow, and can prescribe the best procedure for the patient. As for altruism, the altruistic method has given marrow from unrelated donors to roughly 5,000 people each year. But as many as 3,000 people each year die, waiting for marrow. The plaintiffs in the case are confident that payment will spur more people to come forward.

It is tempting to argue for altruism, but before hoisting that banner, we should ask ourselves: have I signed up to donate bone marrow? If not, then let the market intervene. We might save some of those patients otherwise destined to die on the waiting list. This time, the market can be part of the solution, not the problem.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, April 1, 2012