Bone Marrow Donation Less Painful, Potentially Profitable

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The National Marrow Donation Program (NMDP), which maintains the “Be The Match” registry to help provide individuals who would benefit from bone marrow donation with potential donors, is currently at odds with a ruling made by the Ninth Circuit Court in California. The court ruled that, while it’s not legal to compensate organ donors in the United States for their donation, one of the bone marrow-donating procedures isn’t “technically” organ donation — it’s blood donation — and donors can therefore be compensated.

Bone marrow contains hematopoietic stem cells (HSCs), which multiply and generate the many different cells of the blood. Individuals with certain diseases and cancer, including leukemia, require donations of healthy bone marrow in order to recover from their disease. Because bone marrow is a body organ, donated marrow must match the “type” of the recipient to prevent rejection of the marrow. According to the NMDP’s FAQs, only about 30% of patients requiring bone marrow can find a match among family members; the rest have to rely upon registered bone marrow donors. Because race and ethnicity affect a patient’s marrow type, minorities may have a particularly hard time finding an appropriate donor.

Historically, bone marrow donation has involved an invasive procedure under general anesthetic in which marrow is drawn out of the hip bone of the donor through a long, large-bore needle. The discomfort associated with the donation site after the procedure can be significant, and side effects include fatigue and aching. A newer process, called peripheral blood cell donation, involves several days worth of injections of the drug filgrastim, a granulocyte colony-stimulating factor (G-CSF) analog that stimulates the body to release HSCs from the marrow into the bloodstream. The HSCs are then collected through a simple blood draw. This process, while much less invasive for the donor, is still under investigation, and may not be appropriate as a source of HSCs for all recipients.

The Ninth Circuit Court ruled on donation of peripheral blood cells, stating that because the donation process involves nothing more than collection of blood — a process for which the precedent of providing compensation is well in place — it isn’t properly classified as an organ donation and donors may receive compensation [1]. The NMDP, however, strongly opposes this ruling, on the grounds that it could make it even more difficult for recipients without financial means to pay for donation to receive life-saving marrow. The case was brought about by the non-profit organization MoreMarrowDonors.org, which hoped to encourage more donations, especially by minorities, through offering compensation of $3,000 USD (in the form of scholarships, housing, and other indirect payments) to donors.