The Bone Marrow and Cord Blood Donation and Transplantation
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The recent decision of the Ninth Circuit Court of Appeals in the matter of Flynn, et al v. Holder holding that the National Organ Transplant Act does not prohibit compensation of peripheral blood stem cell donors raises a number of concerns regarding the access to and safety of blood stem cell donations, including:
Interferes with Physicians’ Ability to Provide Quality Care The decision of whether the donation occurs through the traditional method of bone marrow extraction or PBSC donation should be based on the best clinical judgment of the patient’s physician. PBSCs may not be in the best interests of the patient in many cases. Paying for PBSCs may cause donors to choose this method instead of a marrow extraction recommended by the recipient’s physician.
Raises Concerns Regarding Recipient and Donor Safety The current law protects patient and donor safety. Donors may be more likely to withhold medical details and information about risky personal activities if their aim is compensation.
Undermines Altruistic Motivations of Those on the Current Registries Compensating donors could deter those who are willing to donate for purely altruistic reasons. The 10 million members of the national registry, as well as 9 million available on international registries, are proof positive that people do not need material incentive to save a life.
Conflicts with International Standards Compensating donors would mean that the United States would no longer conform to international standards, and therefore patients here may not be able to participate in the current worldwide search process. In 2011, nearly half of the transplants facilitated by the NMDP involved either an international donor or patient.
Raises the Potential of Markets in Marrow Donation Patients may promote donor drives with the promise of compensation, appealing to those with financial need, and not fully disclose the risks associated with the donation. In addition, markets put physicians in the morally dubious position of carrying out medical procedures solely for monetary profit.
For these and other reasons, the Advisory Council recommends that the Secretary take and support all reasonable efforts to insure that compensation for marrow, peripheral blood stem cells and similar products continues to be prohibited.