Nature Medicine | Spoonful of Medicine

Bone marrow donors can be paid, US court rules


In a ruling that may bring relief to cancer patients across the US, a federal appeals court said that a decades-old law banning the sale of human organs does not apply to bone marrow donations.

The US National Organ Transplant Act of 1984 prohibits financial compensation for human organ donations, including bone marrow, but allows people to be paid for blood and plasma donations. At the time, lawmakers made that distinction because the method used to extract marrow was dangerous, and monetary kickbacks could have encouraged desperate people to take unnecessary risks. As a disincentive to sell organs, the crime was made punishable by up to five years in prison. But a group of cancer victims, parents of sick children, a physician and a Californian non-profit called challenged the status quo, arguing that reimbursement was essential to plug the country’s shortage of bone marrow donors.

In a decision released yesterday, the US Court of Appeals for the Ninth Circuit, which covers much of the western part of the country, agreed. “The court’s decision will fundamentally change treatment options for people with deadly blood diseases,” Jeff Rowes, the attorney from the Institute for Justice in Arlington, Virginia who argued the case, told Nature Medicine.

Bone marrow donations have historically involved inserting large needles into people’s hips to suck out the marrow and blood stem cells within — a painful and complex medical procedure with serious medical risks. But in the last 20 years, the advent of less invasive medical technologies has made isolating blood stem cells as painless as donating blood — and, hence, marrow donation is distinct from other types of organ donation, the court ruled.

Critics argue that compensation might lead to medical exploitation of people in financial need, encouraging them to sell their cells for quick cash. “We were surprised and puzzled by the appellate court’s decision regarding allowing compensation for [bone marrow] donation,” said Michael Boo, chief strategy officer of the National Marrow Donor Program, in a press statement. The non-profit does not plan to change its volunteer-based policy based on yesterday’s ruling.

Rowes, however, believes exploitation is not relevant in this context. “Getting an exact [bone marrow] match with someone is so exceedingly rare, that you can’t just go on eBay and offer to sell your bone marrow, because you wouldn’t have a buyer,” he says.

The ruling remains in limbo for at least another 90 days, a period during which the US Attorney General can appeal to overturn the decision in the Supreme Court. If there is no appeal within that time, the court’s decision will immediately go into effect.

Image: Bob Ramsey via


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