It's Marrow That I Love

October 11, 2011 9:43 AM

Amit Gupta needs a bone marrow transplant, and to increase chances of finding a match, Seth Godin offered a $10k bounty to whoever donated to his friend. There was only one problem. The offer was illegal. The National Organ Transplant Act of 1984 made it "felony punishable by up to five years in prison" to offer financial incentive for bone marrow donation. The Institute for Justice has sued the US Attorney General to overturn this restriction (commentary).

The case is still pending.

posted by ThePinkSuperhero (88 comments total)

Without those laws, organs go to the highest bidder. That's NOT a good thing. Yay, laws!
posted by Sys Rq at 9:48 AM on October 11, 2011 [63 favorites]

I'm...actually kind of OK with this being illegal. The Justice Institute link says this: "Common sense suggests that offering modest incentives to attract more bone marrow donors would be worth pursuing, but federal law makes that a felony punishable by up to five years in prison." But common sense suggests to me we're probably not talking about "modest incentives" but rather the wealthy being able to afford bone marrow transplants when everyone else is not.
posted by Hoopo at 9:49 AM on October 11, 2011 [12 favorites]

The lawsuit is specifically targeting the restriction on incentive for bone marrow donation, which makes sense to me, because as some of the articles detail, it's a renewable resource. I couldn't grow another kidney if I sold one, but I can regenerate my bone marrow and/or peripheral blood stem cells.
posted by ThePinkSuperhero at 9:51 AM on October 11, 2011 [5 favorites]

Without those laws, organs go to the highest bidder. That's NOT a good thing. Yay, laws!

Or, organs get donated that otherwise wouldn't (couldn't, due to young healthy people having to, you know, WORK) be donated in the first place, thus taking pressure off the regular list.
posted by small_ruminant at 9:51 AM on October 11, 2011 [2 favorites]

Hello? Bone Marrow is NOT an organ, it's more akin to blood. You can get compensated for donating blood, right? Seems like a no-brainer. I rule in favor of changing the law (or interpreting it such that marrow=blood). NEXT!
posted by joecacti at 9:52 AM on October 11, 2011 [6 favorites]

In other organ donation bounty news from the BBC:

Patients who donate their organs should have their funeral expenses paid for by the NHS, according to a leading ethics body.

The Nuffield Council of Bioethics report said the move could lead to more people donating their organs.

However, it ruled out directly paying donors for their organs.
...

posted by Jahaza at 9:52 AM on October 11, 2011 [3 favorites]

It also sounds like those working on this don't imagine an incentive for donors; rather, there'd be an incentive to join the registry in the first place. I'd be interested to see how that could work- would the incentive draw people who wouldn't be interested in actually donating if they were matched?
posted by ThePinkSuperhero at 9:53 AM on October 11, 2011

I wish that the FPP had made the marrow vs organ thing clear. Marrow can be regenerated. Organs can't. Despite the differences, I'm still not sure how I feel about it. We don't generally transfuse very expensive and exclusive blood directly from one person to the other.
posted by 200burritos at 9:53 AM on October 11, 2011 [2 favorites]

Would it be illegal to purchase a full spread ad in the NYTimes or on a billboard in order to entice people to donate more? Would it matter if he wasn't offering money but dirt bikes instead?
posted by Fizz at 9:53 AM on October 11, 2011

The Institute for Justice was initially funded and continues to be supported by the Koch brothers. Setting up organ markets for poor people to die so the rich can live has been a ultra-libertarian talking point for years.
posted by theodolite at 9:54 AM on October 11, 2011 [16 favorites]

Actually you can't get compensated for donating blood, just blood plasma.
posted by Garm at 9:54 AM on October 11, 2011

You can get compensated for donating blood, right?

Not in California, I don't think. Blood serum you can be compensated for in some places.
posted by small_ruminant at 9:54 AM on October 11, 2011

You can get compensated for donating blood, right?

I don't know anyone that does. People actually do that for free here in Canada.
posted by Hoopo at 9:54 AM on October 11, 2011 [4 favorites]

Yeah, okay, upon RingTFA, I see that they only want to change the restriction for bone marrow and not just overturn the entire organ donor law, which does seem pretty reasonable.
posted by elizardbits at 9:55 AM on October 11, 2011

You can get compensated for donating blood, right?

This is a US thing. The world is a very big place.
posted by bonehead at 9:55 AM on October 11, 2011

(to treat bone marrow donations the same as plasma donations, I mean.)
posted by elizardbits at 9:56 AM on October 11, 2011

So... are they going to throw Godin into prison? Or does the 'void where prohibited' disclaimer actually help?
posted by WalterMitty at 9:57 AM on October 11, 2011

You can get compensated for donating blood, right?

This is a US thing. The world is a very big place.

OK...but this is a US based law, and Amit Gupta lives in the US.
posted by sweetkid at 9:57 AM on October 11, 2011 [3 favorites]

I'll donate. Seth doesn't need to pay me. He can just buy me dinner 75 times or so.
posted by Ad hominem at 10:00 AM on October 11, 2011 [3 favorites]

WalterMitty: So... are they going to throw Godin into prison?

FTFA: "Godin revised his offer. He now promises the money to the first person who matches Gupta, regardless of whether that person goes through with the transplant: no quid pro quo."
posted by ancillary at 10:00 AM on October 11, 2011

I think compensating people for blood donations should be illegal, so I can't say I agree with their premise.
posted by lydhre at 10:00 AM on October 11, 2011 [1 favorite]

So... are they going to throw Godin into prison? Or does the 'void where prohibited' disclaimer actually help?

He tries to work around it by saying, "You win the prize if you're the first certified match, but donating is completely up to you,", but I don't see how he could certify a year after the fact that someone was the first certified match if they didn't donate- what sort of records would exist on that? And what sort of person would come forward to claim the money if they matched but didn't donate? I can't see how the revised offer doesn't violate the spirit of the law.
posted by ThePinkSuperhero at 10:01 AM on October 11, 2011

Where in the US do you get compensated for donating whole blood? Other than the cookie, can of orange juice, occasional mug or t-shirt?
posted by Houstonian at 10:01 AM on October 11, 2011

The Institute for Justice was initially funded and continues to be supported by the Koch brothers. Setting up organ markets for poor people to die so the rich can live has been a ultra-libertarian talking point for years.
posted by theodolite at 9:54 AM on October 11

I vote that employers be allowed to take directly from their hires. It may be necessary to keep the wheels of industry turning during this challenging economic time.
posted by Stagger Lee at 10:01 AM on October 11, 2011

The IJ does some great work, and this is another example of it. Sys Rq, there is room between "no money for marrow donation ever ever ever" and "organs go to the highest bidder."

My wife and I have been on the bone marrow registry for 10 years and have never been a match; the chance of finding a non-relative match are infinitesimally small. If they DID match us to someone, the prize for us would be a painful donation procedure, time away from work, and no compensation even for that. We would of course do it, but I'd a lot of people wouldn't (or couldn't, for financial or work-related reasons).

The reality is that if you want to encourage people to get on the marrow registry - which would increase the % chance that there would a match for needy patients - and further encourage people on the registry to go through with the pain and inconvenience of donating when they are a match, incentives would help.

For those concerned about a rich/poor disparity, you could set up a fund that pays a fixed amount to donors who are matched and go through the procedure.
posted by AgentRocket at 10:02 AM on October 11, 2011 [8 favorites]

Yeah, okay, upon RingTFA, I see that they only want to change the restriction for bone marrow and not just overturn the entire organ donor law, which does seem pretty reasonable.

Not really. Who can pay the "bounty"? Rich people. Who would be so desperate for money that selling bone marrow might seem like a good idea? Poor people.

The poor are not just organ banks for the rich.

And bone marrow donation is nothing like blood donation. It's a serious surgical procedure with all the risks that entails.
posted by Sys Rq at 10:02 AM on October 11, 2011 [3 favorites]

In the US, it's illegal to be paid for whole blood donations that are used for transfusions, per the FDA.
posted by Houstonian at 10:03 AM on October 11, 2011

>The Institute for Justice was initially funded and continues to be supported by the Koch brothers. Setting up organ markets for poor people to die so the rich can live has been a ultra-libertarian talking point for years.

That link doesn't quite say what you think it says.

Not really. Who can pay the "bounty"? Rich people. Who would be so desperate for money that selling bone marrow might seem like a good idea? Poor people.

The poor are not just organ banks for the rich.

And bone marrow donation is nothing like blood donation. It's a serious surgical procedure with all the risks that entails.

So If I'm poor and have something to sell, I can't sell it because a rich person might be buying?
posted by 2N2222 at 10:05 AM on October 11, 2011 [10 favorites]

AgentRocket: Step one should probably be informing the public that there is such a thing as a bone marrow registry, no?
posted by Sys Rq at 10:05 AM on October 11, 2011

I never realized the issue with being paid for organs was tied to them not being regenerated. My understanding was that it created an environment where a wealthy person could afford to buy a standard of health care others could never afford. But that's my crazy Canuckistan upbringing showing.

Beyond which, donating marrow is different than donating blood. It is a procedure that require anasthesia and a couple of days to recover. This is not something I would want anyone to consider doing out of financial considerations or worse, financial necessity.
posted by Hoopo at 10:06 AM on October 11, 2011 [1 favorite]

The poor are not just organ banks for the rich.

I don't totally understand this- if they have the time and ability and willingness, why shouldn't they make some money off of it? I like the idea of having a standard payment for it, though, so it's not all "highest bidder." If I could afford to take time off work, or if I was unemployed, I'd take them up in a heartbeat.

There are far more potential donors than people who need marrow. I expect being able to be compensated would bring the shortage down to nothing.
posted by small_ruminant at 10:06 AM on October 11, 2011 [3 favorites]

The poor are not just organ banks for the rich.

Right, that's why I clarified my statement to say that it doesn't seem unreasonable to treat it like blood donation, if compensation is allowed for blood donation. If it's not, then I am delighted to retract my meaningless internets approval.
posted by elizardbits at 10:07 AM on October 11, 2011

To be honest, I think people should be able to sell body parts. I've got several I no longer need but I am stuck with. Thanks obama!
posted by Ad hominem at 10:07 AM on October 11, 2011 [1 favorite]

And bone marrow donation is nothing like blood donation. It's a serious surgical procedure with all the risks that entails.

Beyond which, donating marrow is different than donating blood. It is a procedure that require anasthesia and a couple of days to recover.

Not necessarily! For a majority of cases (I saw the term 70% somewhere), the patient can receive PBSC - peripheral blood stem cells. They are collected from the donor (after 5 days of filgrastim injections) via a line in each arm- one line takes the blood out and puts it through an apheresis machine to collect the needed cells, and the other line returns everything else. I donated in this manner last month for a match found through the registry, it was uncomfortable at times but never painful. If a donor is unable to produce enough cells via this method, surgery might be requested.
posted by ThePinkSuperhero at 10:08 AM on October 11, 2011 [7 favorites]

Bone marrow donation is usually actually pretty close to donating blood. You take a drug in advance to increase the levels of certain cells in your body, then your blood is run through a machine that takes out those cells and gives you the blood back.

http://marrow.org/Join/Myths_and_Facts/Myths___Facts_about_Donation.aspx

Some people still donate in the surgical way, but it's not surgery like opening up someone's midsection is surgery. It still has risks, of course.

But if anyone is on the fence about signing up for the registry because of surgery worries, this is probably the easiest, least painful way you will ever be able to save another person's life.
posted by thehmsbeagle at 10:12 AM on October 11, 2011 [2 favorites]

This is not as simple as "here's money to donate your marrow to me". There is a 1 in 20,000 chance that any one person will match another. Let's say this drive gets a few thousands of people to register who otherwise wouldn't have. Many, many other people needing marrow will benefit from those thousands being registered.
posted by the jam at 10:14 AM on October 11, 2011 [1 favorite]

Eh... yeah, they can start with just bone marrow but I've got a feeling we'd end up with a highest bidder system fairly quickly.

It would go to the SCOTUS and Scalia/Roberts would find some ground to toss the whole damn thing and not just carve out an exemption for bone marrow.
posted by Slackermagee at 10:16 AM on October 11, 2011 [1 favorite]

@thehmsbeagle, thank you for that information. I just registered.
posted by 200burritos at 10:21 AM on October 11, 2011 [1 favorite]

This is not as simple as "here's money to donate your marrow to me". There is a 1 in 20,000 chance that any one person will match another. Let's say this drive gets a few thousands of people to register who otherwise wouldn't have

Maybe, and maybe this gets more people in the registry, but only one person would get $10,000 and we're talking about incentivizing it, yes? From what I gather they find out whether you're compatible by a swab test. If people are doing this because of the financial incentive (as the Justice Institute thinks they should be allowed to), who's to say they'll be willing to go further than a swab test for anyone not offering cash?
posted by Hoopo at 10:28 AM on October 11, 2011

This issue is close to my heart, because my dad donated a kidney a few years ago and he struggled with the compensation issue then. He went through a huge number of hoops to get to the point where he was allowed to give his organ away to someone, and he saved her life. He had to take time off work for the tests, for the procedure, and for the recovery, and it was noncompensable from his employer. (It was grudgingly given in the first place.)

The family of the donee offered to pay for the time missed from work but the hospital and the kidney donation group that was helping them warned them sternly that it would be a felony. My dad didn't want to get rich from his donation, or even to make a dime from it. But he and the donee family did think it was at least fair that he shouldn't lose money.

I am really proud that my dad was so selfless in his act, and that he went ahead even at a personal cost to him. I don't think many people would do that.

Rich vs. Poor aside, it is in everyone's interest for their to be more organ donations, and right now there is almost a negative incentive for donors. "Slippery slope" advocates frequently say that compensation for donors will devolve into a marketplace where poor people are exploited. But it seems that there must be a way of preventing that other than a wholesale ban on any payment of money.
posted by AgentRocket at 10:29 AM on October 11, 2011 [12 favorites]

For posterity, I recognize and am annoyed by my improper use of "their" (instead of there) in the comment above.
posted by AgentRocket at 10:30 AM on October 11, 2011 [2 favorites]

For the record AgentRocket, I have no issue with indemnifying a donor and frankly it would be best if employers wouldn't put up any hurdles to this sort of thing. The money shouldn't be coming from the recipient though. No one should be taking a financial loss for donating, but it's the potential to profit--along with the possibility of financial concerns necessitating donation--that has me worried.
posted by Hoopo at 10:36 AM on October 11, 2011

There are definitely negative incentives for organ donors, especially for those on individual insurance plans. This needs to be straightened out in law. Also, employers should also be required to treat organ donors with the same reverence they are required to treat jury duty participants.
posted by RobotVoodooPower at 10:41 AM on October 11, 2011 [1 favorite]

This issue is close to my heart, because my dad donated a kidney a few years ago and he struggled with the compensation issue then. He went through a huge number of hoops to get to the point where he was allowed to give his organ away to someone, and he saved her life. He had to take time off work for the tests, for the procedure, and for the recovery, and it was noncompensable from his employer. (It was grudgingly given in the first place.)

I went through the same thing. Despite all the warnings about not compensating me, the donee family paid my bills that month, since I was out of work, but it's not like I ended up better off than before I started, and god bless my boss for letting me take the time off- I work in a small office, and it was a hardship for him.

Fortunately the hoops people have to jump through for "good samaritan" donations are way way fewer these days than they were when I did it, but it is a serious PITA, even disregarding the health consequences, and I don't think paying people for the time they're out of commission would be a bad thing.

Also, as I said before, I am convinced that allowing people to pay for living donors' organs would take the pressure off the cadaver organs available to the rest of us.
posted by small_ruminant at 10:42 AM on October 11, 2011

Also, employers should also be required to treat organ donors with the same reverence they are required to treat jury duty participants.

Here in California, reverence for jury duty participants is only required insofar as giving them time off. In most cases, they do not have to pay you for it.
posted by small_ruminant at 10:44 AM on October 11, 2011

You know what, I am totally ok with our position on this particular slope. I think the hand-wringing here (a lot of it anyway, certainly not all) is because people don't actually understand what's involved in bone marrow transplants.

It's really hard to find a match if you can't find one in your close family (1 in 20,000 to 1 in 100,000, but "much higher for patients of minority heritage"). It costs about $100 for someone to join the registry, a good part of that being the cost of the test itself. A lot of the times this cost is subsidized by various organizations and donors, but not always completely. And people of color are seriously underrepresented on the registry.

So you have a situation where there are financial disincentives for just joining the registry, much less being an actual donor. But being a match for someone is such an unlikely event anyway... it's not like with other organs where anyone will do. Any incentive for the person to ultimately donate benefits EVERYONE ELSE by adding many many more to the registry.
posted by danny the boy at 10:47 AM on October 11, 2011

I am surprised to see that article about health insurance being denied to donors. That has not been my experience, and statistically donors are healthier than the general population. (Not because donation is good for you, but because you have to be in pretty fantastic health to be allowed to donate at all.)
posted by small_ruminant at 10:47 AM on October 11, 2011

What do people think would be a better incentive: $10k for the matching donor, or $10 to each person who gets tested? Or even $20 if they are of SE Asian descent.
posted by smackfu at 10:49 AM on October 11, 2011

Money already plays a significant role in donations as many transplant centers will not transplant to a patient without some form of pharmacy benefit (the post transplant drugs cost in the neighborhood of $30k per year, and without them the transplant gets rejected - so no reason to transplant a precious organ when you already know it will be rejected fairly soon due to non-adherence to the prescription regimen).

Furthermore, I have to say that, for most people, the costs associated with being a donor are astounding. Time off of work, nursing and supportive care, etc. Couple that with an abysmal insurance system and you suddenly have an entire pool of potentially eligible donors unable to donate even if they wished to.

It is a very different proposal to say that there ought to be some bounty for donors to saying that people should be transplanted based upon their ability to pay. But a compensation structure for donors would probably be beneficial to all involved.
posted by jason says at 11:03 AM on October 11, 2011 [5 favorites]

Bone marrow donation is usually actually pretty close to donating blood. You take a drug in advance to increase the levels of certain cells in your body, then your blood is run through a machine that takes out those cells and gives you the blood back.

Yes, this. My mum has donated by this method; her worst complaint was that it was boring. She has also had marrow taken from her pelvis: she was back in work after a couple of days, and the puncture site stopped being tender within a couple of weeks. Even taking into account that my mum is dead 'ard, it didn't seem to be a huge deal.

There's a load more information available from the Anthony Nolan Trust (UK) and Marrow.org (US). The various national registers work very closely together, so they'll have more or less the same information to give you, and it doesn't really matter which one you join. In the US it usually costs $100, although you'll sometimes find it subsidised or free. In most of the rest of the developed world (particularly places with socialised healthcare), it's free. Join!

Basically, if you've ever donated blood you'll be fine with the peripheral blood stem cell method, although you'll want to take a book. If you've ever stubbed a toe you can deal with the discomfort from the pelvic method. Definitely the easiest way to have a crack at saving someone's life.

Especially consider it if you're non-white, and double-especially if you're mixed race. Most non-white people have a much harder time finding matches,* which is compounded by having disproportionately few non-white donors on the registers.

*I've never looked this up to corroborate, but the explanation I was given in a talk about this stuff is that, genetically, white people are pretty dull. There tends to be more diversity of tissue type within non-white populations, so those patients are looking for their needle in a much bigger haystack. Patients of mixed race need to find a match amongst a wider range of possibilities and drawn from a smaller pool of potential donors, so mixed-race donors are particularly needed.
posted by metaBugs at 11:08 AM on October 11, 2011 [1 favorite]

It is a very different proposal to say that there ought to be some bounty for donors to saying that people should be transplanted based upon their ability to pay.

Not when the example being used is a $10,000 bounty for something that apparently doesn't require much more than a couple of hours off work.
posted by Hoopo at 11:08 AM on October 11, 2011

Not when the example being used is a $10,000 bounty for something that apparently doesn't require much more than a couple of hours off work.

Actually, between physicals, doctor visits, the actual donation, and follow up care - it totals up to several days off work. That may not be an issue for you or I, but for a very substantial portion of our country that may well be the difference between donating and not donating.

If you look beyond marrow donation to donating something like a kidney, then the costs are significantly higher.
posted by jason says at 11:16 AM on October 11, 2011

What is more important - keeping things "balanced" for health outcomes between the rich and the poor or increasing the overall health outcome across the board? The wealthy are always going to be able to increase their chances of survival when it comes to health. They go to the best doctors, can afford medicines and treatments that are out of the reach of common people, and can shop around, be it in different countries or different states like Steve Jobs did. Unless you're proposing to do away with capitalism, that's just going to be the way it is.

Our organ donations don't come close to meeting demand. The US is short approximately 60,000 kidneys each year (80,000 are needed). Dialysis and associated treatment is expensive. If a system were set up that would allow 10,000 wealthy people to jump to the front of the line by creating financial incentives for donation that created enough funding that 20,000 additional non-wealthy people to also receive kidneys, would that be a moral victory over the status quo? I think it would be.

http://www.slate.com/articles/business/moneybox/2010/12/the_kidney_trade.html
http://www.npr.org/blogs/health/2010/01/iran_leads_in_innovation_on_or.html
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2322914/
posted by Candleman at 11:21 AM on October 11, 2011 [3 favorites]

Yes, this. My mum has donated by this method; her worst complaint was that it was boring.

Oh my word, was it boring! I thought I might die of boredom, even though I had access to a TV and wifi-internet on my iPod (plus my husband was there to entertain me). I suppose that was the injections talking- after 5 days and 5 shots, you're slightly achy, as though you had the flu.

Especially consider it if you're non-white, and double-especially if you're mixed race. Yes! Let me use this post to make a plug for the organization I registered through, Gift of Life (they feed into the US National and World registries). They do a lot of work adding those of Jewish ethnicity (like me) to the registry- the Holocaust wiped out a lot of blood lines, so the need is especially urgent among this group.
posted by ThePinkSuperhero at 11:31 AM on October 11, 2011 [3 favorites]

it totals up to several days off work.

um, OK. I feel like the goalposts are being moved a bit here (and I'm conflating a bunch of different responses so this isn't directed at you specifically). Sometimes we're talking about something that's akin to giving blood, and it's not like organ donation and we shouldn't get on that slippery slope, but then we're also talking about organ donation being a huge investment and how it's not really like giving blood at all because it takes 3 days off work to do and so we should pay people for it.

To address your point jason says, several days (or weeks for that matter) off work for me would not come anywhere close to $10,000. $10,000 for several days is paying far above and beyond the average American salary and cannot be written off as merely offsetting costs. It's someone with the means buying marrow outright.

keeping things "balanced" for health outcomes between the rich and the poor or increasing the overall health outcome across the board

These things are not mutually exclusive, and I'm not convinced allowing people to buy kidneys would accomplish overall health outcomes across the board. Universally accessible healthcare doesn't mean you have to completely abandon capitalism either, that's a non-starter.
posted by Hoopo at 11:37 AM on October 11, 2011

Slippery slopes, my friends.

Let's not go there at all. Even though I'm sure there are countries where the rich can buy organs, would it be too much to ask that the US possibly lead the way here in saying that it's not acceptable for the poor to be organ banks for the rich? Having a standard fixed amount for payment on organs opens the door for extra payment for 'premium' organs: 2 lungs, non-smoking jogging owner, only breathed pure mountain air. Eventually the courts will cave to the lawyers hired by the rich to defend a "technical" overpayment.

Want more available organs? Pay part of funeral costs of every organ donor, and all of costs for anyone from whom an organ is actually taken. Want more bone marrow? Advertise for donors. I'd be willing to see bone marrow handled on a payment for donation basis, but there is already a million ways in which the plasma donation system is being abused.

Agent Rocket, I believe that donors should be compensated for their medical bills, lost work days, and time. This should be a fixed amount set by law. By law, no employer should be allowed to deny an employee time for donations, and larger companies especially should pay a fixed percentage of the employee's wages--25% maybe? I'm sure companies would be losing out on this, because after all, the people who would do such a thing are obviously work slackers, amirite?

Certainly it would help if this society had an ethic that recognizes selflessness and brotherhood. How many acts of heroism are never acknowledged or recognized by the press? Some people don't want the notoriety, which is fine, but let the world know that we have another generous soul who has made a significant contribution.
posted by BlueHorse at 11:46 AM on October 11, 2011 [1 favorite]

Fizz: "Would it matter if he wasn't offering money but dirt bikes instead?"

Brilliant! Skip the other stuff and just offer free dirt bikes (but no helmets) in exchange for checking the donor option on your driver's license - every organ will be quite plentiful in no time.
posted by idiopath at 11:48 AM on October 11, 2011 [1 favorite]

Hoopo - point well taken. I am not suggesting that 10k should be the goal post. However, I think that a fair compensation structure to cover the costs of donation (or to "encourage" grieving families) would go a long way to increasing the pool of potential donors. I don't really see an ethical issue with create financial incentives to reward a particular behavior. This is certainly not a new concept in US healthcare - and it happens frequently (plans offering movie tickets for well child visits, free car seats if you get your kids immunized, etc).
posted by jason says at 11:50 AM on October 11, 2011 [1 favorite]

It would be nice if he donated the 10k to the foundation to open up the registry for people who wouldn't ordinarily spend the money to be tested to be put on the marrow donation list. When I signed up in college, the drive generated a lot of interest with other college students, but many simply did not have $100 (or iirc, it was $60) to give. If it had been free, I believe many of the same altruistic students who routinely give blood would sign-up, increasing the potential donor pool.

As for the blood donation compensation situation, I work with (but not for) the American Red Cross and it's something we routinely talk about. We organize blood drives on University of Arizona campus and it's tricky about what we can give to presenting donors. It has to be of nominal value, but we also like to give things as a thank you. We've actually had to turn away donations from companies because the item to be distributed was of too great of value. There is also some competition for donors from the nearby plasma place, who pay $20-35 for a bag of plasma, depending on your weight.
posted by lizjohn at 12:13 PM on October 11, 2011

These are real people's lives that could be saved or significantly improved. That's a lot more important than some abstract principle of fairness.

If the only acceptable solution is the creation of a "society had an ethic that recognizes selflessness and brotherhood" then it's hopeless.
posted by The Lamplighter at 12:17 PM on October 11, 2011 [4 favorites]

If a system were set up that would allow 10,000 wealthy people to jump to the front of the line by creating financial incentives for donation that created enough funding that 20,000 additional non-wealthy people to also receive kidneys, would that be a moral victory over the status quo?

If we allowed rich people to purchase their organs directly, then they should also be forced to buy out all of the waiting recipients who are ahead of them in line.
posted by ceribus peribus at 12:18 PM on October 11, 2011

If we allowed rich people to purchase their organs directly, then they should also be forced to buy out all of the waiting recipients who are ahead of them in line.

If the point of the exercise is to greatly increase the number of kidneys available, then your concept fails. Your proposal means that a small number of very wealthy people would get kidneys, ~60,000 people get some amount of money that's not enough to cure them and either continue suffering or die (while costing themselves, their insurance, or the taypayers large amounts of money for dialysis), and a handful of new kidneys would trickle into the pool. Next?
posted by Candleman at 12:26 PM on October 11, 2011

That's a lot more important than some abstract principle of fairness.

There's nothing abstract about it. If I needed marrow I'd die if I had to pay $10,000 for it, because I don't have $10,000.

If the only acceptable solution is the creation of a "society had an ethic that recognizes selflessness and brotherhood" then it's hopeless.

Good thing that's not the only acceptable solution!
posted by Hoopo at 12:27 PM on October 11, 2011

I interperted ceribus peribus' idea as that the rich would have to pay for the organs of each of the people that are ahead of them in line. That I can appreciate, as long as the line is transparent and can't be gamed.
posted by saucysault at 12:28 PM on October 11, 2011 [1 favorite]

One of the biggest issues of communication and pedagogy that advocates in poverty law face is getting across three points which underscore most--if not all--advocacy on issues facing the poor (which, I know, I've said before): "How not to exacerbate and contribute to the depersonalization of the poor families"; "how to recognize ways in which lack of autonomy can demoralize and cripple an individual"; and "What a barrier to decision-making, to self esteem, to self improvement, to basic human dignity poverty is in the U.S."

This last point "poverty is a barrier to decision-making" is part of why selling organs is illegal and, as far as I am concerned, should remain illegal. There is a quantifiable lack of autonomy in the decision to sell your kidney if you are destitute. This lack of decision-autonomy would be exploited in a world where organ-selling is permitted. Even if no-one would be forced to do it in the manner you see in science fiction movies (you know, strapped down, kicking and screaming. or raised in vats or colonies), you are setting up a system which exploits people simply because they have no economic resources and no longer any social reserves. I've yet to see an argument that convinces me this is not wrong.

The difference between someone who needs the money to survive and someone who desires the money to be more comfortable seems really small, when you're the person living on ramen with roommates who doesn't have quite enough room to save for retirement. But it only seems small. It's truly an enormous gap in personal-determination when you are able to feed yourself, as well as your dependents--even if it's cheap food--and able to house yourself--even if it's a shitty apartment with crap roommates--and when you are not.

That said, bone marrow donation does seem, on some level, more like blood plasma or even sperm donation than organ donation. Especially when it's the PBSC process, rather than the other process. I think when you get into the out-patient surgical procedure, you're into egg donation territory, which our society allows money incentives/compensation for. Whether that latter system ($$ for your eggs!) makes people queasy or not, I think the distinction between the various processes is relevant.
posted by crush-onastick at 12:48 PM on October 11, 2011 [14 favorites]

Yes; the idea is they would have to purchase/arrange kidneys for those ahead of them, or take over the full expense of dialysis/healthcare maintenance costs for each person they skip ahead of for the remainder of those person's waiting periods (until they eventually receive the kidney that the rich person was supposed to have waited for). Ideally they would have to receive the same level of care that the rich person would have otherwise afforded themselves during that time.

The point isn't necessarily to increase the number of kidneys available (although that's a welcome side effect if it happens), but to force the rich to subsidize the poor in direct proportion to the benefit being sought taken.
posted by ceribus peribus at 12:48 PM on October 11, 2011 [1 favorite]

Also it seems like the lawsuit is actually geared towards something quite different from the example provided. The Iran case in Candleman's links for example is that the government pays the compensation to donors and there is to be no contact between a the donor and a potential recipient. I can see no reason why a government can't indemnify a donor for lost wages and medical bills if that's what's holding people back from donating kidneys. But creating an organ market with buyers and sellers in direct contact is indeed a slippery slope with what for me and many others are unacceptable outcomes.

The Amit Gupta case is a friend of the recipient offering someone $10,000 for bone marrow. Very different, and not OK as a precedent.
posted by Hoopo at 12:48 PM on October 11, 2011

Why would anyone want this restriction overturned? So only those with means can get organs, and compel those who are poor to give? Sick.
posted by agregoli at 1:05 PM on October 11, 2011

Why would anyone want this restriction overturned?
Frankly, for the same reason that any laws are written: because people with means want it to work that way.

Apologies for answering a rhetorical.
posted by ceribus peribus at 1:10 PM on October 11, 2011 [1 favorite]

I would imagine the cost of maintaining a patient on a long-term waiting list costs a great deal of money, in one way or another, that's spread throughout the society via higher insurance premiums or higher taxes/less spending elsewhere.

If you took 50% of that money and used it to incentivise organ/blood/marrow donation, then society as a whole is better off-- less sick people (who can now be productive) and more money available for preventative medical care.

So how about a monthly lottery, where everyone who has ever donated, automatically gets a ticket, each month a big multi-million dollar winner, regular news reports of "I did a simple, great thing when I donated my marrow! This feels like amazing karma!"
posted by Static Vagabond at 1:15 PM on October 11, 2011

Seconding metabugs comment above.

I've joined Be The Match through Marrow.org, and while they request a donation it is not required so there is really not any reason not to join.
posted by pianomover at 1:28 PM on October 11, 2011

Well, we Guptas do have the rep for always being on the look out for a good deal
posted by infini at 1:54 PM on October 11, 2011

People have died donating bone marrow and stem cells, even just this year. It is a very safe procedure, but not risk free.
It is not a good idea to pay people to take a risk they would not take otherwise.
posted by SLC Mom at 3:03 PM on October 11, 2011

Well duh. You just institute universal healthcare alongside comprehensive, publicly-funded social and employment insurance, then have the government guarantee priority medical treatment for donors as needed and some standardized compensation for lost wages. There's nothing wrong with paying donors back for their time; it's letting transplant recipients set the terms of compensation that's abhorrent and exploitative.

Or something. None of the organizations involved want anything to do with old faggy-bones here and his homo-marrow (or blood, or organs), so I've never given the issue that much thought.
posted by wreckingball at 3:17 PM on October 11, 2011

Seems to me that the easiest way to prevent the sorts of abuses we're all worried about is to simply change the law to specifically prohibit monetary remuneration for body parts that are non-replenishable, like organs. Everything else is fair game.
posted by Civil_Disobedient at 3:18 PM on October 11, 2011

So, take that money, and reward everyone who joins the donor registry, saving not 1 life, but potentially many.

I like knowing that some things can't be (as blatantly) bought.
posted by theora55 at 3:35 PM on October 11, 2011

Why would anyone want this restriction overturned? So only those with means can get organs, and compel those who are poor to give? Sick.

For the reasons I stated above, I want it overturned and I promise you I am not someone with means.

Increasing the organ donation pool can only be a good thing. It means less competition for the "free" cadaver organs and family donations will be as available as they always are. They aren't free either, but the costs aren't as strictly monetary.

People with money would be getting organs that otherwise aren't available at all. People against compensation are dogs guarding the hay- I can't have it, so you shouldn't be able to either.

And, actually, I don't see organ donation as any worse than a lot of other exploitation by the rich. Poor people shouldn't be "organ banks?" Well, I suppose we shouldn't be pack horses, carrier pigeons, or beavers, or whatever other derogatory thing you come up with for different services, either, but we are. I would rather donate marrow than pick strawberries or even stand at a register for 9 hours a day, and that doesn't even touch the things like surrogate motherhood or donating eggs.
posted by small_ruminant at 3:46 PM on October 11, 2011 [2 favorites]

What is the difference between bone marrow and an egg? Don't people pay good dough for egg donations all the time in all 50 states?
posted by bukvich at 3:52 PM on October 11, 2011

This article suggests 10 000 $ is the going rate for "desired" eggs. The bone marrow recipient needs it to save his life and the egg recipient does not need it at all.

Does not compute.
posted by bukvich at 4:00 PM on October 11, 2011

Well, there's a olde ethical discussion. And no mention of Peter Singer yet?

His nutshell argument:

To those who argue that legalizing organ sales would help the poor, Nancy Scheper-Hughes, founder of Organ Watch, pointedly replies: "Perhaps we should look for better ways of helping the destitute than dismantling them."

No doubt we should, but we don't.

and interestingly

To seek an answer, we can turn to a country that we do not usually think of as a leader in either market deregulation or social experimentation: Iran. Since 1988, Iran has had a government-funded, regulated system for purchasing kidneys. A charitable association of patients arranges the transaction, for a set price, and no one except the seller profits from it.

According to a study published in 2006 by Iranian kidney specialists, the scheme has eliminated the waiting list for kidneys in that country, without giving rise to ethical problems.

ymmv
posted by mrgrimm at 4:23 PM on October 11, 2011

There's nothing wrong with paying donors back for their time; it's letting transplant recipients set the terms of compensation that's abhorrent and exploitative.

I'm having a hard time from the tone of your comment determining if you're serious or not, but that actually sounds completely reasonable to me.
posted by Hoopo at 5:05 PM on October 11, 2011

What do people think would be a better incentive: $10k for the matching donor, or $10 to each person who gets tested? Or even $20 if they are of SE Asian descent.

A guaranteed $10 vs. a chance to "win" $10K? No question, the $10k. Of course, that might only work to motivate those who think they have a chance to match the patient (i.e. those from their ethnic/racial group).
posted by ThePinkSuperhero at 6:32 PM on October 11, 2011

People have died donating bone marrow and stem cells, even just this year.

While I am well aware of the risks in any medical procedure, I am surprised to hear this; do you have more details?
posted by TedW at 6:34 PM on October 11, 2011

Well, there's a olde ethical discussion. And no mention of Peter Singer yet?

I'll see your Singer and raise you a Caplan.

Both are required reading in this and many other areas of medical ethics. While fairness is a laudable goal, the current system falls short in many ways; wealthy folks can game the system as noted above (insert favorite liver transplant recipient here), donors do not get compensated for their true costs (there is a similar argument to be made for volunteers for medical research), and in the US health care is too fragmented to address these problems in a systemic, rational way.

The money shouldn't be coming from the recipient though. No one should be taking a financial loss for donating, but it's the potential to profit...
Therein lies there rub. There are huge number of people involved in even a "routine" transplant: not just physicians and nurses but social workers, lab techs, administrative assistants, transporters, even communications specialists (who do you think provides the pagers recipients have so they can be contacted in case of a match? And if they are school kids, who pays to argue with the school board that an exception to the no pager rule should be made?) None of these people are expected to work for free (although the healthcare system may not be reimbursed for a particular patient or may not pursue reimbursement as a matter of corporate charity) but the donor is. It reminds me of big time college football and basketball. It seems the best option is a comprehensive social safety net (universal healthcare and welfare) with a presumed consent law, but what are the odds of that happening in the US any time soon.
posted by TedW at 7:14 PM on October 11, 2011 [1 favorite]

To those who argue that legalizing organ sales would help the poor, Nancy Scheper-Hughes, founder of Organ Watch, pointedly replies: "Perhaps we should look for better ways of helping the destitute than dismantling them."

No doubt we should, but we don't.

Using Singer's arguments as more real-world practical solutions a universal healthcare system and an as-needed-basis waiting list is nuts--the man advocates infanticide and treating livestock better than people in vegetative states, which are 2 of the least likely things I could ever see America embracing. Remember how the US reacted to Terry Schiavo? Or abortion? Imagine how they'd react to killing babies with spina bifida. You know, to reduce suffering and increase overall happiness. Sounds crazy, right? That's Peter Singer's "practical" ethics. I'm not going to say he doesn't make cogent arguments from his own weird utilitarian ethical framework, but by forwarding these positions he's either playing devil's advocate or else he's very selective in presenting things "we don't" do.

But allowing the rich to buy poor peoples' organs is a great solution where everyone wins? I cannot accept a world where organs are considered commodities or financial assets. I mean, if that's how we're looking at it why not let people to put up their kidneys as collateral for a loan, and if they defaulted the bank could claim their organs. One day it will be totally normal, and when a housing bubble bursts we'll be rolling in kidneys!
posted by Hoopo at 11:38 PM on October 11, 2011

Using Singer's arguments as more real-world practical solutions THAN a universal healthcare system and an as-needed-basis waiting list

I suck at writing
posted by Hoopo at 11:39 PM on October 11, 2011

The wealthy will always have ways of getting around the law.

While I know it's slightly off the topic, when people mention slippery slopes I can't help thinking about organ donation. I know many surgeons here in the UK are distinctly uncomfortable at the increase in medical tourism for organ transplant to poorer countries. Many of these wealthy medical tourists come back to the UK and insist on having their aftercare in the public sector (which they are perfectly entitled to do) despite the fact that the surgeon/team providing said aftercare is not furnished with any details of the operation or immediate post-op care. Interestingly they do come furnished with a detailed list of their pharmaceutical needs and needless to say none of them are generics.

What's even more worrying is when a trainee recently asked if there was a point in doing an audit relating to the ongoing costs to the health service of this type of medical tourism he was told it might be "sensitive" as the majority engaged in this are from a ethnic minorities. There are ongoing rumblings in the press every so often.

Shimazono has calculated that renal "transplant packages" cost between $70k-$160kUS, and there is a lot of research about 71% of donors in less developed countries are below the poverty line and massively a) female and b) paying off a debt.

Other research shows that they don't significantly benefit in the long term from their donation.
Loads on info on Wiki, obviously but here's a blog entry that discusses the various studies.
posted by Wilder at 1:03 AM on October 12, 2011

Time off and tax credit legislation for living donors in the US.
posted by dhartung at 1:41 AM on October 12, 2011