ILNews

Dollars for donors

Back to TopCommentsE-mailPrintBookmark and Share
Indiana Lawyer Focus

More than 9 million people in the United States and about 19 million worldwide are registered as bone marrow donors. Yet, doctors sometimes struggle to find donors compatible with their patients. About 70 percent of people who need a bone marrow transplant don’t have a compatible donor in their extended family, according to the National Marrow Donor Program.

A nonprofit corporation has proposed that offering financial incentives for bone marrow donors may lead to an increase in donations. But bone marrow is a human organ, as defined by the National Organ Transplant Act, and that means marrow – like other human organs – cannot be sold.

A recent court decision, however, has opened the door for financial compensation of marrow donors and left many people wondering what the legal, medical and ethical implications may be.

Developments in medicine, law

Doctors used to harvest marrow primarily by aspiration – using a needle to draw marrow directly from the donor’s bone. While that method is still in use today, about 20 years ago peripheral blood stem cell apheresis was introduced allowing doctors to stimulate the production of peripheral blood stem cells in the bloodstream and extract them with a machine that filters the cells out of the blood.

MoreMarrowDonors.org argued in its complaint against United States Attorney General Eric Holder that the ban on bone marrow extraction was a

violation of the Equal Protection Clause. The nonprofit contended that bone marrow extraction is not materially different from blood donation or the harvesting of a human ovum – both of which are legal. The corporation argued that it should be permitted to offer $3,000 in incentives for marrow donors, in the form of housing allowances, scholarships and donations to the donor’s favorite charity, if a donor signed up for and followed through with marrow donation.

The 9th Circuit rejected the Equal Protection Clause claim. But, the court did agree that PBSCs cannot be classified as an organ, as defined by NOTA.

Holder has since filed a petition for an en banc review of that decision.

The debate

Jennifer Girod, attorney for Hall Render Killian Heath & Lyman, was a nurse and assistant professor of bioethics before she attended law school. She said her interpretation of NOTA is that it intended to prevent a market for human organs. And while supporters of the 9th Circuit opinion have argued that NOTA, enacted in 1984, could not have predicted the process of peripheral stem cell apheresis, amendments to the act in the past decade have.

“(Holder) is saying Congress knows what bone marrow is, and they may not have explicitly said it when they passed NOTA, but they did say it when they passed the amendments,” she said. “It doesn’t seem to matter at all that this is a less dangerous procedure, or less painful, or similar to blood donation. It just matters whether Congress intended to prevent a market.”

bone marrowFred Cate, co-director of the Center for Law, Ethics and Applied Research in Health Information for the Indiana University Maurer School of Law, sees a subtle distinction between financial incentives and direct payment with regard to organ donation.

“Compensation rarely means I’ll give you $25,000 for a kidney. It’s rather the thought of modest financial incentives and recognizing that everyone is getting paid for this, why can’t I,” he said, in reference to the high cost of medical care.

Cate is licensed to practice in the 9th Circuit, and he thinks the court’s decision in Flynn could be a sign of progress.

“I have the greatest respect for the attorney general, but I think he’s dead wrong on this issue,” Cate said.

Cate doesn’t see how compensating bone marrow donors could ultimately result in a black market for organ peddling.

“I don’t buy it as a justification for not paying. There’s always going to be wrongdoing and for perfectly good reason. If you were watching a loved one die, you too would say, can I buy an organ? Can I go to Mexico? Can I go to China? Can I save my mother?” Cate said. “I think you can say we’re going to regulate a market – just like we do with pharmaceuticals – to protect vulnerable and ill people from being taken advantage of.”

The National Marrow Donor Program, which oversees the world’s largest donor-matching program, said Holder’s argument is that if the court’s decision about compensation stands, it will create a potential for serious health risks to patients and donors. The NMDP is not a party in the suit but supports Holder’s appeal.

;were we worried about nothing? Should we try this with solid organs?’”


Risks and rewards

The NMDP reports that about 76 percent of the time a patient’s doctor requests a PBSC donation, and about 24 percent of the time a patient’s doctor requests a marrow donation. But Dr. Paul Haut, chief medical officer for Riley Hospital for Children at Indiana University Health and director of its pediatric stem cell transplant program, said whether one method of marrow donation is better than the other is a difficult question to answer.



“Peripheral stem cells have become more popular over time. It is generally safe,” he said. “A lot of donors would rather do that than harvest. The cells that you collect that way tend to grow back faster.”

But in pediatrics, Haut said, research suggests that PBSCs may be more likely to cause graft-versus-host disease, when transplanted stem cells attack the patient’s body.

Recent research suggests a similar pattern may be occurring in adults.

“It may be that in the next few years we see the pendulum swinging back” toward a preference for marrow aspiration, he added.

“The implication from this lawsuit in part is about the donors, but primarily it’s about making the best choice for my patient,” he said. Haut wonders if offering compensation for PBSC donation could cause fewer people to donate by aspiration. If so, Haut may have even more difficulty in finding a good match for his pediatric patients.

The process

For four or five days preceding PBSC donation, donors receive injections to stimulate the production of stem cells. In rare occasions, this medicine can cause the body to produce too many white blood cells too quickly, which can increase the risk of stroke or cause the spleen to rupture, Haut said.

“Ninety-nine percent of the time, it goes fine,” he said. “But it’s definitely not like going to donate blood, where you get hooked up to an IV, and an hour later you walk out with a cookie and juice.”

PBSC donation may offer quicker recovery time for patients. Aspiration generally requires patients to be off work for about a week as the body works to restore its own stem cells.

Unknown outcomes

“Having people die or living lower-quality lives when we could improve the quality of their lives if only we had an organ is a big issue,” Cate said. “These are very longstanding fights, and they are often waged by people of enormous goodwill on both sides, and I guess that’s why I don’t understand why the attorney general would be getting involved in this case.”

Cate thinks that an issue of statutory interpretation would be more appropriately addressed by Congress, the Department of Health and Human Services, and individual states.

Girod said that one of the traditional arguments against compensation for organ donation is that the process must be voluntary. And Haut said that in compensated blood donation, people have been dishonest about medical conditions that would make them ineligible to donate blood, so he could see that being a problem in compensated marrow donation, too.

If the 9th Circuit’s decision stands, it may lead to a new way of thinking, Girod said.

“So far, people have been making proposals that we pay people for kidney donations for 30 years or more, and there’s just tremendous resistance to it because nobody knows what it’s going to do to the voluntary market,” she said. “But I think people might be willing to see how it plays out in the bone marrow transplant context and say, were we worried about nothing? Should we try this with solid organs?

ADVERTISEMENT

Post a comment to this story

COMMENTS POLICY
We reserve the right to remove any post that we feel is obscene, profane, vulgar, racist, sexually explicit, abusive, or hateful.
 
You are legally responsible for what you post and your anonymity is not guaranteed.
 
Posts that insult, defame, threaten, harass or abuse other readers or people mentioned in Indiana Lawyer editorial content are also subject to removal. Please respect the privacy of individuals and refrain from posting personal information.
 
No solicitations, spamming or advertisements are allowed. Readers may post links to other informational websites that are relevant to the topic at hand, but please do not link to objectionable material.
 
We may remove messages that are unrelated to the topic, encourage illegal activity, use all capital letters or are unreadable.
 

Messages that are flagged by readers as objectionable will be reviewed and may or may not be removed. Please do not flag a post simply because you disagree with it.

Sponsored by
ADVERTISEMENT
Subscribe to Indiana Lawyer
  1. California Sex Offender Management Board (CASOMB) End of Year Report 2014. (page 13) Under the current system many local registering agencies are challenged just keeping up with registration paperwork. It takes an hour or more to process each registrant, the majority of whom are low risk offenders. As a result law enforcement cannot monitor higher risk offenders more intensively in the community due to the sheer numbers on the registry. Some of the consequences of lengthy and unnecessary registration requirements actually destabilize the life’s of registrants and those -such as families- whose lives are often substantially impacted. Such consequences are thought to raise levels of known risk factors while providing no discernible benefit in terms of community safety. The full report is available online at. http://www.casomb.org/index.cfm?pid=231 National Institute of Justice (NIJ) US Department of Justice Office of Justice Programs United States of America. The overall conclusion is that Megan’s law has had no demonstrated effect on sexual offenses in New Jersey, calling into question the justification for start-up and operational costs. Megan’s Law has had no effect on time to first rearrest for known sex offenders and has not reduced sexual reoffending. Neither has it had an impact on the type of sexual reoffense or first-time sexual offense. The study also found that the law had not reduced the number of victims of sexual offenses. The full report is available online at. https://www.ncjrs.gov/app/publications/abstract.aspx? ID=247350 The University of Chicago Press for The Booth School of Business of the University of Chicago and The University of Chicago Law School Article DOI: 10.1086/658483 Conclusion. The data in these three data sets do not strongly support the effectiveness of sex offender registries. The national panel data do not show a significant decrease in the rate of rape or the arrest rate for sexual abuse after implementation of a registry via the Internet. The BJS data that tracked individual sex offenders after their release in 1994 did not show that registration had a significantly negative effect on recidivism. And the D.C. crime data do not show that knowing the location of sex offenders by census block can help protect the locations of sexual abuse. This pattern of noneffectiveness across the data sets does not support the conclusion that sex offender registries are successful in meeting their objectives of increasing public safety and lowering recidivism rates. The full report is available online at. http://www.jstor.org/stable/full/10.1086/658483 These are not isolated conclusions but are the same outcomes in the majority of conclusions and reports on this subject from multiple government agencies and throughout the academic community. People, including the media and other organizations should not rely on and reiterate the statements and opinions of the legislators or other people as to the need for these laws because of the high recidivism rates and the high risk offenders pose to the public which simply is not true and is pure hyperbole and fiction. They should rely on facts and data collected and submitted in reports from the leading authorities and credible experts in the fields such as the following. California Sex Offender Management Board (CASOMB) Sex offender recidivism rate for a new sex offense is 0.8% (page 30) The full report is available online at http://www.cdcr.ca.gov/Adult_Research_Branch/Research_Documents/2014_Outcome_Evaluation_Report_7-6-2015.pdf California Sex Offender Management Board (CASOMB) (page 38) Sex offender recidivism rate for a new sex offense is 1.8% The full report is available online at. http://www.google.com/url?sa= t&source=web&cd=1&ved= 0CCEQFjAA&url=http%3A%2F% 2Fwww.cdcr.ca.gov%2FAdult_ Research_Branch%2FResearch_ documents%2FOutcome_ evaluation_Report_2013.pdf&ei= C9dSVePNF8HfoATX-IBo&usg=AFQjCNE9I6ueHz-o2mZUnuxLPTyiRdjDsQ Bureau of Justice Statistics 5 PERCENT OF SEX OFFENDERS REARRESTED FOR ANOTHER SEX CRIME WITHIN 3 YEARS OF PRISON RELEASE WASHINGTON, D.C. Within 3 years following their 1994 state prison release, 5.3 percent of sex offenders (men who had committed rape or sexual assault) were rearrested for another sex crime, the Justice Department’s Bureau of Justice Statistics (BJS) announced today. The full report is available online at. http://www.bjs.gov/content/pub/press/rsorp94pr.cfm Document title; A Model of Static and Dynamic Sex Offender Risk Assessment Author: Robert J. McGrath, Michael P. Lasher, Georgia F. Cumming Document No.: 236217 Date Received: October 2011 Award Number: 2008-DD-BX-0013 Findings: Study of 759 adult male offenders under community supervision Re-arrest rate: 4.6% after 3-year follow-up The sexual re-offense rates for the 746 released in 2005 are much lower than what many in the public have been led to expect or believe. These low re-offense rates appear to contradict a conventional wisdom that sex offenders have very high sexual re-offense rates. The full report is available online at. https://www.ncjrs.gov/pdffiles1/nij/grants/236217.pdf Document Title: SEX OFFENDER SENTENCING IN WASHINGTON STATE: RECIDIVISM RATES BY: Washington State Institute For Public Policy. A study of 4,091 sex offenders either released from prison or community supervision form 1994 to 1998 and examined for 5 years Findings: Sex Crime Recidivism Rate: 2.7% Link to Report: http://www.oncefallen.com/files/Washington_SO_Recid_2005.pdf Document Title: Indiana’s Recidivism Rates Decline for Third Consecutive Year BY: Indiana Department of Correction 2009. The recidivism rate for sex offenders returning on a new sex offense was 1.05%, one of the lowest in the nation. In a time when sex offenders continue to face additional post-release requirements that often result in their return to prison for violating technical rules such as registration and residency restrictions, the instances of sex offenders returning to prison due to the commitment of a new sex crime is extremely low. Findings: sex offenders returning on a new sex offense was 1.05% Link to Report: http://www.in.gov/idoc/files/RecidivismRelease.pdf Once again, These are not isolated conclusions but are the same outcomes in the majority of reports on this subject from multiple government agencies and throughout the academic community. No one can doubt that child sexual abuse is traumatic and devastating. The question is not whether the state has an interest in preventing such harm, but whether current laws are effective in doing so. Megan’s law is a failure and is destroying families and their children’s lives and is costing tax payers millions upon millions of dollars. The following is just one example of the estimated cost just to implement SORNA which many states refused to do. From Justice Policy Institute. Estimated cost to implement SORNA Here are some of the estimates made in 2009 expressed in 2014 current dollars: California, $66M; Florida, $34M; Illinois, $24M; New York, $35M; Pennsylvania, $22M; Texas, $44M. In 2014 dollars, Virginia’s estimate for implementation was $14M, and the annual operating cost after that would be $10M. For the US, the total is $547M. That’s over half a billion dollars – every year – for something that doesn’t work. http://www.justicepolicy.org/images/upload/08-08_FAC_SORNACosts_JJ.pdf. Attempting to use under-reporting to justify the existence of the registry is another myth, or a lie. This is another form of misinformation perpetrated by those who either have a fiduciary interest in continuing the unconstitutional treatment of a disfavored group or are seeking to justify their need for punishment for people who have already paid for their crime by loss of their freedom through incarceration and are now attempting to reenter society as honest citizens. When this information is placed into the public’s attention by naive media then you have to wonder if the media also falls into one of these two groups that are not truly interested in reporting the truth. Both of these groups of people that have that type of mentality can be classified as vigilantes, bullies, or sociopaths, and are responsible for the destruction of our constitutional values and the erosion of personal freedoms in this country. I think the media or other organizations need to do a in depth investigation into the false assumptions and false data that has been used to further these laws and to research all the collateral damages being caused by these laws and the unconstitutional injustices that are occurring across the country. They should include these injustices in their report so the public can be better informed on what is truly happening in this country on this subject. Thank you for your time.

  2. Freedom as granted in the Constitution cannot be summarily disallowed without Due Process. Unable to to to the gym, church, bowling alley? What is this 1984 level nonsense? Congrats to Brian for having the courage to say that this was enough! and Congrats to the ACLU on the win!

  3. America's hyper-phobia about convicted sex offenders must end! Politicians must stop pandering to knee-jerk public hysteria. And the public needs to learn the facts. Research by the California Sex Offender Management Board as shown a recidivism rate for convicted sex offenders of less than 1%. Less than 1%! Furthermore, research shows that by year 17 after their conviction, a convicted sex offender is no more likely to commit a new sex offense than any other member of the public. Put away your torches and pitchforks. Get the facts. Stop hysteria.

  4. He was convicted 23 years ago. How old was he then? He probably was a juvenile. People do stupid things, especially before their brain is fully developed. Why are we continuing to punish him in 2016? If he hasn't re-offended by now, it's very, very unlikely he ever will. He paid for his mistake sufficiently. Let him live his life in peace.

  5. This year, Notre Dame actually enrolled an equal amount of male and female students.

ADVERTISEMENT