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NMDP statement opposing the Ninth Circuit Court Ruling on PBSC Donor Compensation.

The National Marrow Donor Program (NMDP) issued a statement that opposes the December 1, Ninth Circuit Court ruling regarding compensation of certain marrow donors under the National Organ Transplant Act of1984 (NOTA). The NMDP specifically criticized the court's ruling to allow compensation for peripheral blood stem cell (PBSC) donations, citing patient and donor safety, the inability of a physician to provide quality care and the potential costs to the health care system.

The 1984 act bans compensation for donation of human body parts for transplantation, including solid

organs and bone marrow. While the court ruling upholds the ban on compensation for the traditional method of bone marrow donation, it legalizes compensation for peripheral blood stem donations.

"The NMDP strongly objects to the rationale and conclusion of the court regarding compensation for

PBSC donation," said Michael Boo, NMDP chief strategy officer. "The result of this opinion could have unexpected and disastrous consequences for patients in need ofa transplant in the U.S., far beyond the jurisdiction of the Ninth Circuit. It will create an expectation of compensation, which will interfere in the clinical decision of what is best for the patient, may result in actions by donors that raise concerns about the safety and quality of each donation and will significantly increase the cost of transplantation, among other concerns."

Approximately 5,000 people each year in the U.S. receive stem cells as a result of a marrow transplant from an unrelated donor to treat a number of diseases, including leukemia and lymphoma. Two techniques are used to extract the marrow. The first, aspiration, draws marrow from the hip bone of the donor. The second technique, apheresis, extracts PBSCs from the blood through a machine after a drug mobilizes the stems cells to leave the marrow cavity and enter the blood stream. The court ruled that NOTA clearly bans compensation for extraction of marrow through aspiration, but also ruled that the law does not ban compensation for the extraction of PBSCs through apheresis.

In its arguments, the plaintiffs in the case suggested that aspiration donation may not be necessary in the future. However, according to the NMDP's research, the use of aspiration has increased each year for the last five years.

"The decision of whether the donation occurs through aspiration or apheresis should be based on the best clinical judgment of the patient's physician, and will vary from patient to patient," said Boo. "While the donor always has the last say on whether and how to donate, apheresis may not be in the best interests of the patient in many cases. Allowing compensation for one type of donation method could compromise patient decisions."

The NMDP also noted that the reasons for the prohibition against compensation in general are well documented, and include concerns regarding the safety and quality of the donation, the impact on the many potential donors who joined the Be The Match Registry[R] out of the sense of community altruism, and the additional cost this will add to the health care system.

"Our experience and research show that a donor system that relies on the human desire to help others is far superior to one that focuses on self-gain," said Boo.

As operator of the Be The Match Registry, the world's largest listing of potential adult marrow donors, the NMDP has no intention of changing its current policy against compensation.
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Publication:Transplant News
Date:Dec 1, 2011
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