So, my Taboo Trades class has finished blood and is now moving on to bone marrow. To celebrate the occasion, I’ll be posting some thoughts, links to Flynn V. Holder, which held that the National Organ Transplant Act did not prohibit payments to certain bone marrow donors, and miscellaneous entertaining stuff my students brought in this week. I’m starting with the cartoon below, courtesy of Duke Law 3L,Benjamin Wood:
Of course, giving bone marrow isn’t the task it once was, a point made clear in Flynn v. Holder. There are two methods of donation: peripheral blood stem cells (PBSC) and bone marrow aspiration. According to the Court:
Until about twenty years ago, bone marrow was extracted from donors’ bones by “aspiration.” Long needles, thick enough to suck out the soft, fatty marrow, were inserted into the cavities of the anesthetized donor’s hip bones. These are large bones with big central cavities full of marrow. Aspiration is a painful, unpleasant procedure for the donor. It requires hospitalization and general or local anesthesia, and involves commensurate risks.
See this video from marrow.org, the National Marrow Donor Program, on traditional bone marrow donation.
However, according to the Court, in a new technique, now used for at least two-thirds of bone marrow transplants, none of the soft, fatty marrow is actually donated. This new bone marrow donation technique, developed during the past twenty years, is called “peripheral blood stem cell apheresis.” This procedure begins with five days of injections of a medication called a “granulocyte colony-stimulating factor” into the donor’s blood. The medication accelerates blood stem cell production in the mar- row, so that more stem cells go into the bloodstream. Then, with no need for sedatives or anesthesia, a needle is inserted into the donor’s vein. Blood is withdrawn from the vein and filtered through an apheresis machine to extract the blood stem cells. The remaining components of the blood are returned to the donor’s vein. The blood stem cells extracted in the apheresis method are replaced by the donor’s bone mar- row in three to six weeks. Complications for the donor are exceedingly rare.
See this video from marrow.org, the National Marrow Donor Program, on peripheral blood stem cell apheresis.
I'll be back with more later on why this distinction matters to the question of paying bone marrow donors.