Science

Yes, You Tend to Get More of Something When You Pay For It: Bone Marrow Edition

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John Wagner, in the L.A. Times, rebels against the paper's own terribly dumb wisdom regarding compensation for bone marrow donors:

As a bone-marrow transplant specialist who is continuously faced with finding suitable donors for many children with deadly illnesses such as relapsed leukemia, my task is to leave no stone unturned. All too often, donors back out or are not available at the time they are needed. Unless recent updates suggest otherwise, prior reports from marrow donor registries have documented a 30% attrition rate, a persistent problem despite intensive efforts in donor education and awareness…..

The way the proposed [compensation] program would work is simple: Potential marrow donors would sign up with a nonprofit group, MoreMarrowDonors.org, at the time they register. Then, if called on to donate because the tissue type matches a patient's (which could be months or years after registering, if ever), the donor would be entitled to either a $3,000 college scholarship, a $3,000 housing allowance or a $3,000 payment to the charity of his or her choice as compensation. 

The hope is that these modest payments would encourage more people to sign up and follow through with the marrow collection at the time requested should a patient need their lifesaving marrow. The funds for the compensation would come from charitable giving. Wealth or influence wouldn't matter, as we "choose" the donor on the basis of genetic type, rather than the donor "choosing" simply to make a random donation for money.

Contra Dr. Wagner, we should also absolutely make it legal to make "random donation[s] for money" as well, for all the same reasons.

Now, federal law prevents us from considering the option of compensation, which promises to at least reduce the number of donors—currently about one-third—who aren't available when we need them. As an advocate for our patients, I believe we should consider all options for overcoming this major obstacle, which all donor registries have tried unsuccessfully to address for decades.

When the ban was proposed, lawmakers didn't consider the fact that we actually choose the donor, that the "organ"—bone marrow—regenerates itself, or the relative ease of extraction. Comparing this to selling a kidney is foolish.

Again, contra Dr. Wagner's attempts to seem "reasonable" with unreasonable people, we should allow kidney sales, again for all the same reasons, as Ron Bailey explained here at Reason back in 2001.

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36 responses to “Yes, You Tend to Get More of Something When You Pay For It: Bone Marrow Edition

  1. One wonders how many pro-choice people are also inexplicably against making cash for organs legal. I guess a little consistency of opinion is too much to ask for these days.

    1. I guess a little consistency of opinion is too much to ask for these days.

      There is. It’s called being an egg donor. For money even! TEH HORROR!

  2. Ive thought organ donations should be paid for by one of two models:

    1. You agree to organ donation on your death and get paid today based on actuarial tables.

    2. On death, your estate gets paid for organs.

    In case #2, only healthy donors would get money, but would get more. In case #1, nearly everyone could get a little bit of money now, based on probability of them dying with healthy organs.

    Of course, neither of these applies to blood/plasma/marrow donations, which regenerate.

    Why do plasma/sperm donors get paid and blood/marrow donors dont?

    1. Fertility is still mostly out-of-pocket. As long as insurance companies kept organ selling illegal, they don’t have to pay for it.

    2. Why do plasma/sperm donors get paid and blood/marrow donors dont?

      One major reason is because the degree of liability is insanely high versus the liability of donating plasma or blood. Blood use is pretty straightforward (infusion) and whole blood has both a short shelf life with limited research potential, whereas plasma has a number of uses, research applications and the shelf life is considerably longer. Plasma is the more valuable commodity as is sperm, for the same reasons as plasma.

      The odds of dying from donating blood are pretty infintessimal, whereas dying from the process of donating marrow is much higher. Because of this higher overhead from FDA regulation, even if organ donation was legal, would make the cost of donation for profit prohibitive. Enter in the obvious shrill protests of “profiting from the poor people having to give up a kidney to feed their families, like in India and Bumfuckistan” with copious amounts of Huxley references makes it difficult to engage in this very legitimate form of commerce.

    3. because my tiger adonis sperm is da bomb!

      1. Winning.

  3. Liberals are inconsistent, if they oppose the selling of organs why do they allow women to sell their eggs, become surrogate mothers, and men to sell their sperm?

    People are dying while waiting for donors, if they had the choice of buying their organs right now most of them would take it.

    300 New Yorkers protest hearings on US Muslims.
    http://libertarians4freedom.bl…..on-us.html

    1. How was this article about liberals?

  4. In college I knew a hemophiliac. If they had the same laws regarding blood / plasma donation as they do with bone marrow, she probably would have died as a child.

  5. Why don’t we just make a law that everyone has to donate marrow?

    That’s the egalitarian thing to do.

    We can add that to obamacare while we are tinkering with it.

  6. Marrow should be treated as a fluid donation but a kidney, involves the removal of an organ and has serious consequences

    Incentivizing body part donation will lead to abuse. I has already has had serious health consequences for third world countries.

    1. Apparently your brain was removed while you were visiting Somalia…

    2. I have an ear I’m not using. Any bids?

    3. Well, yeah, it could and probably would lead to some abuse. What doesn’t. The fact is everyone in the whole chain of individuals involved in organ transplantation gets compensated, with the sole exception of the person supply to one irreplaceable component – the organ. You are supposed to be all noble and altruistic and donate your organs, yet everyone else involved would not be involved without compensation. The hospitals, the Doctors and nurses, to organ procurers and so on all get compensated for their contribution and will do nothing without that compensation. The organ donor gets to feel generous. You always hear these arguments about the horrors that would ensue if you leave things to the market. This is a tack intended to protect the interests of those who benefit from the way things are. Can imagine if doctors and hospitals and such were required to donate their services in life and death situations. How long do you suppose that would last? But, somehow, it is considered obscene to expect some compensation for donating what is priceless.

  7. “My body; my choice”…. except for:
    drugs
    prostitution
    selling organs
    suicide

    **Feel free to add to the list.

    1. Fried foods.

      1. that is becoming more and more a reality in some parts of the country.

    2. Corn syrup, caffeine (a drug?)

    3. I’ve had many an argument with lefties about their adhereance to the ‘my body’ meme, and it’s always fun to watch them scramble when I argue that that encompasses everything someone wants to do with their bodies.

      1. Tell them that the right to privacy covers my wallet.

  8. Something interesting that I recently learned: In order to be on a transplant list, you have to be able to get to the transplant center within a certain amount of time from when an organ becomes available. Therefore someone with access to a private jet an helichopter (like Steve Jobs) can be on more transplant lists than your average Steve, and hence more likely to recieve a transplant. The rich are already favored in today’s no-payment transplant model.

    1. Hmm, the organ comes to you.

    2. My uncle is on the list for a lung transplant and he had to move from L.A. to Cleveland. You’d think it would be cheaper to live in Ohio than in the hills of Los Angeles, but to be close to the Cleveland Clinic for an indeterminate amount of time costs more money than I’ll ever see in a lifetime. Not to mention the cost of all the daily home care he needs while he’s waiting.

      He’s needed a lung for a long time now, but his health wasn’t bad enough to even get him close to being on a list. People in need of organs pay for a long time before they even spend a dime.

      1. He chose the Cleveland clinic for care. L.A. hospitals do lung transplants.

        1. Go fuck yourself, you hateful cunt.

            1. Another Phil, don’t call Jess a cunt!

              I’ve always wanted to ask if you ever call a woman a loving cunt 😉

  9. The wealthy cheat by paying off their physician to say they will die immediately without a transplant, and they get bumped ahead.

    The other way is to become a Japanese Yakuza http://articles.latimes.com/20…../me-ucla30

  10. It’s actually very interesting that this topic came up because I am doing some grade entering for a class debate on ethics in healthcare. A few of the debates have been on whether or not physicians can deny futile care to patients. I see it both ways, but either way comes down to money. Ultimately it is the patient’s decision on whether or not they want to continue living, and as long as that patient is capable of paying for treatment either through insurance or payment plans then the doctor should not be able to deny treatment. It is only in the case of not being able to afford it should the doctor be able to deny treatment, but that seems like a minor step to overcome if you incorporate various plans of cost coverage, which would be up to the hospital, etc.

    At least in this class, it seems most people were swayed by the argument that doctors know best, and therefore should be able to deny treatment. (In another class the reverse side one). Patient autonomy should be number one, however, and after that the doctor moves to an advisory role. But doctors, nor committees, panels, boards, etc. should not be able to make the decision on who gets treatment provided the treatment can be paid for.

    1. well, it should always reside with the patient. It’s his/her life we’re talking about. They should be the only one making the final decision on whether a treatment is persued or if they will just wait to die… provided they have the money, of course.

  11. A few of the debates have been on whether or not physicians can deny futile care to patients.

    One would hope that a physician can decline to provide services to anyone. They aren’t slaves, you know. If a doctor doesn’t want to do a procedure or enter an order, who can say otherwise? Its not a matter of them knowing best, its a matter of them being free adults.

    I see it both ways, but either way comes down to money.

    Actually, it doesn’t, most of the time. Futile care isn’t stopped over the family’s objections because its costing the hospital a ton of money (even though it is). There’s an awful lot of futile care that is provided for long periods of time regardless of what it costs.

    Its stopped because the doctors, nurses, and hospital administrators think its the wrong thing to do. Trust me on this one. I do it for a living.

  12. Hmm, the organ comes to you.

    What, UPS drops it off on your porch?

    No. Organs go to organ transplant centers. If a patient can’t get to the center where the organ is in a very short time frame, the organ can’t be used.

    1. Are you suggesting that I intended to imply a home delivery?

      It was obvious that my response was a reply to Mango Punch’s assertion that only the wealthy with access to a private jet an helicopter (like Steve Jobs) can be on more transplant lists than your average Steve

  13. Actually you could do pretty well with a law that says if you die while you’re signed up as a donor your funeral is paid for.

  14. Reminds me of a story I saw the other day from here in Canada.

    The back story is that in 2004, the federal government made it illegal to pay sperm donors. Now there’s a shortage of donated sperm, so they have to import it from places like the US (which, strangely enough, has plenty). Our medical experts are stumped: how to fix the shortage?

    The answer, of course, is a taxpayer-funded public education campaign to convince Canadian men of the moral rightness of jizzing into a cup in some dismal clinic for free.

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