A look at the current status of bone marrow transplants.
Everyone has bone marrow, most people need money, most like helping others, and a lot of people have cancer and can’t find a suitable donor, and will die as a result. Watching Dr. Nancy this morning, the issue of submitting bone marrow for financial compensation came up. Now the ethical debate here is just about as heavy and challenging as it gets (which is something the medical field is always good for). Once we start opening up the market to body parts, Pandora’s box may implode, leaving the poor goddess without her namesake. Let’s look at how the bone marrow registry works first...
If you are a relative, or know the patient directly suffering, you can have your bone marrow tested to see if you’re a match. If you are, and chose to, you can go ahead with the transplant procedure. This is the best case scenario, and statistically, your family members have the best chance of being a match (the more siblings you have the better). However, it is no guarantee that a match will be found, therefore, the patient must go into the bone marrow registry where individuals can voluntarily join. The Be the Match Registry, is set up for bone marrow transplants and PBSC (cells from circulating blood) transplants to search for potential matches. You can check out their website for guidelines, but basically, you sign up, submit cheek cell swab or blood sample, and just wait for someone to contact you. After that, there are physical tests, meetings with doctors, and the eventual legitimate surgical procedure (which is not the most pleasant thing to say the least), and then the recovery period and follow up. Not all procedures are surgical however, sometimes the same results can be achieved through a non-invasive peripheral blood stem-cell donation.
Diep Tran over at the OC News has written a couple of interesting articles detailing bone marrow donor issues in the US...
More people need transplants than those who receive them. Out of 10,000 who sought transplants in 2008, only 4,300 received them. This low numbers is due to disparities in access to health care, lack of referrals for such treatment options and the inability to find matching donors.
If you are a member of a minority race and ever in need of a bone marrow transplant, you have less than a 30 percent chance of finding a matching donor because tissue types are the most similar between people of matching ethnicity.
Needless to say, you are beating the odds if you find a successful match on the donor registry. And of course, finding a match is only the first step, there is no guarantee that the transplant will even work! However, shouldn’t the actual procedure and results be the only daunting aspect, the only part of the process where the patient has to wait and hope? It is a tragedy that so many patients die every year because they cannot find a suitable donor, or because their insurance and/or race hinders them. We are talking about human beings, life and death, and mostly children. What can we do about this? How do we get more people to register, more minorities to register, how can we flood the market with potential donors? Well...we can open it up to the market.
Is this ethical? Clearly, this is up to you, and people may need to search pretty deep in their hearts to find an answer. However, I think if you know someone who has been afflicted with blood cancer, and they were not able to find a donor, this decision may be easier for you. Is there harm in creating a financial incentive for selling your bone marrow? If a market were to be created the hope is that it would be controlled, so people are not posting on craigslist to negotiate their own prices. Continue to go through the registry, but just reward people who decide to sign up. The insurance companies may have a fit, but it’s their job to protect us. How many more lives could be saved this way? No doubt, donor match rates would go up, and save countless lives in the process.
The ethical question however is, where does it stop? The most extreme example would be, people who are struggling for money end up selling off their organs to make ends "meat," and hopefully, this day never comes. Right now, people voluntarily donate blood, and there is not too much of a problem with shortages, but sperm and egg donors can profit from their submissions. Why should bone marrow be any different?
The Registry takes pride in the fact that they are for volunteers only. It is a truly selfless act, it takes a very special type of person to be willing to go through a procedure like this, the willingness to risk their own life to save someone they don’t even know. But is this even necessary? Should it be about saving as many lives as possible, or only saving them the "moral way." The fact of the matter is that there are not enough "good" people out there that are willing to do this for free. Can you blame them? I don’t think you really can, it’s their body, their choice. Cancer patients don’t need good people though, they just need people, they just need to find a match.
The frustrating part, is that the technology is there, the market would be willing to submit their marrow, but the ethical ramifications are holding us back. Yes, it is frustrating, but you can also make the argument that it is necessary, that our ethics can put a check on our ambitions. Is this one of those situations, or are we just too afraid to change? The sad truth is, that as we debate this moral dilemma, thousands of patients are searching through the registry, and realizing just how tiny a list of ten million donors is.