The Hidden Economy of HSC Transplantation Is Inconsistent with Prohibiting the Compensation of HSC Donors

Abstract

The Hematopoietic stem cell (HSC) transplantation industry relies on, and mandates, donor altruism. The National Organ Transplant Act (NOTA) prohibits the exchange of valuable consideration for HSCs collected from bone marrow to be used for transplant. At present, NOTA does not prohibit compensating donors for HSCs obtained from umbilical cord blood or peripheral (circulating) blood; however, the Health Resources and Services Administration (HRSA) has proposed expanding the NOTA prohibition to cover all HSCs. In any event, the reliance on altruism is currently so ingrained in HSC transplantation that bureaucratic barriers prevent donors from receiving compensation in situations where it would be legally permissible. Donors are the only parties in the HSC transplant chain who are not compensated for their involvement. HSCs are routinely treated as commodities being bought and sold in a hidden economy that crosses international borders. This shadow industry is underpinned by mandated donor altruism, and is also reliant on such altruism for its very existence. However, it is advantageous for all parties involved to encourage HSC donation. Not only would the compensation of donors increase the number and retention of donors, but it will also serve as an acknowledgement of the important contribution that donors make. This Article will focus on increasing HSC donations by repealing laws prohibiting compensation for HSC donation and permitting limited and regulated compensation for donors.