Bone marrow donation provides hematopoietic stem cells, the foundational cells that develop into all types of blood cells. This procedure is a necessary treatment for patients facing life-threatening conditions such as leukemia, lymphoma, and various other blood disorders that compromise the body’s ability to produce healthy blood cells. The transplanted stem cells replace a diseased or damaged immune system, offering a chance for recovery. Finding a compatible donor is often the sole hope for these patients, underscoring the medical importance of the donation process.
The Legal Status of Selling Human Tissue
The direct sale of bone marrow for profit is prohibited in the United States and within the global altruistic donation system. This prohibition stems from the National Organ Transplant Act (NOTA) of 1984, which makes it unlawful to acquire, receive, or transfer any human organ for valuable consideration for use in transplantation. NOTA specifically listed bone marrow as a human tissue covered by this ban, reflecting an ethical stance against the commodification of the human body and concerns about donor exploitation. This legislation ensures that the decision to donate remains one of altruism, protecting against financially desperate individuals compromising their health.
However, the legal landscape is not uniform due to advances in medical technology. A legal challenge in the early 2010s focused on the newer method of stem cell collection, arguing it was different from the traditional surgical harvest. A federal appeals court ruled that stem cells collected from the bloodstream—a procedure known as apheresis—are not classified as an “organ” under NOTA. This interpretation allowed for the possibility of compensating donors for these specific stem cells, which are not technically bone marrow tissue.
This ruling created a narrow, technologically-defined exception to the national ban. The exception applies only to the non-surgical collection method and impacts a limited number of specialized programs. Despite this legal clarification, the vast majority of national and international donor registries maintain a strict policy of non-payment for the cells themselves. The core principle remains that the donation must be a voluntary, selfless act.
Understanding Compensation and Financial Reimbursement
While the sale of bone marrow cells for profit is generally illegal or ethically prohibited, donors are financially supported throughout the process. This support is termed “reimbursement” and ensures the donor suffers no financial loss due to their altruistic act. The goal is to remove financial barriers that might prevent a potential match from proceeding with the procedure.
Expenses are comprehensive and paid directly by the patient’s insurance, the transplant center, or the donor registry. Travel costs are a primary component of reimbursement, covering flights, ground transportation, and lodging for the donor and a companion. The donor is also reimbursed for wages lost during the preparation, procedure, and recovery period, requiring documentation from the employer.
Registries also cover miscellaneous expenses such as meals, childcare, or eldercare while the donor is away. The amount of reimbursement for lost wages varies depending on the donor’s income and the recovery time required. These payments are not compensation for the tissue itself but support the donor’s commitment. In rare instances where compensation is offered under the legal exception for non-surgical donation, amounts are modest—such as a few hundred dollars—and are framed as compensation for “time and effort.”
The Two Methods of Bone Marrow Donation
A potential donor may undergo one of two distinct procedures to collect hematopoietic stem cells. The most common method, accounting for approximately 90% of donations, is Peripheral Blood Stem Cell (PBSC) donation. This non-surgical procedure is similar to donating platelets or plasma and involves apheresis.
Leading up to PBSC donation, the donor receives daily injections of filgrastim for five days, which stimulates stem cells to move into the peripheral bloodstream. During the procedure, blood is drawn from one arm, passed through a machine that filters out the stem cells, and returned through the other arm. The outpatient process takes four to eight hours, and the median time for a full return to normal energy levels is about one week.
The second method is the traditional surgical Bone Marrow (BM) harvest, reserved for cases where the recipient requires the specific cell composition found in the marrow. This procedure is performed in a hospital operating room under general or regional anesthesia. A specialized needle withdraws liquid marrow from the back of the donor’s pelvic bone.
This surgical procedure takes one to two hours, and the donor is monitored in the hospital until the anesthesia wears off. Because this method is invasive, recovery time is longer than for PBSC donation, with the median time to full recovery being two to three weeks.
Eligibility and the Donor Registry Process
Becoming a donor begins by joining a national registry, usually by requesting a home testing kit. The first step involves a simple cheek swab, which collects a sample for tissue typing. This sample is analyzed to determine the donor’s human leukocyte antigen (HLA) type—a set of proteins the immune system uses to recognize cells.
Registries prioritize potential donors between the ages of 18 and 44, as younger donors provide better long-term outcomes for recipients. Individuals may be eligible to join the registry up to age 60, provided they meet general health requirements. Prospective donors must be free of major health issues, such as severe heart conditions, certain autoimmune diseases, and a history of most cancers, to ensure the safety of both the donor and the recipient.
If a potential donor’s HLA type is identified as a close match, they are contacted for detailed blood testing to confirm compatibility. Once a strong match is confirmed, the donor undergoes a thorough physical examination and medical consultation to ensure they are informed and medically fit to proceed. This stage moves the commitment from passive registration to an active medical process.