The process of blood stem cell donation, which includes both peripheral blood stem cell (PBSC) collection and traditional bone marrow harvest, is a voluntary, altruistic act intended to save the life of a patient with a blood cancer or disorder. Individuals who register to donate are not paid a salary, wage, or bonus for the cells or tissue they provide. The financial discussion centers on the costs incurred by the donor and the legal framework prohibiting the commercial sale of human tissue. While direct payment is not permitted, comprehensive expense coverage removes all major financial barriers that could prevent a person from donating.
The Legal Status of Donor Compensation
Federal law in the United States prohibits the sale of human organs, tissues, and cells, which is the primary reason donors do not receive a wage for their donation. The National Organ Transplant Act (NOTA) of 1984 made it a felony to acquire, receive, or otherwise transfer any human organ for valuable consideration. This law was initially intended to prevent a black market for non-renewable organs, but its language historically included bone marrow. The legal prohibition aims to prevent the exploitation of low-income individuals and ensure that the decision to donate remains purely altruistic. Paying donors could create a coercive environment, where financial need drives the decision to undergo a medical procedure.
A significant legal distinction arose with the development of the Peripheral Blood Stem Cell (PBSC) donation method. Unlike the surgical extraction of bone marrow, the PBSC method collects stem cells directly from the bloodstream, a process similar to donating blood plasma. A 2011 ruling by the Ninth U.S. Circuit Court of Appeals found that PBSC, collected via apheresis, is more akin to blood, which is already legally compensated, and is therefore not covered by the NOTA ban. Despite this legal finding, major registry organizations maintain a policy against paying donors a wage or salary for the cells themselves. This stance prioritizes the ethical framework of altruistic donation, providing financial relief by covering expenses rather than offering direct payment.
Costs That Are Covered for Donors
Donor organizations ensure that a donor incurs no out-of-pocket costs related to the donation process. This comprehensive financial coverage is structured as reimbursement for expenses, not payment for the cells, to uphold the altruistic nature of the act. All medical expenses, including the initial health screening, the donation procedure itself, and follow-up care, are covered by the patient’s insurance or the donor organization.
Travel expenses are fully covered, which often includes round-trip airfare, lodging, and ground transportation for both the donor and a companion who provides support. Donors are also reimbursed for incidental costs, ensuring the donor’s personal life is not financially burdened by their decision:
- Meals
- Gas mileage
- Parking fees
- Dependent care (childcare or elder care)
A major component of financial support is the reimbursement for lost wages due to time taken off work for the procedure and recovery. This reimbursement is provided to cover income the donor would have earned, not to compensate them for the donation. Lost wage reimbursement can amount to a few hundred to over one thousand dollars, depending on the time needed away from work. To qualify, donors are required to provide documentation to verify their employment and income. This usually includes submitting the two most recent pay stubs, and sometimes a copy of the previous year’s tax return or a signed IRS Form W-9 for self-employed individuals. The organization then calculates a daily wage to determine the amount to be reimbursed for each day of missed work.
Understanding the Two Donation Methods
The two primary methods used to collect the necessary blood-forming cells are Peripheral Blood Stem Cell (PBSC) donation and bone marrow harvest. The difference in the time commitment and invasiveness between these two procedures significantly impacts the amount of time a donor may need off work, which then relates to the lost wage reimbursement. Approximately 90% of all donations are performed using the PBSC method.
Peripheral Blood Stem Cell (PBSC) Donation
PBSC donation involves giving the donor a daily injection of a drug called filgrastim for four to five days before the collection. This medication mobilizes the stem cells from the bone marrow into the peripheral bloodstream. The collection process, known as apheresis, is non-surgical and similar to donating platelets. Blood is drawn from one arm, passed through a machine to separate the stem cells, and then returned to the other arm.
The apheresis procedure typically takes between four and eight hours and may need to be repeated on a second day to collect a sufficient number of cells. The time commitment for the donation days plus the days of pre-donation injections means a donor may miss a full week of work, but the recovery is generally swift, with most people returning to normal activity within one to seven days.
Bone Marrow Harvest
Bone marrow harvest is a surgical procedure performed in a hospital operating room under general or regional anesthesia. The doctor uses a sterile needle to withdraw liquid marrow from the back of the pelvic bone, which is known as the iliac crest. This procedure usually takes one to two hours, and the donor may be kept overnight for observation.
Because this is a surgical procedure, the recovery time is typically longer, leading to a greater need for lost wage reimbursement. Donors often experience soreness, bruising, and fatigue at the collection site, similar to a severe fall. While many donors feel better within a few days, a full recovery and return to all normal activities can take between one and three weeks, requiring more time away from work than the PBSC method.