As Dr. Carlos Zayas battled an aggressive lymphoma, the good news came that a donor had been identified as an almost perfect match for a bone marrow transplant.

And then the bad news: The anonymous donor didn’t want to go through with the procedure.

A colleague suggested payment might convince this stranger otherwise. But Zayas couldn’t fathom it.

"If you want to save a life, it should come from your heart, not from your pocket," said Zayas, who leads the kidney and pancreas transplant program at Piedmont Hospital in Atlanta.

The pocket may have more power now that a federal court declared it legal to pay people for body tissue needed for certain common bone marrow transplants, adding fuel to the ongoing debate about the ethics, and effectiveness, of compensation for body parts.

Though payment for bone marrow and other organs is banned under the 1984 National Organ Transplant Act, the Dec. 1 ruling from the 9th Circuit Court of Appeals based in California exempted a technique that doesn’t touch the bone marrow itself, but rather removes relevant stem cells from the bloodstream in a process similar to plasma donation, for which payment is allowed.

Although some bone marrow transplants require putting a donor under anesthesia and inserting a long, hollow needle into the pelvic bone, three-quarters of marrow donations use a less invasive method to remove peripheral blood stem cells (PBSC): blood is drawn from one arm, cycles through an apheresis machine that separates out the cells to be used in the transplant, and is returned to the donor’s body through the other arm. The donor’s stem cells are grafted into the recipient through a catheter in a chest vein. The donor regenerates his or her own cells within a few weeks.

Jeff Rowes, lead counsel in the lawsuit against the government, said the ruling allows for experimentation in a system in which, he estimates, 2,000 to 3,000 people die annually from not getting a needed marrow transplant.

"We want to find out if compensation works," said Rowes, senior attorney at the Institute for Justice, a libertarian public interest law firm.

Attorney General Eric Holder has until Feb. 29 to petition the Supreme Court to take the case. If he doesn’t, donors could be paid for PBSC, but not for traditional techniques requiring marrow extraction from the pelvic bone.

Some 10,000 people who are fighting lymphomas, leukemia and other life-threatening blood diseases depend on an unrelated donor for a bone marrow transplant, a needle-in-the-haystack search for genetic compatibility.

The challenge is especially acute for racial and ethnic minorities because of their complex genetic makeup and underrepresentation in donor registries, which collect cheek swabs from millions of anonymous potential donors. The chance of finding a good and willing match on the National Marrow Donor Program’s Be The Match Registry, which with 9 million members is the largest in the world, is 93 percent for white people, 72 percent for Hispanics and Asians, and 66 percent for blacks.

Zayas, who faced a 10 percent chance of survival when his donor match backed out, experienced firsthand the limitations of the system. But he opposes compensation to increase the donor pool, his gravest concern being where the money would come from to ensure freedom from coercion and equal access for patients of all economic means. (Zayas is now cancer-free, thanks to rolling the dice on a risky bone marrow donation from his brother, a less-than-perfect match.)

(EDITORS: BEGIN OPTIONAL TRIM)

The California nonprofit More Marrow Donors (moremarrowdonors.org), one of the plaintiffs in the case, wants to use private charitable funds to reward donors with a $3,000 scholarship, housing allowance or gift to a charity. But a general lifting of a compensation ban opens the door to any financial arrangement.

The ruling has come under fire from the National Marrow Donor Program, which worries that legalizing compensation could complicate relationships with international partners, discourage people who donate for altruistic reasons and compromise the safety of the patient and donor, said Michael Boo, the organization’s chief strategy officer.

With a monetary incentive, cash-strapped donors might be less inclined to reveal medical problems that could endanger their own health or the recipient’s, Boo said. Although the risk of serious adverse effects with the PBSC procedure is less than 1 percent, the procedure is no walk in the park.

For five days before the blood procedure, donors must have injections of a medicine called filgrastrim to encourage the marrow’s stem cells to move into the bloodstream, which can cause headaches, bone pain or, in rare severe cases, damage the spleen. The apheresis itself takes six to 12 hours, can cause fatigue and dehydration and may require a central line in a chest or neck vein.

Because there’s no guarantee a match, or money, will be made, Rowes said bone marrow compensation is at low risk of drawing undesirable candidates or exploiting the poor. Only one in 40 people on the Be The Match Registry ever gets a call to get additional testing, and just one in 540 goes on to donate.

"I think the jury is still out on this one," said bioethicist Tarris Rosell, at the Center for Practical Bioethics in Kansas City, Mo. "I think we need a good deal of public and professional discussion to make sure we have the facts right, lest we start down a road we don’t want to be on."

(END OPTIONAL TRIM)

(EDITORS: BEGIN OPTIONAL TRIM)

For Erin Wright, the hardest part of donating peripheral blood stem cells wasn’t the two days she took off from medical school to sit connected to an apheresis machine, for 5 ½ hours each day, antsy and tired but otherwise OK.

It was waiting the requisite 12 months of anonymity before she could, with mutual consent, make contact with the 14-year-old boy who received her stem cells to fight his untreatable anemia.

"Just hearing his voice meant everything to me," said Wright, 29, who lives in Jersey City, N.J., and was notified that she was a match eight years after she signed up for the registry. "I could care less about the 18 needles in my arm; I knew he was OK."

Laura Houghton was similarly touched after the tearful meeting with her marrow recipient. Houghton, who joined Be The Match after a friend was diagnosed with leukemia, was shocked when, two months after her friend died, she got a call saying she might be a match for a leukemia-stricken 3-year-old boy.

Excited to help, Houghton underwent a traditional bone marrow extraction under general anesthesia.

Home the same day, Houghton said she felt like she had fallen and hit her tailbone. She took a week off from work (her employer comped the time), and ached for two or three weeks, but was back on the volleyball court after a month.

The boy, now 5 and playing soccer and taking swimming lessons, called Houghton on Thanksgiving, and she bought the family Christmas presents.

"I consider them part of my family," said Houghton, 26, who lives in Brooklyn Park, Minn.

(END OPTIONAL TRIM)

———

People age 18 to 60 can join Be The Match at a donor registry drive or by mailing in a cheek swab. Visit bethematch.org/join.