The 9th Circuit’s proper call on bone marrow donations

by George Will

Washington Post
December 29, 2011

The U.S. Court of Appeals for the 9th Circuit is famously liberal and frequently reversed. Recently, however, a unanimous three-judge panel of this court did something right when it held that bone marrow donors can be compensated. In effect, it revised a law, the National Organ Transplant Act (NOTA) of 1984, because of a medical technique developed since then.

Was this “judicial activism” — judges acting as legislators, imposing social policies they prefer? Or was it proper judicial engagement — performance of the judicial duty to ensure that the law is applied in conformity with the actual facts of the case? Herewith an example of a court’s conscientious application of law in light of a pertinent change — a technological change — in a medical sphere the law regulates.

NOTA made it a felony to sell human organs for transplants. This codified two moral judgments. One is that there is wisdom in an instinctive repugnance about the commodification of the human body, or at least of body parts that are not renewable. The other judgment is that a market for organs — offering perhaps $50,000 for a kidney — would usually, and troublingly, involve affluent people buying from low-income people whose consent is influenced by their neediness.

Here, however, is another moral dilemma resulting from NOTA’s codification of moral impulses: Potentially deadly blood diseases strike tens of thousands of Americans each year. For example, of the 44,000 who will be diagnosed with leukemia, including 3,500 children, half the adults and 700 of the children will die from it. Nearly 3,000 Americans die of various blood diseases because they cannot find matching bone marrow donors. Compensation would substantially increase the number of lifesaving donors. Unfortunately, NOTA classifies as an organ the bone marrow that is the source of lifesaving stem cells that generate white and red blood cells, and platelets.

The 9th Circuit panel ruled this month that a new medical technique has made the phrase “bone marrow transplant” anachronistic. When NOTA was written, extracting bone marrow involved a protracted, painful and risky semi-surgical procedure in which long needles were inserted into the hip bones of anesthetized donors.

More