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Remuneration of hematopoietic stem cell donors: principles and perspective of the World Marrow Donor Association

Michael Boo1, Suzanna M. van Walraven2, Jeremy Chapman3, Brian Lindberg1, Alexander H. Schmidt4, Bronwen E. Shaw5,6, Galen E. Switzer7, Edward Yang8, Torstein Egeland9, and on behalf of the World Marrow Donor Association

1 National Marrow Donor Program, Minneapolis, MN; 2 Europdonor Foundation, Leiden, The Netherlands; 3 The Transplantation Society, Centre for Transplant and Renal Research, Westmead Hospital, University of Sydney, Sydney, Australia; 4 DKMS German Bone Marrow Donor Center, Tuebingen, Germany; 5 Department of Haematology, Anthony Nolan Trust, UCL Cancer Centre, London, United Kingdom; 6 Royal Marsden Hospital, Sutton, United Kingdom; 7 Department of Medicine, Psychiatry, and Clinical Translational Science, University of Pittsburgh, Veterans Health Administration Pittsburgh Healthcare System, Pittsburgh, PA; 8 Buddhist Tzu Chi Marrow Donor Registry, Hualien, Taiwan; and 9 Norwegian Bone Marrow Donor Registry, Institute of Immunology, Oslo University Hospital Rikshospitalet, Oslo, Norway

Hematopoietic stem cell transplantation is a curative procedure for life-threatening hematologic diseases. Donation of hematopoietic stem cells (HSCs) from an unrelated donor, frequently residing in another country, may be the only option for 70% of those in need of unrelated hematopoietic stem cell transplantation. To maximize the opportunity to find the best available donor, individual donor registries collaborate internationally. To provide homogeneity of practice among registries, the World Marrow Donor Association (WMDA) sets standards against which registries are accredited and provides guidance and regulations about unrelated donor safety and care. A basic tenet of the donor registries is that unrelated HSC donation is an altruistic act; nonpayment of donors is entrenched in the WMDA standards and in international practice. In the United States, the prohibition against remuneration of donors has recently been challenged. Here, we describe the reasons that the WMDA continues to believe that HSC donors should not be paid because of ethical concerns raised by remuneration, potential to damage the public will to act altruistically, the potential for coercion and exploitation of donors, increased risk to patients, harm to local transplantation programs and international stem cell exchange, and the possibility of benefiting some patients while disadvantaging others.

Reference: Blood. 2011;117(1):21-25

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