Social Justice, Current Events

Pay for bone marrow, save lives

15036487_10100700323104051_2510168469186508591_nThis past week, I was on a panel for a Senate Hill Briefing entitled “Should compensation for bone marrow donors be legal?” The panel included myself, Robert McNamara (Institute for Justice), Mario Macis (Associate Professor of Economics, Johns Hopkins Carey School of Business), Samuel Hammond (Poverty and Welfare Policy Analyst, Niskanen Center), and Doug Grant (founder and CEO of Hemeos).

The event was co-sponsored by the Niskanen Center and the Georgetown Institute for the Study of Markets and Ethics. The Niskanen Center’s Samuel Hammond released a report entitled “Bone Marrow Mismatch” that same day, wherein he argued that the Department of Health and Human Services should not intervene to prohibit compensation for bone marrow donors (which is currently legal).

My comments were about the ethics of compensating people for their bone marrow. Here is what I said (video of my comments is at the end, if you prefer watching to reading):

Recently, Congressperson Nanci Pelosi said the following:

“We have a little time to save lives. What more important thing does any of us have to do than to stay here and pass a law to save lives? Somebody said to you, you could save 90 lives by passing a bill today, wouldn’t you do that? Or why wouldn’t you do that? Why wouldn’t you do that?”

Here we have an opportunity to save much more than 90 lives. We have the opportunity to save hundreds, if not thousands of lives.

All that the Department of Health and Human Services (HHS) has to do is nothing.

The question is, why wouldn’t they do that?

There is one company, Hemeos, that stands ready to help save more than 90 lives. All they require is the continued legal permission to operate.


So why would HHS not permit companies like this to operate?

I looked at the Department’s arguments in favor of passing a new rule that would prevent companies like Hemeos from saving more than 90 lives.

I also had a look at all of the public submissions to the Department of Health and Human Services when they opened this question for public comment. (Of 527 submissions, only 20 were in favor of the new rule. 507 submissions were opposed.)


The first and most frequent response has to do with wrongful exploitation. The worry is that offering payment for bone marrow donations will unduly incentivize at-risk populations to make a health-related decision that may not be in their own best, long-term health interest.

There is no question that wrongful exploitation is a legitimate worry. If it were true that compensating bone marrow donors were wrongfully exploitative, that would be a significant objection. However, the compensatory model would not be wrongfully exploitative.

Unlike aspiration, apheresis is a non-invasive procedure. While there are risks, the procedure is not dangerous. In most cases, recovery, which is generally minimal or non-debilitating, lasts one week.

In addition, hematopoietic stem cells quickly regenerate. Donors do not permanently “lose” a part of themselves.

Given that the burdens are not significant, they provide no grounds for concern about wrongful exploitation.

There is also no evidence that compensation for bone marrow donations would be low, or that only poor or desperate people would be willing to donate for compensation. For example, Hemeos is offering $2,000 per completed donation. That is a sum that is sufficient to persuade middle- and upper-income individuals to donate, just as they now donate eggs or sperm for compensation.

Finally, donors would not be compensated on the day that they sign up to be placed on the registry. Instead, they are paid only after a match is found, and they complete the donation, which can take a long time, possibly years. Worries about wrongful exploitation are about people making desperate decisions in moments of desperation. A waiting period of months or possibly years gives people an opportunity to reconsider.


The second objection to the compensatory model is that it would promote the view that human beings, their bodies, or subparts thereof, are appropriately viewed as “commodities.”

We should mark a distinction between paying for something, and thinking of that thing as a mere commodity. It is trivially true that anything that is paid for or compensated is a “commodity,” but this is ethically irrelevant. What is ethically relevant is that the compensatory model would promote the view that bone marrow is a “mere commodity,” meriting no more ethical regard than other mere commodities, such as cars or clothing or widgets.

However, there is no evidence that the compensatory model would promote this view.

For example, there is no evidence that compensation for blood or blood plasma donations, nor for sperm and egg donations, has promoted the view that people or their blood, sperm, or eggs are mere commodities.

We also compensate Presidents, Senators, Congresspersons, members of the military, police officers, actors, artists, and so on. Mario and I are compensated as professors, mostly from the tuition our students pay. But there is simply no evidence that a paycheck for our labor promotes the view that we are mere commodities, nor that the services we provide — protection, education, artistic expression, representation, and so on — are regarded as mere commodities.

There is simply no evidence that a compensatory model would promote the view that donors or their bone marrow are mere commodities.


The third, frequently cited, objection to compensating donors for bone marrow donations is that it would take away an opportunity for altruism. Of course altruism is desirable, and we should be careful to preserve and promote altruistic and benevolent motives and actions. But this is an unpersuasive argument.

The compensatory model leaves open the possibility for donors to reject the compensation. It also leaves open the possibility for a parallel non-compensatory model. Some blood drives, for example, are uncompensated, while, in other cases, blood donors are offered compensation. Both operate successfully side by side.

It is also true that compensation and altruism are not mutually exclusive. In many cases, people who are compensated are motivated either simultaneously or primarily by altruistic impulses. This is true of many teachers, of many doctors and nurses, of members of the military, and so on. Blood donors who are compensated are often moved by altruistic motives. There is no reason to think that compensation for bone marrow donations would completely, or even significantly, crowd-out altruism.


None of the three most frequently-cited objections to the compensatory model withstand ethical scrutiny.

This is not my view alone.

39 professional ethicists from across the political spectrum signed on to an open letter addressed to the Department of Health and Human Services presenting the arguments I have offered. They include well-known and well-regarded ethicists like Peter Singer, Gerald Dworkin, and David Schmidtz. The letter is hosted on

In that letter, we also argued that given the ethical importance of avoiding preventable death, the proposed Rule by the Department of Health and Human Services is itself unethical.

When people stand ready, willing, and able to save lives, we need very good reasons to prevent them. In this case, we do not have sufficient reason to prevent them. Hemeos, and companies like Hemeos, would like to save lives. Because we do not have sufficient reason to prevent them, the proposed new rule is not merely “a bad idea,” it is morally wrong.

Passing this new rule is unethical. What is being proposed is morally wrong. We have the opportunity to save more than 90 lives. Why wouldn’t we do that?

  • IceTrey

    “Of course altruism is desirable”

    And you call yourself a libertarian.

    • Dr. Jaws

      Yes, I do.

      What’s the conflict?

      • IceTrey

        It IS the conflict. It’s the basis for positive liberty the very thing we are fighting against.

        • Dr. Jaws

          From my having an obligation to x, it doesn’t follow that the government ought to enforce x.

          • IceTrey

            There’s nothing we’ve GOT to do except die.

          • Dr. Jaws

            I’m not sure what you mean. But we’ve got to do lots of things. Like not murder and be decent to people, for example.

          • Puppet’s Puppet

            Are you genuinely surprised to meet a self-identified libertarian who believes that helping others in commendable? Are you surprised to encounter one writing for this website? (Or, for that matter, Cato or Reason? Most are of like mind on this point.) I am a “baby libertarian” myself, and even I find that remarkable.

            In general, people who hold roughly the same beliefs about the proper role of government will not have the same beliefs about individual moral decisions. Take, for instance, the belief that the government is not morally permitted to force you to be kind to your wife. One might believe this because (as some libertarians indeed do) one believes that you have no moral obligation to be kind to your wife. (You appear to believe it would not even be commendable.) But one does not need to believe this to come to the exact same conclusion about government. One might instead simply believe that no other person is morally permitted to force you to be kind to your wife, therefore no group of people, therefore no entity that might constitute a “government.” I might believe that your unkindness is utterly forbidden, the gravest sin imaginable, and still hold the view that it is completely inappropriate for the state to use its police power to enforce that morality. Individual moral obligation to others is not, in and of itself, “the basis for positive liberty” or anything of the sort. Enforcing such “liberties” requires something else–the moral permission for government force.

            This is what you will find the bulk of libertarians swearing by–this gap between the immoral and the unlawful, the idea that it is not the government’s job to enforce anyone’s moral code including theirs. You’ll find others like yourself (though perhaps not so extreme as to think that helping others is not even “desirable”), but these are not premises you can assume to be starting from. Your moral premises are the foundation of neither mainstream liberal political philosophy nor mainstream economics. If you want to make a case for them you’ll have to take on that project head-on.

          • IceTrey

            Well you have to first understand that morality is both objective and subjective. Morality deals solely with actions. Since there are two types of actions there are two types of morality. Objective morality deals with actions between individuals. Subjective morality deals with actions that only effect an individual. In your example being kind to your wife falls under subjective morality. Is it good or bad for you? If you are unkind to your wife by hitting her that falls under objective morality. This is the realm of government whose function is to defend individual negative liberty. Hitting your wife is objectively immoral because it violates her negative liberty.

          • King Goat

            You can’t imagine anything more in ‘being kind to your wife’ than not hitting her? I hope you’re not married!

          • IceTrey

            You need a reading comprehension class.

        • Theresa Klein

          You’re confusing egoism/objectivism and libertarianism.

          Objectivism (Ayn Rand’s philosophy) and egoism more generally is a personal moral philosophy governing how one ought to act. I.e. in one’s self interest.

          Libertarianism is a political philosophy governing how the government ought to act. it says nothing about how one ought to behave in one’s personal life. You can be an absolute egoist, or you can be the most generous philanthropist or altruist in the world. You can be Ghandi or Mother Teresa, or you can be Hank Reardon and libertarianism says that’s a-ok.

          Egoism is compatible with libertarianism because libertarianism allows people to behave selfishly, if they choose, as long as they remain within certain bounds defined by others rights. However, there is no moral *obligation* to be an egoist entailed by libertarianism.

          • IceTrey

            “What is the moral code of altruism? The basic principle of altruism is that man has no right to exist for his own sake, that service to others is the only justification of his existence, and that self-sacrifice is his highest moral duty, virtue and value.” – Ayn Rand

            I’m pretty sure that’s the basis of progressivism. They want the government to force altruism.

          • Theresa Klein

            So to get back to the original topic … libertarianism says nothing about whether you should be altruistic or not. it merely says the government cannot force you to be.

          • IceTrey

            An altruistic libertarian is like a pro-choice Catholic. They are one in name only.

          • Puppet’s Puppet

            Ah, this is starting to make a little more sense.

            You will find Objectivists to be in the minority in most libertarian intellectual communities, for better or for worse. This includes places like Cato and Reason; and it certainly includes Bleeding Heart Libertarians, whose very name suggests altruism and which is dominated by people working within mainstream philosophy. Besides the fact that this means that most of us are not, in fact, arguing from egoist premises, it also means that we will use terminology that may be quite different from yours; the two communities have not had a lot of intercourse over the decades.

            I can see how you’d be appalled if you thought we believed that “man has no right to exist” if he does not help others. That is monstrous. But that is not what any of us think. Whether Ms. Rand was operating on a different definition of the word “altruism,” or defined it as we do and (incorrectly, in our opinion) reasoned toward that conclusion I do not know. Like many (perhaps most) folks you encounter here, I am almost completely ignorant of Objectivism. (If you are opposed to egoism in the first place, sitting down to learn the works of a rather obscure–from our perspective–egoist is not going to be a high priority, especially since there is such a rich and brilliant body of libertarian literature to tackle within mainstream philosophy. Nothing to be proud of, just a reality of human limitation.)

            That’s going to mean, for better or for worse, it’s going to be on someone like you to familiarize us with Objectivist arguments. Make the case for them from the ground up! Because in general libertarians are not egoists, and cannot be presumed to have the slightest familiarity with Ayn Rand.

          • IceTrey
          • Puppet’s Puppet

            Ah, yes. This was very helpful, thank you.

            Rand equivocates here among a wide variety of positions, and gives no justification in this passage (though she may elsewhere) for believing that they stand and fall together. Some would even suggest mutual opposition, if anything.

            No libertarian, it’s safe to say, would ever support the most extreme statements in the passage: “Man has no right to exist for his own sake” and “man is to be regarded as a sacrificial animal.” I want to stress, though, that other positions stated, extreme as they are, are completely compatible with libertarianism. Suppose that I follow a moral philosophy of the most extreme abnegation: I believe that everyone has a moral obligation to show complete disregard for their own well-being, to live only for others and not at all for themselves. Preposterous as this is (few libertarians, or anyone else, would think it mandatory or even commendable to show less regard for oneself than for others), it still has absolutely nothing to do with the notion that it is permissible for anyone else to deprive you of your own well-being. If anything, a person favoring extreme abnegation might be expected to vigorously oppose such a social order! The abnegationist presumably does not take such an extreme position for consequentialist reasons, out of pure concern for the well-beings of society’s members; if individual well-being were his bottom line, why would he want everyone to act to sacrifice theirs? More likely, he holds great intrinsic value for the act of self-sacrifice. And a system of appropriating the resources of others, of forceably depriving individuals of their well-being for the benefit of some third party, would do nothing to further acts of self-sacrifice and everything to impede them.

            This is how stark the difference is between the notions of moral obligation and permissible public compulsion. I cannot stress this enough.

          • Theresa Klein

            I’m actually quite sympathetic to ethical egoism as a moral philosophy. I just don’t think it’s relevant or helpful to connect it to libertarianism as a political philosophy. Ethical egoism doesn’t even necessarily exclude altruism. I mean, a radical egoist would simply say “f**k you, I be can altruistic if I feel like it.” He wouldn’t let anyone else tell him how he *ought* to act.

  • King Goat

    We all know what the boogeyman ‘end game’ is here, so it seems it’s that that should be addressed. It’s a market where poor people are selling their blood to a bunch of Peter Thiels that want it under the belief it makes them live longer. If that were made into a novel most people would label it ‘dystopian science fiction.’ That’s where the moral intuition lays. Now, maybe that intuition is wrong, but the phenomenology of ethics has to be addressed by the side going against it.

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