Time for Updates

1-17-12

I have not posted anything new for a few weeks, so it is probably time to update a couple of items.

Of course, the most important update concerns my brother’s progress since the transplant in September.  Since then, there have been periods of good improvement and periods when progress seemed to have come to halt.  Overall, it seems that Paul’s condition is much better than it was and the doctors are satisfied that he should keep improving.  Before the transplant, he required blood transfusions every week or two simply to stay alive.  It is now going on two months since his last transfusion.  Recent lab work has shown that his blood counts are increasing and that the amount of fibrous tissue in his bone marrow is decreasing.  Although it will be several more months before we know with certainty that the procedure was successful, we remain optimistic – and it is an optimism supported by the laboratory tests.

On another subject, I previously commented on the controversy as to whether stem cell donors should be compensated.   It seemed that such compensation is prohibited by the National Organ Transplant Act of 1984 (NOTA).  However, on December 1, 2011, the United States Court of Appeals for the Ninth Circuit decided a case entitled Flynn v. Holder.  The court stated that peripheral stem cell transplants using cells collected from the blood through apheresis is not a procedure for which compensation is specifically prohibited by NOTA – because the procedure was not being done when the law was enacted.  The court focused on the fact that although the stem cells originate in the bone marrow and are in the blood stream in large numbers only because of the Neupogen injections given to the donor, they are gathered from the blood stream and not from the marrow.  Therefore, the court held that the procedure is form of blood donation for which compensation is permitted, rather than a bone marrow donation for which NOTA prohibits compensation.

There is nothing intrinsically wrong with that reasoning – and there would have been nothing intrinsically wrong if the court had gone the other way and seen the procedure as essentially a bone marrow donation.  No other federal circuit has yet addressed the issue.  Therefore, compensation for stem cell donations is now lawful in those jurisdictions over which the Ninth Circuit exercises appellate jurisdiction (California, Oregon, Washington, Idaho, Montana, Nevada, Arizona, Alaska, Hawaii, as well as Guam and the Northern Mariana Islands).  Who knows when the issue may be considered by other circuits and whether the result will be the same.

My primary concern about permitting compensation is that I am not sure whether American patients and donors will be able to participate in international registries, possibly limiting the chances of matching appropriate donors and recipients.

Be that as it may, the most important thing to take from the post is that Paul is progressing well and we look forward to his continued improvement and to his future good health.