Doreen Flynn v. Eric H. Holder Jr.
684 F.3d 852 (2011)
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Rule of Law:
The National Organ Transplant Act (NOTA), which criminalizes compensation for human organ donations, does not prohibit compensation for hematopoietic stem cells collected from a donor's peripheral blood via apheresis. Such cells are a component of blood, not 'bone marrow' or a 'subpart thereof' within the meaning of the statute.
Facts:
- Plaintiffs include parents of children with diseases like leukemia who need bone marrow transplants, and a physician whose patients die due to a scarcity of matching donors.
- A nonprofit corporation, MoreMarrowDonors.org, sought to operate a pilot program offering $3,000 awards (scholarships, housing allowances, or charitable gifts) to incentivize bone marrow donations, especially from minority and mixed-race individuals for whom matches are rare.
- The National Organ Transplant Act (NOTA) criminalizes compensating donors for human organs and explicitly includes 'bone marrow' in its definition of 'human organ'.
- MoreMarrowDonors.org refrained from launching its program due to fear of criminal prosecution under NOTA.
- Historically, bone marrow was collected by 'aspiration,' a painful procedure involving inserting large needles into a donor's hip bones.
- A modern technique, 'peripheral blood stem cell apheresis,' is now used for most transplants. This method involves giving a donor medication to increase stem cells in their bloodstream.
- In apheresis, blood is drawn from a donor's vein, filtered by a machine to extract the hematopoietic stem cells, and the remaining blood components are returned to the donor. The process is procedurally similar to donating blood plasma.
Procedural Posture:
- Plaintiffs, a group of individuals and the nonprofit MoreMarrowDonors.org, filed a complaint in a U.S. District Court against the Attorney General, seeking declaratory and injunctive relief.
- The U.S. District Court granted the government's motion to dismiss the complaint for failure to state a claim.
- Plaintiffs-Appellants appealed the dismissal to the U.S. Court of Appeals for the Ninth Circuit.
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Issue:
Does the National Organ Transplant Act’s prohibition on providing valuable consideration for 'bone marrow' donations apply to hematopoietic stem cells collected from peripheral blood through apheresis?
Opinions:
Majority - Kleinfeld, Senior Circuit Judge
No. The National Organ Transplant Act's prohibition on compensating for 'bone marrow' donations does not extend to hematopoietic stem cells collected from the bloodstream via apheresis. The court reasoned that the statute's language must be given its ordinary meaning. 'Bone marrow' refers to the soft, fatty substance inside bone cavities, which is not what is extracted during apheresis. The government's argument that these stem cells are a 'subpart' of bone marrow because they originate there fails, as this logic would also prohibit paying for blood donations—a practice the government concedes is legal—since red and white blood cells also originate in the marrow. The court concluded that once stem cells enter the bloodstream, they are a 'subpart' of the blood, not the bone marrow. Therefore, because paying for blood donations is not prohibited by NOTA, paying for the donation of stem cells collected from the blood is also not prohibited.
Analysis:
This decision creates a significant, technology-driven exception to the National Organ Transplant Act's ban on compensating organ donors. By distinguishing the modern apheresis technique from traditional bone marrow aspiration based on statutory interpretation, the court opened the door for financial incentives to increase the supply of life-saving hematopoietic stem cells. The ruling demonstrates how courts may interpret statutes enacted before the development of new technologies, focusing on the plain meaning of the text rather than attempting to divine legislative intent for a circumstance Congress could not have foreseen. This could lead to a substantial increase in the donor pool, particularly for patients from minority and mixed-race backgrounds who face the greatest difficulty in finding suitable matches.
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