Thursday, July 7, 2011

Is Donating Bone Marrow A Charitable Act?

A few weeks ago, the Australian Bone Marrow Donor Registry contacted and informed me that I have matched with a person who may require a bone marrow transplantation. I told them that I was interested and went in last week for some confirmatory testing. An interesting thing that I have noticed is that a significant number of people who I have told about this have responded with “that is so generous; I could never do that”. This is the idea that I wish to explore. I’d like to begin with an apparently unrelated hypothetical:
A man is out for a late night walk down a country road and he notices a car stopped on the side of the road with its hazard lights on. Upon investigation, he finds a woman breathing heavily and clutching her chest. She tells him she believes she is having a heart attack. Unfortunately, neither of them have a mobile phone on them. She asks him to use her car to drive her to the hospital, as she is in too much pain to do so. The man does have a license. After a few seconds, the man says that he rather not, as the potential risk of crashing the car is too high.
While I cannot say for certain, I think most people would find the justification for not offering help to be quite weak; no one sees driving a car as being too risky as to not offer help to someone who may die without it. To get an idea of the risk associated with driving a car, the world death rate for motor vehicle accidents is 20.8 per 100,000 people (from the Wikipedia page, which quotes WHO statistics).

The point of this hypothetical is to highlight a contradiction in with the way that the people who I spoke of at the beginning think about bone marrow donation. Statistically speaking, donating bone marrow is safer than driving a car. For clarification, there are two procedures used to harvest bone marrow. The first and most common is a peripheral bone marrow harvest’; this is where the donor is given a drug to stimulate their blood marrow to grow and then they give blood and the bone marrow cells are harvested (in the same way as white blood cells are harvested for donation). As such, the risk associated with donating bone marrow by this method has the similar risk to donating blood; that is, a negligible risk. When most people think of a bone marrow donation, they think of extraction from the hip bone. This requires a general anaesthetic in most cases and it is this that presents the only risk of death (in that, no deaths have ever been recorded due to the actual extraction process). However, using even the most conservative figures (i.e. the ones that show the highest mortality rate), the death rate for general anaesthesia is around 14 per 100,000 people (from this study).

So, statistically speaking, it would be safer to give bone marrow to someone that to drive them to the hospital. However, I do not think that the people that I spoke of would change their view of not wanting to donate bone marrow because of this (I specifically did express this point to one of them and they did indeed not change their view). I am not entirely sure why. I see only minor differences in the scenarios and nothing to make them categorically different (well, as far as I can tell). So I throw it open to my highly intelligent audience; is there anything that would make not donating bone marrow more justifiable than not driving someone to a hospital?

[One potential criticism I could see is that I have used the world data motor vehicle accident death rates and, as such, will be much higher than any given country (for example,  the death rate in Australia is around 5 per 100,000; much lower than the world figure). However, the same is true of general anaesthesia figure; the study used data from any published study (excluding only those that were not in English). As such, it would probably be much lower in any given first world country (as is the case with the death rate from motor vehicle accidents).]


  1. I volunteer in animal rescue.  I drive to shelters to pull dogs, or foster them, or help out in a crisis (our local rescue flooded recently), or post pictures to the web, or whatever.  The total time involved is rarely more than 10 hours per month yet people treat me like I"m some kind of saint.  I don't notice the time at all, it's just part of what I do.  I do spend money on these dogs but it's money I can spare.

    Then there are the Christians who will go on "mission" trips to places where their religion really isn't welcome.  They pat themselves on the back yet there's a place right here in town that's called a "mission" that gives homeless people a place to stay, feeds them, and helps them with their personal problems.  Why travel to Africa when you can help people here at home?

    I don't get people sometimes.

    I hope you turn out to be a match.  Whoever needs that marrow needs it reeeeeeally badly.

  2. I hate hypothetical scenarios, especially when you conflate two scenarios that are really not comprisable when broken down. However with that in mind I agree with you. The materialist in me can’t help but also point out that like giving blood you are giving something that you are going to get back eventually. BUT where is the fun or exploration in agreement?

    So hear is why you are wrong and I utterly disagree with you.

    1)    The scenarios are categorically different

    I’m not sure you really want me to go into this; it would involve an argument in dot points.

    2)    Stupidity/Naivety is not charity

    It is not charitable to give up more then you can afford or more then you can afford to risk; that’s just being stupid. The way you have chosen to do the stats break down and the comparison with motor vehicle accidents detracts from the actual risks involved. As the National Marrow Donor Program explains the risks are on the balance of probability less likely, but not significantly improbable (

    Not just the individual feels the effect of being incapacitated; the repercussions effects family and loved ones in both the short and long term. The possibility of saving a life needs to be considered along side the possible life long consequences of a diminished quality of life. You and I believe in one life, which means saving a life is a priority; however taking measures to ensure the quality of that life is equally a priority. Diminished earning capacity, dependency, health cost, rehabilitation, time away from loved ones, mental health – these are all risks of a complicated procedure. Further more these are just the risks to that effect the individual, the cost to others needs to also be taken into account.

    3)    Obligation to others

    How much obligation do you have and to who? We have an obligation not to inflict pain or injury on others (even though we do it indirectly every day). However to the alleviation of another’s pain at cost to our selves, how much responsibility do we have? Derryn Hinch is an awful human being and has inflicted a disproportionate amount of hurt in his long career as a professional wanker. Not surprisingly after years of heavy drinking and smoking Hinch developed liver cancer. He got a liver; someone else missed out and will probably die. We would all love to believe that our organs or the organs of our loved ones would go to “deserving” people. But some are more deserving then others. Do you have a moral responsibility to give away your bone marrow to just anyone at risk to your self? It is more moral to insure your own health and quality of life for both you and your loved ones, taking the risk when you own quality of life and happiness would be affected (aka for a friend or family member).

    Best of luck with the match! I’m also on the register, I hope you have the chance to help someone. =D

  3. I appreciate the disagree :-p

    The reason I chose to go with death rates rather than morbidity rates is that the death rates were much easier to access. I agree that giving beyond what you can afford (and therefore diminishing your own well-being) is stupid. I just don't think that, even including the risk associated with bone marrow donation, most people are justified in not wanting to donate. Sure, maybe a mother and father with a lot of kids that are dependant on them might have justification not to, but no one I spoke to fell into that category. I mean, technically speaking, I should have good enough reason to not want to donate (in that, I'm training to be a doctor and therefore could save more lives if I don't die or become significantly disabled in some way). Maybe that makes me in the wrong for risking that, but as I said, I don't think the risk is high enough that it is an issue.

  4. There is a difference. The thing with bone marrow donors is that they actively are made to understand what going on the marrow register means. That at some point they may have to undergo a painful (hence the GA) procedure. 

    The person with the car has "charity" thrust on them. I would say the difference is charity and heroism. Charity is doing something knowing full well your actions. It is seeking to do something on purpose. 

    The car with a heart attack patient in it is however an act of heroism. It is thrust upon the bystander whose choices are to try and be a hero or forever go down in local infamy as the guy who refused to help. 

    You don't regard non bone marrow sufferers as villains, you would regard the man who refused to drive a person to a hospital despite the fact he could as one though.

  5. Really? I would say the car example is not a charitable act at all, but a moral obligation (then again, my ethical system is probably a bit stricter than the public in general).

    Though, most of Europe and Canada seem to agree with my view; all of them have Duty to Rescue Laws which require individuals to either provide or seek help for a stranger in peril. Canada's description of the law is really quite nice;

    "Every human being whose life is in peril has a right to
    assistance. Every person must come to the aid of anyone whose life is
    in peril, either personally or calling for aid, by giving him the
    necessary and immediate physical assistance, unless it involves danger
    to himself or a third person, or he has another valid reason."

    I'm guessing there would be some kind of limit as to what constitutes a danger that is significant enough to warrant inaction; however, I have no doubt that a licensed driver refusing to drive someone to save their because of the danger of crashing would not be significant enough.

    The only real difference I see between the two scenarios is that in the car one, you know specifically that someone is in danger of death, but in case of bone marrow donation, you do not unless you are on the registry and are contacted.

  6. The problem is in one you are being called upon to make split second decisions and most people aren't ready for that. It scares people. A lot of people at accidents will simply stand and watch despite being capable of doing something because of this. It's not that they are bad people but the thought of intervening hasn't yet come up. 

    Is it a hypothetical situation? Because in most cases it is better for an ambulance to come out. 

  7. That is why I constructed the hypothetical the way I did; I removed the possibility of a bystander effect (by making there only one bystander) and removed the possibility of calling for help (which probably be the better thing to do).

    As I said, my expectations of what people should do are higher than what they generally do. But I don't think they are that high as to be unreasonable and I do think that people who do not help are, at least in the specific situation, are behaving immorally. A single immoral act does not make an otherwise moral person immoral; it is just a cross against them and something that they (and others who are aware of the situation) should try to avoid in the future.

  8. I think the hypothetical is actually VERY relevant. Donating Bone Marrow carries its risks for both the recipient and also the donor. I think almost anyone given the possibility would donate bone marrow, despite the risks. I think most people would feel empathetic towards another human beings situation and feel almost inclined to help! At least I would hope they would...