NOTA made it a felony to sell human organs for transplants. This codified two moral judgments. One is that there is wisdom in an instinctive repugnance about the commodification of the human body, or at least of body parts that are not renewable. The other judgment is that a market for organs — offering perhaps $50,000 for a kidney — would usually, and troublingly, involve affluent people buying from low-income people whose consent is influenced by their neediness.
Here, however, is another moral dilemma resulting from NOTA’s codification of moral impulses: Potentially deadly blood diseases strike tens of thousands of Americans each year. For example, of the 44,000 who will be diagnosed with leukemia, including 3,500 children, half the adults and 700 of the children will die from it. Nearly 3,000 Americans die of various blood diseases because they cannot find matching bone marrow donors. Compensation would substantially increase the number of lifesaving donors. Unfortunately, NOTA classifies as an organ the bone marrow that is the source of lifesaving stem cells that generate white and red blood cells, and platelets.
The 9th Circuit panel ruled this month that a new medical technique has made the phrase “bone marrow transplant” anachronistic. When NOTA was written, extracting bone marrow involved a protracted, painful and risky semi-surgical procedure in which long needles were inserted into the hip bones of anesthetized donors.
Now, however, there is an essentially risk-free technique — called apheresis — for obtaining the stem cells not from hip bones but from the arms — the blood streams — of donors as they rest for six or so hours in a recliner.
Paying donors of blood plasma has long been legal, routine and effective in increasing donations of blood. It — like sperm and eggs, donors of which can be compensated — is quickly regenerated. As are the lifesaving cells captured by apheresis.
One of the plaintiffs — represented by limited-government litigators from the Institute for Justice — who challenged NOTA’s compensation ban is a California nonprofit organization that wants to encourage donations by offering $3,000 awards. These would be in the form of scholarships, housing allowances or contributions to charities chosen by donors. The program would initially target potential minority and mixed-race donors who are likely to have marrow cell types that are the most difficult to match.
Unfortunately, the 9th Circuit panel decided that it did not need to reach the constitutional issue the plaintiffs raised, which was this: NOTA, in today’s context of the noninvasive cell-procurement technique, apheresis, violates the constitutional guarantee of equal protection of the laws. It does because it makes a distinction — between compensation for donors of blood plasma and donors of bone marrow — that no longer has a “rational basis.”
The “rational basis test” makes courts excessively deferential to Congress regarding the reasons it gives for regulations it imposes. Courts applying this test usually approve any “conceivable” interest that Congress asserts unless it is so preposterous it makes the judges laugh until their ribs ache.
It would have been nice if the 9th Circuit panel had been more assertive — if it had struck down NOTA’s proscription of compensation for bone marrow donors on equal-protection grounds. The panel said that it did not need to reach this constitutional question. It simply ruled that Congress did not really ban compensation for bone marrow donors under the apheresis method — which does not take actual bone marrow — because this method did not exist in 1984.
Pushing back against the too-permissive rational basis test is a project for another day. For now, it suffices to say this: At this moment of careless rhetoric about “judicial activism,” the 9th Circuit judges have judged, thereby providing a reminder that proper judicial engagement is different and admirable.