You generally cannot be paid a fee to donate bone marrow for money under federal law, but the practical picture is more forgiving than that sounds. The National Organ Transplant Act makes buying or selling bone marrow a felony, yet a 2011 federal appeals court ruled that the collection method used in roughly 86% of unrelated-donor transplants today sits outside that ban. And every donor who goes through the National Marrow Donor Program gets full reimbursement for medical costs, travel, lodging, lost wages, and childcare, even without a payday attached.
The Federal Ban and What It Covers
The National Organ Transplant Act of 1984, codified at 42 U.S.C. ยง 274e, makes it illegal to knowingly acquire or transfer any human organ for “valuable consideration” when the transfer affects interstate commerce. The statute lists bone marrow as a human organ alongside kidneys, livers, hearts, and lungs. A violation carries a fine of up to $50,000, up to five years in prison, or both.1Office of the Law Revision Counsel. 42 USC 274e – Prohibition of Organ Purchases
The law does carve out specific exceptions from “valuable consideration.” Reasonable payments tied to the removal, transportation, processing, preservation, and storage of the organ are permitted, and so are a donor’s expenses for travel, housing, and lost wages connected to the donation.1Office of the Law Revision Counsel. 42 USC 274e – Prohibition of Organ Purchases You cannot receive a lump-sum payment for your marrow, but you can be made financially whole for the costs the donation imposes.
The Court Ruling That Changed the Picture
In Flynn v. Holder, the Ninth Circuit Court of Appeals distinguished between two collection methods. The traditional procedure extracts soft marrow tissue directly from the pelvic bone with a needle. The newer peripheral blood stem cell (PBSC) apheresis method filters stem cells out of a donor’s bloodstream after several days of medication that pushes those cells from the marrow into circulating blood. The court held that PBSC apheresis is functionally a blood donation, not a bone marrow extraction, and therefore falls outside NOTA’s prohibition.2U.S. Court of Appeals for the Ninth Circuit. Flynn v. Holder, No. 10-55643
The reasoning turned on what counts as “bone marrow” versus “blood.” The court read the statutory term “bone marrow” as the soft, fatty tissue inside bone cavities. When stem cells are collected from peripheral blood, nothing is being removed from the marrow itself. As the court put it, “the statute does not prohibit compensation for donations of blood and the substances in it, which include peripheral blood stem cells.”2U.S. Court of Appeals for the Ninth Circuit. Flynn v. Holder, No. 10-55643
That distinction is not a technicality. PBSC apheresis accounts for about 86% of unrelated-donor transplants and 77% of related-donor transplants in the United States.3Health Resources and Services Administration. Donation and Transplantation Statistics Traditional surgical marrow extraction, which remains clearly prohibited from cash compensation under NOTA, is used for roughly the remaining 10% of unrelated-donor transplants.
Why There Still Isn’t a Paid Market
After Flynn, at least one nonprofit (MoreMarrowDonors.org) proposed offering $3,000 in non-cash incentives such as scholarships and housing allowances to PBSC donors. No large-scale compensation market has developed since. The NMDP coordinates the overwhelming majority of unrelated donations in the United States, and it does not offer cash payments. For most donors, “getting paid” in practice means getting every donation-related cost covered rather than earning income from the procedure.
What the NMDP Covers Instead of Payment
According to the NMDP’s reimbursement guidelines, covered costs include medical expenses, travel expenses for the donor and a companion, childcare, and lost wages. Donors receive a medical services coverage card to present at donation-related appointments. The card tells healthcare providers to bill the NMDP directly rather than the donor or the donor’s personal insurance.4NMDP. Reimbursement and Billing
If a donation-related medical bill does arrive at the donor’s mailbox, the NMDP instructs donors not to pay it and instead to forward it to their workup specialist for resolution. Out-of-pocket expenses like food and mileage are reimbursed within two to four weeks after a complete request is submitted.4NMDP. Reimbursement and Billing
Lost-wage reimbursement is often the benefit that closes the financial gap for donors without generous paid time off. Donors are encouraged to raise this early with their workup specialist, who can either coordinate with the donor’s employer or arrange NMDP reimbursement for wages lost during donation-related activities. The NMDP does not publish a specific dollar cap on lost-wage reimbursement.
The workup specialist is the first point of contact for any financial question, from booking travel to chasing down an errant medical bill. Other organizations, including the Bone Marrow and Cancer Foundation, provide additional financial support to transplant patients and their families for medication, transportation, and housing.5NMDP. Financial Assistance Before and After Transplant
Paid Leave for Bone Marrow Donors
Paid leave is one of the most underappreciated financial benefits available to bone marrow donors. Federal employees are entitled to up to seven days of paid leave per calendar year specifically for bone marrow donation, separate from their regular sick or vacation time.6Office of the Law Revision Counsel. 5 USC 6327 – Absence in Connection With Serving as a Bone-Marrow or Organ Donor The same statute provides up to 30 days for organ donation.
Many states have their own bone marrow donor leave laws. California requires employers with more than 15 employees to provide up to five days of paid leave for bone marrow donation. Louisiana and Minnesota impose similar requirements on employers with 20 or more employees, providing up to 40 hours of paid leave. Some states are more generous with their own workforce: Massachusetts and Michigan allow up to 30 days of paid leave for state workers who donate marrow. The details vary considerably by state, so checking your state labor department or your employer’s HR office before scheduling a donation is worth the call.
FMLA and Pending Federal Protections
The Family and Medical Leave Act provides up to 12 weeks of unpaid, job-protected leave for serious health conditions, and organ donation recovery generally qualifies. You need to work for an employer with at least 50 employees and have been there for at least a year. FMLA leave is unpaid, so it protects your job but not your paycheck.
As of early 2026, the Living Donor Protection Act (S.1552) has passed the Senate HELP Committee and sits on the Senate legislative calendar, but has not been signed into law.7Congress.gov. S.1552 – 119th Congress (2025-2026) – Living Donor Protection Act of 2025 If enacted, it would prohibit life, disability, and long-term care insurers from denying coverage or raising premiums based on a person’s status as a living organ donor. It would also explicitly add organ donation recovery to the FMLA’s definition of a serious health condition. A separate House bill, H.R. 4582, would make the same FMLA clarification.8Congress.gov. H.R.4582 – 119th Congress (2025-2026) – To Amend the Family and Medical Leave Act Neither bill is law yet.
Tax Treatment of Donor Expenses and Reimbursements
Unreimbursed out-of-pocket medical costs related to bone marrow donation may be deductible on your federal tax return. IRS Publication 502 classifies medical expenses for organ donors, including transportation costs, as deductible medical expenses.9Internal Revenue Service. Publication 502 (2025), Medical and Dental Expenses The standard rules apply: medical expenses are deductible only to the extent they exceed 7.5% of your adjusted gross income, and you need to itemize rather than take the standard deduction.
Reimbursements you receive from the NMDP for travel or medical costs are generally not taxable because they replace expenses you actually incurred. Dependent care reimbursements can be treated differently. The National Living Donor Assistance Center notes that dependent care reimbursements may be considered income subject to federal or state income tax reporting. If you receive reimbursements for childcare or lost wages, a tax professional can walk you through how they will land on your return.