Deadly blood diseases kill more than 1,000 Americans every year, many of whom could be saved by finding matching bone marrow donors. The human body regenerates bone marrow—donors are whole again in just a few weeks after donation—so why are so many lives lost for lack of marrow?

The answer lies in the National Organ Transplant Act of 1984, which prohibits the compensation of bone marrow donors and stymies a market response to the demand for this renewable resource. Enacted to curtail a black market in nonrenewable solid organs (such as lungs and kidneys), NOTA provides for up to five years’ imprisonment for anyone involved in a compensated donation—including doctors, nurses, patients, and donors. NOTA’s prohibitions, while not covering other renewable cells such as blood (for which compensated donation is legal), do extend to bone marrow, creating the dire shortage of marrow donors.

The Institute for Justice has filed a lawsuit to challenge NOTA’s application to bone marrow. IJ represents Doreen Flynn, a single mother of five children, three of whom suffer from a deadly disease that often requires marrow transplants. Flynn’s urgent situation and the lawsuit filed on her behalf present an opportunity to reexamine NOTA and prohibitions on compensating renewable-cell donation in general. What are the benefits of such restrictions? If compensation is permitted in some form, how would the new donation system work and what would be the federal government’s role, if any?