A Penny For Your Stem Cells

As you may recall, the first big step in the stem cell transplant procedure that I underwent two years ago was the harvesting of my own stem cells. Over a period of several days I was given a drug (Neupogen) that stimulated the bone marrow's production of stem cells, and pushed them out into the blood stream. When there were enough of them out there, they were extracted (a process called "apheresis") and frozen for future use. This type of peripheral blood stem cell transplant, in which I was both the donor and the recipient of the stem cells, is called "autologous". In the other type of stem cell transplant, called "allogeneic", the donor and the recipient of the stem cells are different people. And according to the provisions of the National Organ Transplant Act, the donor must not be compensated for his or her role in the transaction.

The Act doesn't say so explicitly, though, because in 1984, when it became law, neither type of peripheral blood stem cell transplant existed. At that time, stem cells had to be extracted physically from the donor, in a process known as "aspiration" -- the same process I undergo when I get a bone marrow biopsy. It involves anesthetics, and big hollow needles that are pushed directly into the donor's bones. Except whereas just a small amount of marrow is quickly extracted for a biopsy, a great deal more must be taken for a bone marrow transplant. It's a lengthy, dangerous and painful process for the donor, which is why bone marrow donors have traditionally been difficult to come by, and why this older type of bone marrow transplant has been progressively replaced by peripheral blood stem cell transplants. But the anti-compensation provisions of NOTA have been assumed to apply uniformly to stem cells, irrespective of the method of their extraction, even though the law's text necessarily refers only to bone marrow extracted via aspiration.

Until now, maybe. Recently the 9th U.S. Circuit Court of Appeals ruled that stem cells extracted by apheresis are more akin to ordinary blood than to an "organ" -- it has always been possible to pay people for their blood -- and that therefore NOTA does not apply to stem cells extracted via apheresis. It hardly need be said that such a ruling is controversial -- it's thought by some to represent a "camel's nose" for the eventual development of a market in organs -- and is probably headed for final resolution by the U.S. Supreme Court, if Their Honors are interested.

The New #27

At long last I have the long-term replacement for tooth #27. On Thursday I returned to the dentist's office for the "delivery" (official dentist terminology) of the crown. He worked quickly, unscrewing the temporary insert and screwing in the real abutment. As an aside, you haven't lived until a dentist has climbed into your mouth to tinker in there with a wrench, as if he was a mechanic changing the plugs on a mid-size sedan. Fitting the crown required a couple of attempts, with adjustments to the shape made with a grinder. When he was satisfied, the crown came off one last time, and a semi-permanent cement was applied to the abutment. The cement is not the strongest dental cement available, so that the crown can be removed later, if necessary for some reason, without destroying it. The crown was then mounted for the last time, and the cement allowed to set for a couple of minutes. Finally came the most painful part of the process: The dental technician had to clean up the excess cement sticking around the lower edge of the crown, using a sharp implement; this caused substantial irritation to the surrounding gum.

Thus ends the strange and sorrowful tale of tooth #27, about which nothing more needs to be said, I hope.

One Step Removed From The Crown

Progress has seemed glacial all along, but today saw one step closer to the end of the saga of the late lamented tooth #27. I traveled to the dentist's office to have the impression taken for the implant's crown. The man used a grinder on the adjoining teeth to get a bit of clearance, unscrewed the oral surgeon's temporary abutment and replaced it with the real, permanent one, and then stuck an undersized version of your typical caulking gun into my mouth. The solidified result of the squishy stuff that came out of it will be sent off to the lab to be used to manufacture the crown. I will return on December 22 to have it installed.