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FAQ's

Q:	Describe the stem cell donation process.
Q:	What are the risks for the stem cell donor?
Q:	Does marrow donation hurt?
Q:	Where is the marrow donation done?
Q:	How many people have donated marrow?
Q:	How is a donor found?
Q:	How are patients matched with donors?
Q:	What are the chances of finding a match?
Q:	What happens if a match is found?
Q:	Can someone who is identified as a potential donor match decline to donate?
Q:	What is the difference between marrow and PBSC (peripheral blood stem cell) donation?
Q:	How will I know whether I'll be asked to donate marrow or PBSC?
Q:	Which method of donation is easier for the donor?
Q:	Does donation hold any special risks?
Q:	Who pays for the donation procedure? How much does it cost?

Answers

(Information below is from the National Marrow Donor Program)

Describe the stem cell donation process.

A: When you donate marrow, it is removed with a surgical needle from the back of your pelvic bone. All marrow donors are given either general or regional anesthesia. Usually, four to eight tiny incisions are made in the pelvic area. These incisions are so small that stitches are not necessary. The procedure lasts between 45 and 90 minutes. Marrow is constantly regenerating itself and is replaced within several weeks. 

For a donation of peripheral blood stem cells, the donor receives one injection of Filgrastim each day for four to five days. Filgrastim is a drug that increases the number of stem cells released from the bone marrow into the blood stream. The stem cells are collected from the blood stream through a process called apheresis. During apheresis, which is done at a blood center or a hospital, your blood is removed through a sterile needle placed in a vein in one arm and passed through an apheresis machine that separates out the stem cells. The remaining blood, minus the stem cells, is returned through a sterile needle placed in a vein in the other arm.

What are the risks for the stem cell donor?

A: Bone marrow donation is a surgical procedure. There is minimal risk involved. Serious complications are rare but could include anesthesia reactions, infection, transfusion reactions, or injury at the needle insertion sites. With a marrow donation, donors can expect to feel some soreness in the lower back for several days or longer following the donation. 

Peripheral blood stem cell (PBSC) donors may experience bone pain, muscle pain, nausea, insomnia and fatigue while receiving injections of Filgrastim. Bone pain and headaches have been the two most frequently reported symptoms. These effects disappear promptly when the collection is complete. During the apheresis procedure some donors experience a tingling feeling from the anticoagulant used to keep the cells from clotting. Others experience chills. These effects are relieved after the donation is complete.

Does marrow donation hurt?

A: Following the procedure, donors can expect to feel some soreness in the lower back for a few days or longer. Some donors have also reported feeling fatigued and having some difficulty walking.

Where is the marrow donation done?

A: The NMDP works with more than 100 medical centers nationwide. Usually, a donor doesn't have to go far from home for the procedure. The donor usually enters the hospital the morning of the procedure and sometimes spends the night there. Afterward, the time it takes to recuperate varies from person to person. Most donors are back to their usual routine within a few days. Some may take two or three weeks before they feel completely recovered.

How many people have donated marrow?

A:More than 11,000 individuals have donated marrow for unrelated patients since the NMDP began operation in 1987. Thousands more, perhaps 50-60,000, have donated for family members.

How is a donor found?

A: The first place physicians look for a match is within the patient's immediate family. Regardless of race or ethnicity, each person has a unique tissue type inherited from his or her parents, which is why the chances of finding a match are best among family members. The chances of two siblings matching each other are one in four.

If no related donor can be found, the search for an unrelated donor begins. To help match patients and unrelated donors, the NMDP maintains a computerized Registry that records the tissue type of individuals who have agreed to donate stem cells. The computer crosschecks its records to see if there is a match for the patient. The Registry currently contains approximately four million potential donors.

How are patients matched with donors?

A: Proteins called antigens are found on the surface of the white blood cells and other body tissue. Particular antigens, named HLA-A, HLA-B and HLA-DR are essential to the success of stem cell transplants. These antigens are used to "match" a patient with a donor. When looking for a match it's important to remember that people of the same race and ethnic groups are more likely to match each other.

What are the chances of finding a match?

A: Approximately 80 percent of all patients identify at least one potential match on their preliminary search. This number has improved significantly (in 1991, it was 41 percent) because of increased recruitment efforts to add racial and ethnic diversity to the Registry. Remember, however, that not all of the 80 percent of patients who identify an identical donor at the preliminary search will necessarily go on to the transplant stage. Similarly, the 20 percent who do not immediately find a match may subsequently locate one or else receive a transplant from a donor who is less than a complete match.

What happens if a match is found?

A:Once the initial search identifies a potential match, the donor is called and asked to come in to the Donor Center for further testing. If the tests show the donor's stem cells are truly compatible with the patient's, the donor will be given a physical examination and a full explanation of the marrow and stem cell donation processes. After reviewing all the information, the donor is asked to sign an "Intent to Donate" or "Consent" form. At this point, the donor must be absolutely certain about their decision to donate, since the patient will begin to undergo treatment to prepare for the transplant.

Can someone who is identified as a potential donor match decline to donate?

A:Sometimes a potential donor who is successfully matched with a patient needing a transplant may decide not to go forward with the procedure. There are many reasons for saying no, including illness, amount of time involved, the risk, or even fear of the donation process. As a volunteer, the donor is under no form of legal obligation. Individual decisions are always respected.

However, because a late decision not to donate can be life-threatening to the patient, the significance of this decision is explained to the donor right from the start. A last minute change of mind may be fatal to the patient awaiting the transplant. Many people contacted to be stem cell donors experience some hesitation, which is perfectly natural. Donating marrow or PBSC is a serious commitment. But most decide to go ahead with the procedure once they balance all the facts and consider what their decision will mean to themselves and the recipient.

What is the difference between marrow and PBSC (peripheral blood stem cell) donation?

A: Unlike marrow donation, a PBSC donation requires no anesthesia. Marrow donors may experience pain and residual stiffness up to a few weeks after the procedure. PBSC donors experience symptoms such as bone pain and muscle pain prior to the donation while receiving Filgrastim, the drug used to increase the release of stem cells from the bone marrow.

How will I know whether I'll be asked to donate marrow or PBSC?

A: If it has been determined you are a complete match for the patient, you will be told which method the patient's physician requests prior to your preparation to donate. You will receive further education about bone marrow and PBSC donation. You will then be asked to sign an "Intent to Donate" or "Consent" form. At this point, the donor needs to be absolutely certain about making the donation because the patient will begin to undergo treatment to prepare for the transplant.

Which method of donation is easier for the donor?

A:It is not so much a matter of one or the other being easier. Each method has its own discomforts and side effects. One individual may feel marrow donation is the easier procedure, while another may feel that PBSC donation would be easier.

Q: Does donation hold any special risks?

A:The safety and well being of donors is the first concern of the NMDP. While neither donation procedure has any affect on the reproductive ability of women or men, pregnant women are prohibited from donating marrow or PBSC. The marrow donation procedure requires anesthesia, which could affect a developing fetus. The PBSC procedure requires injections of Filgrastim, which may also be associated with risk to the developing fetus. For this reason, women are asked to take a pregnancy test prior to receiving anesthesia or Filgrastim.

Who pays for the donation procedure? How much does it cost?

A: All medical costs for the donation procedure are covered by the patient or the patient's medical insurance, as are travel expenses and other non-medical costs. The only "costs" to the donor might be time taken off from work.