When it comes to organ transplants, the closer the match between donor and recipient, the better the outcome. This is especially true for bone marrow transplants, which have more stringent requirements for matching than solid organs since they aim to rebuild all the bone marrow in the patients after treatment has eliminated both the defective blood cells associated with their cancer and their healthy blood cells. Indeed, matches are often very difficult to find, even in the National Bone Marrow Registry which keeps a list over 18 million prospective, volunteer donors throughout the world.
Earlier this year, a leukemia patient at the Hospital of the University of Pennsylvania was in dire need of a bone marrow transplant. Joanne Hinkle, Unrelated Bone Marrow Donor Coordinator, found only one potential donor on the Registry but there was a big problem: he was in another country and in a place that was not readily accessible to a location where he could have his blood drawn. “The situation was absolutely critical,” she said.
Working with the donor center in the originating country, Hinkle was able to get the donor brought to a U.S. donor center within a couple days, but he could only stay for a week. Normally HLA (human leukocyte antigen) testing – which is necessary to confirm compatibility of most organ matches -- can take up to 10 days to complete, but members of the hospital’s HLA lab went into overdrive for this patient. The results came back within two days, with good news: The donor was a match. Within a week, the donor’s bone marrow was harvested and hand carried to HUP and the transplant went ahead.
Although the need for a bone marrow transplant can typically be scheduled and is not normally an emergency situation -- such as a heart and lung transplant candidates whose organs are shutting down – “we couldn’t put it off because who knew when another matching donor might become available.”
Currently, more than 18,000 people in this country diagnosed with leukemia and lymphoma, sickle-cell and other life-threatening diseases need bone marrow transplants to save their lives. The vast majority – 70 percent – do not have a matching donor in their family.
There are two ways to become a marrow donor. In the circumstance above, the donor had bone marrow removed from his hip in the operating room under anesthesia. Today, however, many bone marrow donations occur through a process similar to donating blood. Instead of the blood flowing into a bag, though, a process known as apheresis removes blood through a needle from one arm, passes it through a special machine which separates blood stem cells from the peripheral blood, and then returns the blood through the other arm.
Despite these advances, many myths surround bone marrow donation. For example, many people believe it’s painful with a long recovery. Or they think it’s dangerous and weakens the donor. In reality, for those donating actual bone marrow, only 5 percent of the donor’s marrow is removed, which the body replaces within four to six weeks. Donors usually return to normal routines within a couple days. For those donating blood stem cells by apheresis, recovery of one's bone marrow or one's ability to return to a normal routine is not an issue. A recent story on NBC’s Rock Center about the controversy around whether to compensate marrow donors to encourage more people to participate, featured a woman in HUP’s apheresis unit who was donating her blood stem cells for her brother, who needed a bone marrow transplant as part of his leukemia treatment. “It’s easy,” the woman said, noting that the donation process required only a needle stick and a few hours of her time.
Although everyone over 18 is encouraged to register to become a donor, the more diverse the donor population in terms of racial and ethnic heritage, the more likely a patient will find a match. Compatible blood types and tissue markers – critical qualities for matching donors and recipients – are more likely to be found among members of the same ethnicity, but currently, a shortage of minority donors leaves many patients without a readily available donor.
Registering to be part of the National Bone Marrow Donor Registry is fast and easy, requiring only a swab of the inside of the cheek and ending with the power to save a life. To learn more, go to www.bethematch.org
To get a glimpse of who you could help by becoming a donor, click on the video below.