The Precious Gift of Bone Marrow
Most people have heard about bone marrow donations but may be unclear about who makes the best match and how complicated and safe donations are. Health’s Denise Hamilton asked Dr. Dennis L. Confer, chief medical officer with the National Marrow Donor Program, to walk us through the procedure.
Question: Could you tell us what marrow is, what kind of patients need transplants and why it’s important that people donate?
Answer: The bone marrow is a jelly-like substance that is located in the bone cavities. It makes blood cells: red blood cells that carry oxygen, platelets that are essential to control blood clotting and white blood cells, which comprise the body’s immune system. People need bone marrow transplants when their own cells are abnormal, either because they are cancerous or because they fail to do their job (due to congenital defects that may develop later in life, such as aplastic anemia).
Finding a bone marrow match--what we call tissue-type matching--is very complicated and bears no relationship to blood-type matching. Only about one person in three will have a family member match. An alternative for these people is an unrelated donor. The National Marrow Donor Program has registered and tissue-typed 4 million potential donors, but despite this large number, only about 50% of searching patients identify a suitable donor. This unfortunately means that several thousand people die annually for lack of a transplant.
Q: How many people donate marrow each year? What are the risks to the donor? I’ve read rare, but riveting, horror stories of people developing acute infections and almost dying as a result of donating marrow.
A: Donating stem cells for marrow or blood stem cell transplantation is a very safe and common procedure, with more than 7,000 taking place worldwide each year. Because the donation requires anesthesia and puncturing of the skin, complications do occasionally arise, but the frequency of major and life-threatening complications is very small, at approximately 0.2%. In the 30 years that stem cell transplants have been performed, only three known deaths have occurred that were clearly associated with the marrow collection procedure.
Q: Who can donate?
A: Anyone over 18 in good health who is not pregnant or under medication. You can donate once a year. But you have to be very sure, very comfortable with your decision. Because once your marrow is found to be a match, you’ll sign a consent form, and the person needing a transplant begins a harsh, seven- to 10-day regimen of chemotherapy and radiation to destroy all his or her diseased stem cells. Changing your mind after signing the consent form could be potentially fatal for the patient, since if the patient doesn’t receive the new cells, he or she will probably die.
Q: So you’ve convinced me that this is important. I’m all set to donate marrow. What’s my first step?
A: You’ll provide a small blood sample that will be tested for human leukocyte antigens, protein markers on the surface of your white blood cells. When someone is identified as a potential match for a patient, he or she will also be screened for HIV, hepatitis and other blood-transmitted diseases.
Q: Is there a fee?
A: Not if you’re a person of color. We have a severe shortage of donors of color, so we receive grants and subsidies to encourage them to donate, since transplants work best when donors and patients share the same racial or ethnic background. Additionally, some companies subsidize the blood-screening procedure for all employees, and some blood centers have sliding scales, depending on income. If there is a fee, it should range from $35 to $90, depending on the donor center where you join.
Q: What happens after that?
A: Your blood information is entered into the registry and searched against any patient looking for a donor. If you’re identified as a potential match, you’ll be called in for another blood test to confirm the typing. Then you’ll receive a complete physical exam, get counseled and sign the consent form. You’ll check into a hospital that serves as a collection center to harvest cells. Since donating marrow is a surgical procedure, you will be put under general or local anesthesia, depending on your preference. Then the doctor will insert a special needle and syringe into your pelvic area, on each side of your hip, because that’s where the largest concentration of marrow is. The needle is bigger and longer than the average. The cells are extracted and put into a transfusion, or IV bag. Depending on the size of the patient, doctors may need to harvest between two to four bags. The whole procedure takes 90 minutes.
Q: Does it hurt?
A: When you wake up, you’ll feel achiness. It’s not a sharp pain.
Q: And what happens to your marrow?
A: The transplant itself is a simple procedure, like a blood transfusion. The cells are infused into the patient’s bloodstream in four to six hours. That’s it, no surgery or incisions.
Q: How soon do you know if it took?
A: Doctors look for an increased white blood cell count in the first three weeks. That means the cells are engrafting, taking to the new body and starting to multiply.
Q: What’s the likelihood that a transplant will be successful?
A: The odds are 40% to 60%. It depends on the age and health of the patient. If it still doesn’t take, and no other match is found, it’s possible the patient will die.
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The National Bone Marrow Donor Program Foundation in Minneapolis can be reached at (800) MARROW-2 or https://www.marrow.org. The Caitlin Raymond International Registry in Worchester, Mass., can be reached at (800) 726-2824 or https://www.crir.org.
