ACS :: The Donor Experience

People usually volunteer to become stem cell donors either because they have a family member in need of a match or because they want to help people they don't know.

People who want to donate stem cells or join a volunteer registry can speak with their doctors or contact the National Marrow Donor Program to find the nearest donor center. Potential donors are asked some questions to make sure they are healthy enough to donate and don't pose a risk of infection to the recipient. For more information about donor eligibility guidelines, contact the National Marrow Donor Program or the donor center in your area (see the "Additional resources" section).

A simple blood test is done to learn the potential donor's HLA type. There is often a one-time, tax-deductible fee of about $50 to $100 for this test. People who join a volunteer donor registry will most likely have their tissue type kept on file until they reach age 60.

Pregnant women who want to donate their baby's umbilical cord blood can contact the National Marrow Donor Program to find the nearest cord blood donation center. Donation is safe, free, and does not affect the birth process. As with donors of other sources of stem cells, the mother must meet certain guidelines. (Privately storing a baby's cord blood for future use is not the same as donating. It is covered in the section, "Other issues related to stem cell transplants.")

If a potential stem cell donor is found to be a good match for a recipient, steps are taken to teach that person about the transplant process and make sure he or she is making an informed decision. A consent form must be signed after the risks of donating are fully discussed, if the person decides to donate. The donor is not pressured take part. It is always a choice.

If a person decides to donate, a medical exam and blood tests are done to make sure the donor is in good health.

A donor might also give a couple of pints of blood, which is stored in a blood bank. The blood is given back to the donor on the day the stem cells are removed.

The donor is put under general anesthesia (given medicine to put them into a deep sleep) while bone marrow is taken. This is often called bone marrow harvest, and is done in an operating room. The marrow cells are taken from the back of the pelvic (hip) bone. Enough cells must be collected for the transplant, but the amount taken depends on the donor's weight. Often, about 10% of the donor's marrow, or about 2 pints, are collected. This takes about 1 to 2 hours. The body will replace these cells within 4 to 6 weeks. Or, if the donor gave blood before the marrow donation, it may be given back to the donor at this time.

After the bone marrow harvest is done, the donor is taken to the recovery room while the anesthesia wears off. The donor may then be taken to a hospital room, and be watched until they are fully alert and able to eat and drink. In most cases, the donor is free to leave the hospital within a few hours or by the next morning.

The donor may have soreness, bruising, and aching at the back of the hips and lower back for a few days. Over-the-counter acetaminophen (Tylenol^®) or non-steroidal anti-inflammatory drugs (aspirin, ibuprofen) are usually helpful. Some people may feel tired, weak, and have trouble walking for a few days. The donor might be told to take iron supplements until the number of red blood cells returns to normal. Most donors are back to their usual activities in 2 to 3 days. But it may take 2 or 3 weeks before they feel completely back to normal.

Risks for donors are minimal and serious complications are rare. But bone marrow donation is a surgical procedure. Rare complications could include anesthesia reactions, infection, transfusion reactions (if a blood transfusion is needed), or injury at the needle insertion sites. Problems such as sore throat or nausea may be caused by anesthesia.

Allogeneic stem cell donors do not have to pay for the harvesting because the recipient's insurance company usually covers the cost.

Once the cells are collected, they are filtered through fine mesh screens. This prevents bone or fat particles from being given back to the recipient. For an allogeneic or syngeneic transplant, the cells may be given to the recipient through a vein soon after they are harvested. Sometimes they are frozen, such as when the donor lives far away from the recipient.

For several days before starting the donation process, the donor is given a daily injection (shot) of filgrastim (Neupogen^®). This is a growth-factor drug that causes the bone marrow to make and release stem cells into the blood. Neupogen can cause some side effects, the most common being bone pain and headaches. These can be treated with over-the-counter acetaminophen (Tylenol^®) or non-steroidal anti-inflammatory drugs (like aspirin or ibuprofen). Nausea, sleeping problems, low-grade (mild) fevers, and tiredness are other possible effects. These all go away once the injections are finished and collection is completed.

Peripheral blood stem cells are taken through a catheter (a thin, flexible plastic tube) that is put in a large vein in the arm. Blood is taken out and cycled through a special machine that separates the stem cells from the other blood cells. The stem cells are kept while the rest of the blood is returned to the donor. This process is called apheresis. It takes about 2 to 4 hours and is done in an outpatient clinic. Sometimes the process needs to be repeated daily for a few days, until enough stem cells have been collected.

Possible side effects of the procedure can include trouble placing the catheter in the vein, infection in the catheter, and blockage of the catheter. Blood clots are another possible side effect. During the apheresis procedure donors may feel lightheaded or tingling and/or chills from the anti-coagulant drug used to keep the blood from clotting in the machine. These effects go away after donation is complete.

The process of donating cells for yourself (autologous stem cell donation) is pretty much the same as when someone donates them for someone else to use (allogeneic donation). It's just that in autologous stem cell donation the donor is also the recipient, giving stem cells for his or her own use later on.

Some centers clean or "purge" the stem cells used for autologous transplants. This is done before the stem cells are given back to the patient to remove any cancer cells that might be mixed in with them. It is uncertain whether this helps, as it has not yet been shown to reduce the risk of cancer coming back (recurrence).

A possible downside is that some stem cells can be lost during the purging process. This may cause the patient to need more time to begin making normal blood cells and leave the patient without white blood cells or platelets for a longer period of time. This, in turn, may cause an increased risk of infection or bleeding problems. Research is being done to look at the need to purge stem cells and the best way to do it.

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