What’s It Like to Donate Stem Cells?

People usually volunteer to donate stem cells for an allogeneic transplant either because they have a loved one or friend who needs a match or because they want to help people. Some people give their stem cells so they can get them back later for an autologous transplant.

If you want to donate stem cells for someone else

People who want to donate stem cells or join a volunteer registry can speak with a health care provider or contact the National Marrow Donor Program to find the nearest donor center. Potential donors are asked 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 Be the Match or the donor center in your area.

Be the Match (formerly the National Marrow Donor Program)
Toll-free number: 1-800-MARROW-2 (1-800-627-7692)
Website: www.bethematch.org

A simple blood test is done to learn the potential donor’s HLA type. There may be a one-time, tax-deductible fee of about $75 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 cord blood should make arrangements for it early in the pregnancy, at least before the third trimester. Donation is safe, free, and does not affect the birth process.

Informed consent and further testing: Before the donation

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

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

How stem cells are collected

Stem cells may be collected from these 3 different sources:

• Bone marrow
• Peripheral stem cells
• Umbilical cord blood

Each method of collection is explained here.

Collecting bone marrow stem cells

This process is often called bone marrow harvest. It’s done in an operating room, while the donor is under general anesthesia (given medicine to put them into a deep sleep so they don’t feel pain). The marrow cells are taken from the back of the pelvic (hip) bone. The donor lies face down, and a large needle is put through the skin and into the back of the hip bone. It’s pushed through the bone to the center and the thick, liquid marrow is pulled out through the needle. This is repeated several times until enough marrow has been taken out (harvested). 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. If blood was taken from the donor before the marrow donation, it’s often given back to the donor at this time.

After the bone marrow is harvested, the donor is taken to the recovery room while the anesthesia wears off. The donor may then be taken to a hospital room and watched until fully alert and able to eat and drink. In most cases, the donor is able 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 nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen, or naproxen) are helpful. Some people may feel tired or 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 schedule in 2 to 3 days. But it could take 2 or 3 weeks before they feel completely back to normal.

There aren’t many risks for donors and serious complications are rare. But bone marrow donation is a surgical procedure. Rare complications could include anesthesia reactions, infection, nerve or muscle damage, transfusion reactions (if a blood transfusion of someone else’s blood is needed – this doesn’t happen if you get your own blood), 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 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’re frozen, for example, if the donor lives far away from the recipient.

Collecting peripheral blood stem cells

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 a lot of stem cells into the blood. Filgrastim can cause some side effects, the most common being bone pain and headaches. These may be helped by acetaminophen (Tylenol^®) or nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen, or naproxen). Nausea, sleeping problems, low-grade (mild) fevers, and tiredness are other possible effects. These go away once the injections are finished and collection is completed.

After the shots, blood is removed through a catheter (a thin, flexible plastic tube) that’s put in a large vein in the arm. It’s then cycled through a 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, often through the same catheter. (In some cases, a catheter may be put in each arm – one takes out blood and the other puts it back.) This process is called apheresis. It takes about 2 to 4 hours and is done as an outpatient procedure. Often the process needs to be repeated daily for a few days, until enough stem cells have been collected.

Possible side effects of the catheter can include trouble placing the catheter in the vein, blockage of the catheter, or infection of the catheter or at the area where it enters the vein. Blood clots are another possible side effect. During the apheresis procedure, donors may have problems caused by low calcium levels from the anti-coagulant drug used to keep the blood from clotting in the machine. These can include feeling lightheaded or tingly, and having chills or muscle cramps. These go away after donation is complete, but may be treated by giving the donor calcium supplements.

The process of donating cells for yourself (autologous stem cell donation) is pretty much the same as when someone donates them for someone else (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. For some people, there are a few differences. For instance, sometimes chemotherapy (chemo) is given before the filgrastim is used to tell the body to make stem cells. Also, sometimes it can be hard to get enough stem cells from a person with cancer. Even after several days of apheresis, there may not be enough for the transplant. This is more likely to be a problem if the patient has had certain kinds of chemo in the past, or if they have an illness that affects their bone marrow.

Sometimes, a second drug called plerixafor (Mozobil^®) is used along with filgrastim in people with non-Hodgkin lymphoma or multiple myeloma. This boosts the stem cell numbers in the blood, and helps reduce the number of apheresis sessions needed to get enough stem cells. It may cause nausea, diarrhea, and sometimes, vomiting. There are medicines to help if these symptoms become a problem. Rarely the spleen can enlarge and even rupture. This can cause severe internal bleeding and requires emergency medical care. The patient should tell the doctor right away if they have any pain in their left shoulder or under their left rib cage which can be symptoms of this emergency.

Collecting umbilical cord blood

Cord blood is the blood that’s left in the placenta and umbilical cord after a baby is born. Collecting it does not pose any health risk to the infant. Cord blood transplants use blood that would otherwise be thrown away. After the umbilical cord is clamped and cut, the placenta and umbilical cord are cleaned. The cord blood is put into a sterile container, mixed with a preservative, and frozen until needed.

Some parents choose to donate their infant’s cord blood to a public blood bank, so that it may be used by anyone who needs it. Many hospitals collect cord blood for donation, which makes it easier for parents to donate. Parents can donate their newborn’s cord blood to volunteer or public cord blood banks at no cost. For more about donating your newborn’s cord blood, call 1-800-MARROW2 (1-800-627-7692) or visit Be the Match.

Other parents store their newborn’s cord blood in private cord blood banks just in case the child or a close relative needs it someday. If you want to donate or bank (save) your child’s cord blood, you’ll need to arrange it before the baby is born. Some banks require you to set it up before the 28th week of pregnancy, although others accept later setups. Among other things, you’ll be asked to answer health questions and sign a consent form.

Parents may want to bank their child’s cord blood if the family has a history of diseases that may benefit from stem cell transplant. There are several private companies offer this service. But here are some things to think about:

• A single cord blood unit might not have enough stem cells for most adults, so personal cord blood use could be limited.
• Some diseases that can be treated with transplant require stem cells that come from another donor (allogeneic). Infusing autologous cord blood stem cells that contain the same defect would not cure the disease.
• The “shelf life” of cord blood is not known. Because cord blood storage is a recent development, scientists don’t know whether blood taken at birth will be useful if a family member develops a disease treatable by stem cell transplant 50 years later.
• The private collection fee can be a few thousand dollars, with another couple hundred dollars per year to store the cord blood. You’ll want to check on costs because they’ll probably increase over time, and they may vary from one part of the country to another.

More information on private family cord blood banking can be found at the Parent’s Guide to Cord Blood Foundation. You can visit their website at www.parentsguidecordblood.org.