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2001-AN ANALYSIS OF BONE MARROW DONATION REQUESTS TO THE WELSH ...

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					            AN ANALYSIS OF BONE MARROW
          DONATION REQUESTS TO THE WELSH
       BONE MARROW DONOR REGISTRY (WBMDR)
         THAT DID NOT PROCEED TO DONATION
           WELSH BLOOD SERVICE                                         T J REES, H HAMBLEY,
           GWASANAETH GWAED CYMRU                                      M McGREGOR, D POWELL AND
                                                                       C DARKE
           WELSH TRANSPLANTATION AND
           IMMUNOGENETICS LABORATORY
                                                                       Failure to provide bone marrow donation due to WBMDR
                                                                       donor causes
            FS 27925                      28-JAN-2000 TO 28-JAN-2001
                                                                       A further 25 donation requests (14.2% of the total closed-out
                                                                       requests and 16.5% of the 152 non-cancelled requests) did not
Introduction                                                           proceed to marrow donation due to WBMDR donor causes.

The process of finding a suitable stem-cell donor for a potential      Three donors had become pregnant between the confirmatory
recipient is achieved in several obligatory steps. These include:      typing sample testing stage and their selection for donation, and
The initial search for a suitably HLA matched donor; confirmatory      two donors finally declined to donate. The remaining 20 donors
typing sample testing, sometimes preceded by “expanded” HLA            were excluded from undergoing marrow harvest, which involves
typing by the WBMDR, and volunteer donor work-up, including            general anaesthesia, for medical reasons identified at their pre-
counselling and medical examination, for bone marrow donation.         donation independent medical assessment. The reasons for these
                                                                       included: Abnormal liver function tests; cardiac problems;
Some degree of donor “loss” occurs at all these stages. For            obesity, ie, body mass index (BMI) of > 35; and respiratory
example, failure to obtain a confirmatory typing sample, for           problems (Table 2).
various reasons, occurs in about 16% of instances while over 20%
of donors who are finally requested by transplant units fail to         Table 2. Failure of 25 WBMDR donors to provide bone
proceed to actual bone marrow donation (1).                             marrow donations
                                                                        _________________________________________________
Donor loss after Transplant Units’ request for a bone marrow
donation                                                                 Causes              Number    % of total failures
                                                                        _________________________________________________
Since June 1996, (when the WBMDR joined Bone Marrow Donors
Worldwide), and the end of April 2000, the WBMDR received 184            Abnormal liver function      6                24.0
requests to provide bone marrow donations for patients in the UK         Cardiac problems             5                20.0
and overseas.                                                            Obesity (BMI > 35)           3                12.0
                                                                         Respiratory problems         3                12.0
A total of 176 of these were completed during the period and 49
(27.8%) of these were unfulfilled. We have studied the reasons for
                                                                         Other reasons:
donor loss at this late stage of donation provision.
                                                                         Low mental ability
Bone marrow donation requests cancelled by Transplant Units              Factor VII deficiency
                                                                         Severe anaemia               3                12.0
Of the 176 requests that were closed-out during the period of the
study 24 (13.6%) were cancelled at the request of the Transplant
                                                                         Pregnancy          3          12.0
Units. The main reason for cancellation was the deferral of the
transplant, followed by patients’ death and selection of another         Declined           2           8.0
donor (Table 1).                                                        _________________________________________


                                                                       Conclusion
Table 1. Donor cancellations by Transplant Units
______________________________________________________                 This information indicates that even though the WBMDR donor
                                                                       panel is comprised of healthy, largely regular blood donors, 1 in 6
  Reason               Number    % of total cancellations              will finally either decline or be medically excluded, from actual
______________________________________________________                 bone marrow donation.

  Transplant deferred    14             58.3                           Reference
  Patient died            6             25.0
  Other donor chosen      4             16.7                           1. Darke C. An overview of the Welsh Bone Marrow Donor
______________________________________________________                    Registry: 10 years of bone marrow donor provision. Bone
                                                                          Marrow Transplantation 2000; 25: 771-777.



                                                                                                                     Compiled by L Lane

				
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