The Donation Process
Before the Donation
In order to determine whether you can be a donor, we will first perform a cheek swab for HLA-typing (human leukocyte antigen) typing, which is a test that determines whether your bone marrow type is similar to that of the patient receiving the transplant.
What is a Stem Cell?
A stem cell is the progenitor or originator (forerunner) that produces the major components of the blood: red blood cells (RBCs), white blood cells (WBCs), and platelets. Stem cells are produced in the bone marrow, which is located inside the bones.
Who Needs a Stem Cell Transplant?
Patients suffering from a variety of diseases, such as leukemia, lymphoma, myeloma, myelodysplastic syndromes, aplastic anemia and some immune disorders are the conditions for which a transplant is most frequently used. Sometimes, standard chemotherapy (and other treatments) are not effective in eradicating the cancer or condition. Bone marrow or stem cell transplant can be life saving for these patients.
How Does the Transplant Work?
The patient undergoes a “preparative” regimen with chemotherapy and/or total body irradiation to kill cancer cells and to prepare his/her marrow to receive the new cells from the donor. Approximately 12-14 days after the infusion, donor stem cells can be detected in the blood stream as white blood cells. “Engraftment” is a term that indicates the donor cells are working in your bone marrow and growing. Exactly how the stem cells find their way to the marrow and start producing new cells is not fully understood.
Once it has been established that your HLA-type is sufficiently close to serve as a donor, we will schedule you for an appointment for a physical exam, blood test, chest x-ray and a heart test called an electrocardiogram (ECG or EKG). This first visit will be lengthy; you should expect to spend about 2-4 hours in our facility.
The purpose of these tests is to determine if donating would pose any risk for you, or for the patient. Donation is acceptable for most people even with medical conditions. Conditions which will usually prevent donation will be active non-skin cancer, or infections that can be given to the patient, such as HIV.
During this visit you will discuss the donation process with a physician and a transplant coordinator. You will also be asked to sign consent forms for the stem cell collection and testing.
The medical evaluation and testing to determine if you can be a donor will be billed to the transplant recipient’s medical insurance.
*All donors are required to have their physical exam, testing, and stem cell collection at New York Presbyterian Hospital.
Peripheral Blood Stem Cell Collection
The most common way to collect stem cells from adults is by a peripheral blood stem cell donation. For 4 consecutive days before the donation, the donor receives an injection of Neupogen (filgrastim). This medication promotes the stem cells to leave the bone marrow and circulate in the bloodstream, from where they can easily be collected. A nurse will teach you how to self-administer Neupogen. If you are uncomfortable with self-administration, you have the option of coming into the clinic each day for the injection. On the fifth day, you will be ready to have your stem cells collected. The transplant coordinator will provide you with a schedule to follow throughout the process.
Your blood will be removed through a needle placed in one arm. It is then passed through a machine that separates the stem cells from the other blood cells. Your blood is then returned to you through a needle in the other arm. This process is called “apheresis.” Because a large volume of blood circulates through the separator machine, good venous access is needed. If your veins are too small, we may need to insert a temporary central catheter (central line) in one of the largest veins to be able to collect the cells. The apheresis process takes 4 to 6 hours and is completed as an outpatient procedure. Depending on the number of cells collected, a second day of collection may occasionally be necessary.
Bone Marrow Donation
Peripheral blood stem cells are much more commonly used, but there are occasional instances in which a bone marrow collection is required. The process is called “bone marrow harvest,” and it is performed in an operating room. To make the procedure as comfortable as possible, the donor will be given an anesthetic, either general anesthesia or regional (where you are awake but medication in the lower back blocks the pain). A large needle is put through the skin and onto the back of the hip bone. It is pushed through the bone to the center, and the thick, liquid marrow is pulled out through the needle. This process is repeated several times until enough marrow has been harvested. The amount taken depends on the donor’s weight. The procedure takes about 1 to 2 hours. The body will replace these cells within 4 to 6 weeks. After the procedure, the donor is taken to the recovery area and monitored until the anesthesia wears off. Most donors experience some soreness (or stiffness) in the lower back where the marrow was collected. However, the soreness usually subsides within several days. Serious complications are rare but could include reaction to anesthesia, infection, transfusion reactions (if a transfusion is needed), or injuries at the needle insertion sites.