People typically give stem cells for an allogeneic transplant; because they have a loved one or acquaintance who needs a match or because they wish to help others. Some people donate their stem cells in the hopes of receiving them back in the future; if they require an autologous transplant.
If you want to donate stem cells for someone else
The medical guidelines protect the health of potential donors; as well as the health of bone marrow and stem cell transplant patients. Many factors can influence whether or not a person is qualified to register as a donor.
People who want to donate stem cells or join a volunteer registry, including cancer survivors, should check the registry’s qualification list. They can also talk to their doctor or contact the National Marrow Donor Program to identify the closest donor center. Experts question the potential donors to ensure that they are healthy enough to donate and that they will not infect the receiver.
The experts administer a simple blood test 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.
Before the donation: Informed consent and further testing
If a potential stem cell donor is discovered to be a good match for a recipient, the donor is educated about the transplant procedure to ensure that he or she is making an informed decision. If a person agrees to donate, they must sign a consent form after getting proper information about the hazards of doing so. The donor is under no obligation to participate. It’s always a decision.
If a person chooses to donate, an expert will do a medical exam and blood to make sure the donor is in good health.
Collecting stem cells
- Bone marrow
- Peripheral stem cells
- Umbilical cord blood
Collecting bone marrow stem cells
Bone marrow harvest is the common name for this procedure. Experts do it in an operating room; where the expert sedates the donor (i.e., gives medicine to put them to sleep so they won’t experience pain). The cells come from the back of the pelvic (hip) bone. An expert inserts a huge needle through the skin and into the back of the hip bone of the donor, who is lying facing down. The needle is driven through the bone to the core, where the thick, liquid marrow is extracted. The experts do it multiple times until he/she extracts (harvests) all of the marrow.
The weight of the donor determines the amount taken. Typically, an expert takes roughly 10% of the donor’s marrow, or about 2 pints. This takes 1 to 2 hours. The body will replace these cells within 4 to 6 weeks. If an expert takes blood from the donor before the marrow donation, the expert often gives it back to the donor at this time.
After harvesting the bone marrow, the expert takes the donor to the recovery room while the anesthesia wears off. They may later take the donor to a hospital room and watch them until fully observant 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.
For a few days, the donor may have discomfort, bruising, and aching in the back of the hips and lower back. Nonsteroidal anti-inflammatory drugs (NSAIDs) or over-the-counter pain relievers can assist. For a few days, some people may feel weary or weak and have difficulty walking. A doctor can prescribe iron supplements to the donor until the quantity of red blood cells returns to normal. In 2 to 3 days, most donors are back to their normal routine. However, it may take up to two or three weeks for them to feel completely normal again.
Donors have few risks, and severe consequences are uncommon. Bone marrow donation, on the other hand, is a surgical process. Anesthesia responses, infection, nerve or muscle damage, transfusion reactions or injury at the needle insertion sites are all rare complications. Anesthesia might produce problems such as a sore throat or nausea.
The recipient’s insurance company normally covers the harvesting, thus allogeneic stem cell donors do not have to pay for it. Even so, before you decide to have the bone marrow harvest done, make sure you ask about insurance coverage.
Once the doctor collects the cells, they filter them through fine mesh screens. This prevents giving bone or fat particles to the recipient. For an allogeneic or syngeneic transplant, the doctors may give the cells to the recipient through a vein soon after harvesting them. Sometimes they’re frozen; for example, if the donor lives far away from the recipient.
Collecting peripheral blood stem cells
The donor is given a daily injection (shot) of a medication that induces the bone marrow to create and release a large number of stem cells into the bloodstream for many days before beginning the donation process. Filgrastim has a number of potential adverse effects, the most prevalent of which being bone pain and headaches. Over-the-counter pain relievers and nonsteroidal anti-inflammatory medicines may be helpful. Other side effects include nausea, sleeping problems, low-grade (moderate) fevers, and exhaustion. After performing the injections and completing the collection the collection, these will vanish.
After the shots, the experts remove the blood using a catheter. They then cycle it through a machine that separates the stem cells from the other blood cells. The experts then keep the stem cells while returning the rest of the blood to the donor, often through the same catheter. This process is apheresis. It takes about 2 to 4 hours and the experts do it as an outpatient procedure. Often the experts repeats the process daily for a few days until collecting enough stem cells.
Problems inserting the catheter into the vein, catheter obstruction, or infection of the catheter, or the location where it enters the vein are all possible side effects. Another possible side effect is blood clots. Low calcium levels from the anticoagulant medicine used to keep the blood from clotting in the machine may pose complications for donors during the apheresis operation. Light-headedness or tingling, as well as chills or muscle cramps, are all possible symptoms. These go after the donation, although the experts can treat them by giving calcium supplements to the donor.
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 the doctor gives chemotherapy (chemo) before the growth factor drug. 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.
Collecting umbilical cord blood
Cord blood is present in the placenta and umbilical cord after a baby is born. Collecting it does not pose any health risk to the infant or the mother. Cord blood transplants use blood that would otherwise be thrown away. After the experts clamp and cut the umbilical cord, they clean the placenta and umbilical cord. The cord blood is put into a sterile container, mixed with a preservative, and frozen until needed.
Some parents opt to give their child’s cord blood to a public blood bank so that anyone in need can utilize it in need. Many hospitals collect cord blood for donation, making the process easier for parents. At no cost to the parents, they can donate their newborn’s cord blood and can be to volunteers or public cord blood banks.
Other parents deposit their newborn’s cord blood in private cord blood banks in the event that the child or a close relative requires it in the future. You must make arrangements to donate or bank (save) your child’s cord blood before the baby is born. Some banks require you to open an account before the 28th week of pregnancy, while others allow you to open an account afterward.
Among other things, experts may ask you 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 that offer this service. But here are some things to think about:
- Because a single cord blood unit may not have enough stem cells to meet the needs of most individuals, personal cord blood use may be limited.
- Some disorders that can be treated with transplants necessitate the use of stem cells from a different donor (allogeneic). The disease would not be cured by infusing autologous cord blood stem cells with the same disease or condition.
- Cord blood has an unknown shelf life. Because cord blood storage is a new concept, experts are unsure if blood obtained at birth will be useful if a family member develops an illness that can be treated with stem cell transplantation 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.