The Donor Experience
The Donor Experience
All stem-cell donors are evaluated in the IBMT clinic before the patient receives the chemotherapy (and/or radiation) treatment that begins the transplant process. All donors will meet with an IBMT physician. To protect the donor's interests and confidentiality, the donor's physician will be a physician other than the primary one caring for the stem-cell recipient before transplant. A complete history and physical examination will be performed, and the donation process will be explained. Furthermore, laboratory tests, chest X-ray and EKG will be done. Then the donor will be asked to sign the consent for the procedure. Either a bone-marrow harvest or peripheral blood stem-cell collection will be scheduled.
Bone Marrow Harvest
Bone marrow harvests are usually done under general anesthesia, but can also be done under epidural or spinal anesthesia. The collection takes place in a sterile operating room. The procedure is often done as a "same day procedure" with the donor being admitted early in the morning, and discharged in the late afternoon or early evening. Donors are asked not to eat or drink anything after midnight the night before the procedure, and to report to the hospital around 6:00 am. Some final blood tests will be drawn and an Operating Room consent will be signed. After surgery, donors will be taken to the recovery unit. Once they are fully awake and stable, they will go to a nursing unit of the hospital. Then they either stay overnight, or are released later the same day.
Many donors will be asked to donate a unit of their own blood about 2-4 weeks prior to surgery. This blood will be stored and returned to the donor during, or immediately after, the bone-marrow collection. Blood can be donated for this purpose at many places around the state. The IBMT physician who does the donor physical examination will determine whether the donation of blood is necessary. Donors are also asked not to take aspirin-or ibuprofen-containing drugs for1-2 weeks prior to the bone marrow harvest.
After a bone marrow harvest, donors will feel soreness in the hip areas like they have fallen on ice or have had a bout of the flu. Tylenol® or other pain medication will relieve most soreness. Aspirin or ibuprofen-containing painkillers are not recommended, because they can increase bruising. Most donors are able to return to work 1-2 days following the procedure. Donors who do a lot of lifting or bending, may require more time to recover. Appropriate statements for work will be supplied upon request. Bandages that were applied at the end of surgery, should remain in place for 48 hours.
Blood Stem Cell Donation
Peripheral blood stem cell (PBSC) donations take place in the IBMT Clinic Apheresis Center. These collections are done much like donations of platelets or plasma (see Apheresis pamphlet). The procedure involves separation and collection of white cells from the peripheral blood using a cell separator machine. Large I.V. tubes will be placed in both arms; blood will flow from one arm into the machine, the white cells will be collected, and the rest of the blood will be returned to the donor through the other arm. If a donor's veins are not adequate to allow the machine to collect at a sufficient rate, the donor may need to have a catheter placed in a vein under the collar bone or in the groin. In either case, a single collection will take two to four hours. Depending upon the number of cells required and collected, this process may be repeated two or three days in a row.
If a donor is being asked to donate "mobilized" stem cells, daily shots of "growth factor" (Neupogen®) are given under the skin (like insulin shots) for 4 days prior to the start of the collections. This growth factor increases the number of stem cells in the blood, but may also cause bone pains or headaches. Tylenol® will relieve most of the symptoms, but occasionally stronger painkillers are needed. These side effects will disappear rapidly after the shots have been stopped. Donors who have a history of blood clots, stroke, or coronary artery disease may be at increased risks for problems associated with "growth factor" mobilized collections.
Additional Requests of Donors
Instances may occur where the donor will be asked to come back after the original collection to donate additional blood products. Occasionally, platelets may be needed if the patient does not respond to platelets from blood bank donors. More frequently, additional stem cells (either bone marrow or peripheral blood stem cells) or white blood cells ("donor lymphocytes") will be required, because either the patient still has low counts, or there is an increased risk for recurrence of the cancer. Unless an emergency arises, the IBMT physicians will discuss that issue with the donor prior to transplant.
Please discuss any concerns with your IBMT physician or the transplant coordinator.