Summary of the Donor Work-Up Phase
The compatibility testing phase is complete and we have identified a volunteer who meets our match criteria for unrelated stem cell donors. We have reached a point where we will finally be able to obtain answers to some very critical questions. Is the donor educated about stem cell donation? Does the donor want to donate their stem cells? Is the donor healthy enough to donate? All of these questions will soon be answered.
To enter this phase, our transplant center is required to submit completed paperwork, including the results of confirmatory tissue typing, to the donor registry. We have fulfilled all requirements and the identified donor is now officially in the work-up phase.
The following is a summary of the donor's involvement in this process, tests that will be performed, and the amount of time it usually takes to complete this phase.
Donor Information Session
The volunteer will be contacted by a member of their donor center and informed that they are the chosen stem cell donor for a patient who is in need of a stem cell transplant. The volunteer will be asked to come in to the donor center for an information session. They will be encouraged to bring a family member or close friend with them. If the volunteer agrees to continue, an information session will be scheduled.
During the information session, the donor and their companion will be counseled about stem cell donation. They will view a video featuring stem cell donation from both a donor and patient perspective. Members of the donor center staff will further outline the procedure and answer questions. The donor will be told of the consequences to the patient should a donor change their mind and decide not to proceed to donation once a patient has begun ablative therapy.
The risks of donating stem cells will be reviewed with the donor. The risks to the donor are low, but problems that could occur are highly significant.
At the end of the information session, the donor is asked if they are willing to proceed towards donation. Most donor centers encourage their volunteers to take at least one night to think about their interest in donation prior to giving an answer.
Donor Physical Evaluation
If a donor decides to proceed, they will be scheduled for a physical evaluation. Most often, the donor is evaluated by a physician at the intended collection center. The donor will have a physical examination, chest x-ray, EKG, and lots of blood drawn for laboratory work. The harvesting physician along with the Medical Director of the donor center will determine if the donor is medically able to donate stem cells. It generally takes 10 to 14 days to receive the results of the physical evaluation.
Intent To Donate Stem Cells
Once the donor center knows that the donor is educated about stem cell donation, willing to proceed, and has been cleared for donation by the harvesting physician and the Medical Director of their donor center, the donor will be given an "Intent to Donate" form. The donor is told that their signature on the form indicates an intent to donate but is not their final consent to donate. The final consent to donate is signed just prior to the actual harvest procedure. A donor is not legally bound to donate their stem cells at any point in this process. Many donors are told that there is a moral obligation to proceed to stem cell harvest once the patient has begun ablative therapy.
Our transplant center will be notified when the "Intent to Donate" has been signed by the donor and the donor center Medical Director has cleared the donor for the harvest procedure. It is at this point that our transplant program will recognize that a suitable marrow donor has been found for you.
Tests on the Donor
In addition to the tests listed above, the donor will have another series of tests known as "infectious disease markers" run. This series includes:
- HBsAg (hepatitis B surface antigen)
- STS (serologic test for syphilis)
- Anti-HBc (antibody to hepatitis B core antigen)
- Anti-HCV (antibody to hepatitis C virus)
- Antibodies to Human Immunodeficiency Viruses (Anti-HIV 1 or Anti-HIV 2)
- HIV Antigen
- Anti-HTLV-1
- Cytomegalovirus (CMV) Antibody
If the donor is donating marrow, they will have at least one unit of their own blood drawn and stored for administration to them after their marrow harvest.
When Will I Know?
Many factors may affect the length of time of the donor work-up phase. Most donor work-ups take 4 weeks from the date of the request to the day we learn that the donor has passed their physical evaluation and signed their "intent to donate." Donor work-ups may be requested as urgent. Your transplant physician will decide if an urgent donor work-up is needed for you.
The next step is to schedule the harvest date. The actual date needs to be coordinated with you, our transplant team, the donor, the donor center, and the donor's collection center.