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What is marrow?
Marrow is the spongy tissue found in the central cavity
of bones. It contains young blood cells, which enter
the bloodstream when they mature. These cells develop
into red blood cells, white blood cells, and platelets.
Blood cells can be collected from the marrow, from
the circulating blood, or from umbilical cord blood
after a baby is born.
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Who needs a
transplant?
Marrow and blood cell transplants are used to treat
over 60 different types of blood diseases including
leukemia. Every year, over 30,000 new patients are diagnosed
with one or more of these diseases.
30% of patients will find a matching
donor within their family. The remaining 70% of patients
must search national and international registries for
an unrelated donor.
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What is the
chance of matching a patient?
The chances of matching a patient vary widely and depend
on the donor's tissue type. A patient may find matches
from several potential donors or from only a single
donor. Or, a patient may not find a matching donor.
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What happens after a donor is identified as a match?
A local donor center will contact the donor. If still
interested, the donor will be asked to attend an information
session to learn about the donation procedures. Further
blood tests will also be completed. If these tests indicate
that the donor is a good match for the patient, the
donor will receive a physical examination to ensure
that donating is safe for the donor and the patient.
The patient's doctor will determine which donation procedure
will be completed.
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Who pays for
the donor's expenses?
The donor's medical and non-medical expenses are paid
for by the patient's medical insurance or the patient.
Although this typically excludes reimbursement for time
away from work, many employers allow their employees
to take time off for the donation.
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Are potential
donors obligated to donate?
Donors are not obligated to donate if they match a patient.
However, a donor may be a patient's only match, so deciding
not to donate may present a false hope to the patient.
Because time is critical for searching patients, it
is also important for donors to update their contact
and health information with their local donor center.
Knowing whether a donor is unavailable or ineligible
will minimize time spent trying to contact potential
donors.
If the donor decides to donate, it
is important that the donor does not decline after signing
the "Consent to Donate" form. The patient
will receive intensive chemotherapy and/or radiation
to kill diseased blood cells. This destroys the patient's
immune system, so the patient will probably not survive
if he or she does not receive the transplant.
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What is a PBSC
donation?
During a Peripheral Blood Stem Cell (PBSC) donation,
blood-forming cells are collected from the circulating
blood. The donor is first given injections of a drug
called Filgrastim for 4-5 consecutive days to increase
the number of blood cells released from the marrow
into the circulating blood. On the fifth day, the circulating
blood is collected through a sterile needle in one arm,
the blood cells are separated, and the remaining
blood is returned to the donor through the other arm.
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Is PBSC donation
painful?
The Filgrastim medication may cause flu-like symptoms
such as bone pain, headaches, muscle aches, and nausea.
These symptoms will dissipate 1-2 days after the last
dose is administered. During the collection procedure,
donors may experience a tingling feeling or chills,
which subside after the donation is complete.
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What are the risks of PBSC donation?
Although long-term data on Filgrastim administration
is limited, several studies have evaluated PBSC donors
one to five years after donation and have found no adverse
effects.
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How is marrow
collected?
A small amount of marrow is collected from the back
of the donor's pelvic bone using a special needle and
syringe. (The amount of marrow that is collected is
determined by the recipient's weight.) All donors receive
general or regional anesthesia for the procedure. This
process typically lasts 60 minutes. The donor's marrow
replenishes itself within 4-6 weeks.
Marrow donation is a surgical procedure.
The donor may enter the hospital either the night before
or the day of the marrow donation. The donor may remain
in the hospital for several hours or overnight after
the marrow collection.
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Is marrow donation
painful?
Because anesthesia is used, marrow donation is not painful.
After the procedure, donors may feel lower back soreness,
may feel tired, and may have some difficulty walking.
Most donors feel better within a few days. Some donors
may not feel completely recovered for a few weeks.
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What are the
risks of marrow donation?
As with any surgical procedure, there is a small amount
of risk with marrow donation. Although serious complications
are rare, they may include bruising at the needle insertion
site, infection, or adverse reactions to the anesthesia
or transfusion. Many precautions are taken to ensure
the safety of the donor. Donors are asked to complete
a health questionnaire before joining the national donor
registry. If a donor is a match for a patient, they
are given a thorough physical examination to ensure
they are healthy enough to donate. The donor's safety
is a primary concern of the National Marrow Donor Program.
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How does a patient
receive a transplant?
After a donor has agreed to donate their marrow or blood
cells, the patient undergoes chemotherapy and/or
radiation to destroy their unhealthy blood cells. The
patient then receives the donated marrow or blood cells
intravenously. After approximately one month, an increase
in the patient's white blood cell count will indicate
that the patient's marrow is producing new blood cells.
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What are the
patient's risks?
Although a transplant can save a patient's life, it
is not always successful. Some patients may not survive
the pre-transplant chemotherapy and radiation treatment.
Complications may occur after the transplant, including
graft-versus-host disease (the donor's cells fight the
patient's body), non-engraftment, rejection, infection,
and relapse (the original disease reappears). While
a transplant's success is not guaranteed, it may be
a patient's only treatment option.
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Do the patient
and donor meet?
The donor and patient's identities remain anonymous.
One year after the transplant, the donor and recipient
may write anonymously to each other with the help of
a coordinator from the National Marrow Donor Program
(NMDP). If the donor and recipient both wish to meet
after that time, an NMDP coordinator may help arrange
their meeting.
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*Information is compiled from You Could
Be the Missing Piece. Minneapolis: National Marrow Donor
Program, May 2004.
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