Bone marrow donors need not fear
Doctor says the procedure for extracting vital stem cells does not involve drilling and is painless
The South African Bone Marrow Registry (SABMR) is celebrating 30 years in existence this year. And despite contending with cultural, societal and religious beliefs that can deter people from registering as donors, there are more than 73000 donors on its register.
But that’s still not enough.
Since 1991, the SABMR has facilitated 550 bone marrow transplants.
Bone marrow transplants — or “stem cell” transplants — might be the best chance of recovery for patients with various blood disorders. According to SABMR chief executive Dr Charlotte Ingram, 4 000 new cases of blood disorders such as leukaemia and lymphoma occur in South Africa each year.
Finding matching tissue types to conduct the bone marrow transplant is the difficult part. The likelihood of finding a matching tissue type for a patient who needs a bone marrow transplant outside their family is one in 100 000, or, as Ingram says, “like finding a needle in a haystack”.
For patients with unique tissue types, it becomes even harder.
That is why “the more donors we have across racial demographics, the greater the likelihood of a match and saving a patient’s life,” says Ingram.
The SABMR added 1 525 new donors to its registry in 2020 but lost 1 763 others, mainly due to some donors reaching the cut-off age of 45 years (1 177), while 282 could not be traced and 106 had emigrated.
An international marrow registry makes it possible to connect donors to recipients across borders.
The SABMR is the only accredited member of the World Marrow Donor Association in Africa, enabling it to collaborate with 70 registries worldwide to search for compatible stem cell donors. Countries such as Germany, Russia, Spain and Cyprus have donated stem cells to South Africa, while SABMR donors have helped patients in Sweden, England, France and Austria, among others.
Ingram says the SABMR plays an integral role in the donation process. “We facilitate and improve access to transplants, conduct research, educate and support patients and physicians. From the moment a physician contacts us for a donor to the safe delivery of the cells to a patient, we are there every step of the way.”
Bone marrow transplants are now routinely carried out worldwide since the first world register of unrelated stem cell donors was established in 1988.
“Back in the 1950s, bone marrow transplants could only be done when the donor and recipient were related. The chance of finding a match within your family is 30%, whereas the other 70% will have to look to a stranger,” Ingram said.
SABMR facilitated the first unrelated donor match in 1997.
Bone marrow transplants are now more common and techniques have advanced to nonsurgical and noninvasive procedures — meaning donors can return to normal activities within hours of donating.
In 2018, the SABMR simplified collecting DNA samples with an online platform and buccal swabs, through which it collects DNA from cells inside a person’s cheek for initial tissue typing.
The most common method of extracting bone marrow is through a peripheral blood stem cell collection, and not through drilling into bones, as is the popular misconception. In rare cases, Ingram said, marrow is collected through the bone in a procedure performed under anaesthetic.
According to Ingram “misunderstandings of religious views and ignorance of the donation process” are some of the biggest deterrents to donors. Another is mistrust in medical procedures, as well as a lack of awareness about how transplants can save lives.
Perhaps the biggest misconception is that the procedure is painful, says Ingram, adding that this could not be further from the truth.
“Five days prior to the collection of the stem cells, a donor receives a series of five injections which stimulates the bone marrow to produce extra stem cells, which are now found circulating in your blood.”
Then follows a nonsurgical procedure where “blood is removed through a needle in one arm, passed through an apheresis machine that collects stem cells, and returned through a needle in your other arm”.
Last year, South Africa became the second country to allow 16-year-olds to become stem cell donors, down from 18.
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