The transplantation basics
Bone marrow donors are placed in donor registers in Greece and abroad.
Blood diseases and donors
A large number of our fellow human beings, many of which are children, die from serious blood diseases because their bone marrow, the body’s blood cell factory, malfunctions.
Nowadays, the advent of science gives us the chance to save these people, offering a part of ourselves.
Each one of us may be the one compatible donor for a patient needing haematopoietic cell transplantation.
However, it is very important to be absolutely certain of your decision to become a donor. People with doubts or people registering under emotional or other duress without being certain whether they are truly willing to go ahead should understand that they are giving false hope to patients.
Organised international transplantation system
A transplantation is the result of a complex process, carried out by an organised international system, in accordance with the rules laid down by the World Marrow Donor Association (WMDA).
The system brings together:
- Donor centres, which recruit volunteers, check their tissue type and keep confidential records about them.
- Bone marrow donor pools, which coordinate the search process into records with the tissue types of volunteers.
- The haematology/transplantation centres that carry out the transplantations.
Based on current data (number of volunteers and patients who need a donor annually), 1 in 15,000 volunteers will be eventually asked to donate bone marrow to a patient.
The situation in Greece
Greek transplantation centres that hold an international operating licence to carry out unrelated bone marrow transplantations operate within:
- Evangelismos General Hospital of Athens.
- Agia Sofia Children’s Hospital in Athens.
- Papanikolaou General Hospital of Thessaloniki.
- University General Hospital of Patras in Rio.
A central bone marrow donor pool has been operating since 2002 at the Hellenic Transplant Organization (EOM), which coordinates all haematopoietic cell transplantations in Greece.
How to become a bone marrow donor
You must be aged 18-55 and follow a simple and painless process.
To become a donor you must:
- Be 18-55 years old.
- Not have a history of contagious diseases, cancer or heart disease.
Who to contact
Find out all about bone marrow donation and fill in the relevant application form online at one of the following organisations:
- Charise Zoi – Centre for Information and Promotion of Voluntary Bone Marrow Donation, University of Partas (KEDMOP)
- Bone Marrow Donor Bank, Orama Elpidas Association.
The process step-by-step
The process is simple and painless. You need to:
- Fill in a questionnaire with your medical data, to determine whether you are eligible to become a volunteer.
- Fill in a form with your personal data (name, address, phone number, etc.), which remain strictly confidential.
- Sign the consent form, where you express your desire to become a volunteer. This does not mean that you commit to following the next steps of the process if you are found to be a compatible donor for a patient.
- Submit a sample of your spit, to get your tissue type (human leukocyte antigen – HLA) identified, so it may be compared to that of the patients.
Entry in the national and international registries
Your tissue type is entered in the Hellenic Transplant Organization (EOM) registry and the World Marrow Donor Association (WMDA) registry. You remain in the registries until you are 55 years old.
You have the right to ask to be deleted from the registries at any time. You also must inform the organisation of any changes to your health or personal details.
How is the graft collected
The graft is collected either with a blood raw or in an operating room, through aspiration from the pelvic bones.
Donor medical tests
If you are identified as a compatible donor, and provided you still wish to donate bone marrow, additional compatibility confirmation tests are performed.
You then undergo a check-up to confirm that you are in good health.
You may withdraw your consent for bone marrow donation at any time.
A few months after the donation, you may be placed in the donor registry once again.
Isolation of haematopoietic stem cells
The graft is collected at the transplantation centre nearest to you. The graft is then processed to isolate the haematopoietic stem (progenitor) cells.
On rare occasions of inadequate implantation of the graft, you may be asked to give an additional quantity of cells for the same patient.
Bone marrow cells
If the source of the haematopoietic stem cells is the bone marrow, then it is collected in an operating room by haematology specialists, through aspiration from the pelvic bones. The procedure is performed under general or spinal anaesthesia.
The quantity of bone marrow collected is about 5% of the donor’s total bone marrow and it is replenished quickly, without affecting their general health condition.
The donor returns home on the following day and the only symptom is slight pain in the area of the aspiration.
Peripheral blood cells
If peripheral blood cells are used, then the cell collection procedure is similar to a simple blood draw.
A few days before the blood draw, the donor is administered special growth factors, which result in an increase in haematopoietic stem cells.
FAQs about bone marrow donation
Get answers to the most frequently asked questions about bone marrow donation and compatibility.
What is bone marrow?
It is spongy tissue found in bones that contains haematopoietic stem (progenitor) cells, meaning progenitor forms of white blood cells, red blood cells and platelets that circulate in the blood.
Haematopoietic stem cells exist in blood too, at a smaller rate, while there is great number of them in umbilical cord blood.
The bone marrow is not the same as the spinal cord, which is located in the spinal canal of the vertebral column and is nervous tissue linked to neural functions and not blood production.
What is haematopoietic cell transplantation?
If the bone marrow is not adequate, has been destroyed or has been infiltrated by malignant (cancer) cells, serious blood diseases develop, such as leukaemia, bone marrow aplasia, etc. These diseases are treated with various pharmaceutical regimens.
However, many times transplantation is the only option. In this case, the diseased bone marrow is replaced with bone marrow that will be created by the patient’s body if they receive haematopoietic stem cells from a compatible and healthy donor.
The haematopoietic stem cells may come from:
- Bone marrow
- Peripheral blood
- Cord blood
The product is collected from the bone marrow or peripheral blood of the donor and undergoes processing. The final graft from haematopoietic cells is administered to the patient with intravenous infusion (similar to a blood transfusion).
When a cord blood graft is used, the blood is collected from neonatal cord. It then undergoes processing and is kept frozen in special cord blood banks. It is again administered by intravenous infusion.
What does suitable / compatible bone marrow donor mean?
For a transplantation to succeed, it is absolutely necessary for the donor and recipient to have tissue compatibility, meaning similarity in special molecules known as HLAs (Human Leukocyte Antigens), which are expressed on their cells.
The HLAs differ from person to person and define their tissue identity, which is determined in special tissue compatibility labs from a blood sample.
To estimate compatibility between donor and recipient, their tissue identity must be compared.
The main feature of HLAs is their huge polymorphism. Based in the ABO blood type system, people are ranked in 4 blood types (A, B, AB, O). If the ranking was based on HLA, there would be a huge number of types. Therefore, understandably, the chance of HLA similarity between two random people is extremely low.
How is a compatible donor identified?
The first search for a suitable donor is within the family of the patient. This search may produce the desired result in just 1/3 of patients.
For the rest, an unrelated donor must be sought among volunteers who have expressed the desire to donate bone marrow.
To find suitable, acceptable and compatible unrelated donors, there must a large number of volunteers available. The search for donors among people with common ethnicity is more effective, due to genetic similarities. Therefore, there is an imperative need to have more Greek donors, for the benefit of Greek patients, but also for the more active participation of the country in this international effort.
Donors started being registered in the 1970s in the Netherlands, the USA and the UK. In each country, the registered volunteers are pooled together in a central register, known as the national pool of the country.
The donor data is then pooled together in an international register kept by the World Marrow Donor Association (WMDA). Today, the register has more than 38,000,000 registered volunteers and units of cord blood. All cooperating national pools have access to this international register.
Is the donation anonymous?
Yes, for at least 1 year. The donor and the recipient (patient) are only informed of the gender, age and country of origin of the other. However, the donor is also informed of the progress of the patient.
A few months later, and depending on the rules in force in each country, the donor and recipient may exchange anonymous mail.
After 1 year has gone by, and provided both wish so, they are permitted to exchange information that reveals their identity.
Do I have to pay anything as a donor?
No. Any expenses incurred (transportation, loss of wages, etc.) is covered by the patient’s insurance, without the donor having to contribute anything.
It is strictly forbidden for the patient to make any financial offer to the donor.