The Donor

There are several different types of donors including relatives (usually siblings or parents) and unrelated volunteers. In general all donors feel proud to make such a valuable life-saving contribution. Often they feel frightened of the unknown and feel better after discussing their thoughts and fears. Information about donation is discussed at an "age appropriate" level. Children who are donors meet with the child life specialist and are given a chance to use puppets and other forms of play.

Depending on a number of factors, the donor may either undergo a bone marrow harvest or a peripheral blood stem cell collection.

Bone marrow harvest

During the bone marrow harvest, which usually occurs on the day of the transplant, a small portion of bone marrow is collected from the anesthetized donor in the hospital. Because a significant amount of blood is taken with the marrow, the adult donor may be asked to donate 1-2 units of his or her own blood (auto-donation) approximately 1-2 weeks prior to the harvest. The nurse coordinator or the clinical nurse specialist will make these arrangements. Following the marrow harvest, the donor's blood is then infused back into the donor. This approach is intended to minimize the chances of the marrow donor having to receive a blood transfusion from another individual.

One to two weeks prior to the transplant day, the adult donor is seen by an internist for a screening history and physical, and the sibling donor is seen by the attending transplant physician. On the day before the transplant, the consent for anesthesia and surgery is signed with the transplant attending and the donor is evaluated by the anesthesiologist in the Pre-Sep department near the Admissions Department (room L169). Paperwork and additional blood tests are a part of the pre-admission process.

After midnight, the donor cannot eat or drink anything. On the morning of the bone marrow harvest or collection, the donor is admitted to the pre-op area on the 4th floor. There will be doctors, nurses and other patients in this area, including the transplant physician who will be performing the bone marrow harvest. The operation usually begins around 7:30 AM.

In the operating room the anesthesiologist will "put the donor to sleep." The physicians will then collect a small portion of bone marrow from the upper part of the pelvic bones. This process usually takes 2-4 hours, but may take longer depending on the amount of marrow needed.

The donor will wake up in the recovery room before being taken to his/her hospital room. A large bandage will cover the area from where the bone marrow was taken. Between 1-6 needle marks will be visible on the donor's skin. The donor will be sore following donation and will have some bruising. The amount of pain varies from donor to donor, and can last from a few days to several weeks. Medications will be given to help relieve the pain. The nurses will be checking the dressings for drainage at the needle sites and change the dressings as needed. An IV will be in place following surgery in order to administer routine antibiotics to minimize infection. Adult donors are admitted to one of the adult medical units (usually 11 Moffit). Sibling donors are admitted to 7Long. The adult donor usually leaves the hospital one day after surgery. The sibling donor may be able to leave on the evening of surgery.

For unrelated donor marrow transplants, the same procedure occurs but at a donor center nearest to the donor's home. The marrow is then brought to UCSF for further processing and/or administration to the recipient.

Peripheral blood stem cell (PBSC) collection

The PBSC collection is done as an outpatient. Beginning five days prior to transplant, the donor receives 1-2 daily injections under the skin of a drug, granulocyte colony stimulating factor (G-CSF), which stimulates recruitment of bone marrow stem cells into the circulating blood. Common side effects include headaches and bone pain, which are relieved with Tylenol and/or ibuprofen.

The donor is admitted on the morning of the fifth day (the day of transplant) to the Leukapheresis Unit (9Long) as an outpatient. For most adult donors, special catheters are placed under local anesthesia in the veins in each arm. For the young sibling donor, a double lumen catheter is placed under local or general anesthesia either in a vein in the neck or in the groin. This may be done in the operating room by one of the Pediatric Surgeons using general anesthesia or in the Leukapheresis Unit or the Cardiac Cath Unit by one othe Pediatric Cardiologists using local anesthesia. The catheters are necessary in order to carry blood to the apheresis machine where the stem cells are collected, and to return the residual blood back to the donor.

The PBSC collection takes 4-5 hours during which the donor can sleep, read, or watch TV (a VCR is also available). Typically, only a single collection is necessary, following which the catheter(s) are removed and the donor is able to go home. The PBSC are either administered directly to the recipient or taken to the Pediatric BMT Laboratory for further processing prior to transplant. When a second donation is necessary, the donor will need to receive another injection of G-CSF and may need to stay in the hospital overnight.