Following your work-up, and once the patient’s doctor is satisfied he/she has enough information to choose you as the best donor for their patient, the collection of your cells will be arranged. You and your doctor will decide which of the two ways to donate your cells is the best for you (noting that the patient may need you to donate in a particular way, particularly if they are a child). Usually you will have about a month’s notice, sometimes a bit longer and sometimes, although rarely, you may be asked to donate at fairly short notice (but not usually with less than two weeks notice). You will be encouraged to to have a family member or friend attend your cell collection with you.
Your donation may be a life-changing experience for you. There may be a temporary disruption to your daily physical routine and in addition you may experience some emotional ups and downs, especially if the transplant is not successful and you receive bad news about your recipient. However it is always important to remember the value of your gift.
Peripheral blood stem cell collection
Most donors will have their blood stem cells collecting this way. “Peripheral” means that the collection is made from veins in your arms. But first, you will receive a hormone-like treatment known as G-CSF to stimulate your bone marrow to produce stem cells more quickly and in large numbers, which are then released into your blood stream. G-CSF is administered by a small injection under your skin daily for four days before your collection.
Thousands of healthy donors have received G-CSF worldwide to date. Available data from healthy people who have received G‑CSF suggests that there are no long-term risks associated with its use for this purpose.
You may experience varying symptoms including bone or muscle pain, fatigue, headache, low-grade fever, nausea, insomnia, and generally feeling a “bit off”; while receiving injections of G-CSF. The symptoms are usually mild and controlled by paracetamol (eg Panadol), but occasionally some donors can feel more unwell and need stronger painkillers. These effects disappear shortly after collection. Severe side effects are rare and will be discussed with you.
The PBSC donation takes place at an ‘apheresis centre’. Apheresis is a process of collecting blood from a vein in one arm and passing it through a cell separator machine, which collects the cells that are needed for the transplant. The remaining blood is returned to you through a vein in your other arm.
During the collection some donors experience nausea, a tingling feeling or chills. These effects go away shortly after donating. When asked about their discomfort, most donors are quick to point out that it was worth it to help save a life, and they would be willing to do it again. The procedure does not require a general anaesthetic and takes approximately 3-4 hours. After the procedure you may leave straight away if feeling well. If any side effects (eg nausea) have been experienced, you may be asked to stay while your symptoms are being treated and monitored.
Occasionally, insufficient cells are obtained from the collection. If this happens, you will be asked to receive a fifth injection and have a further collection procedure the next day.
Bone marrow collection
Marrow donation is a surgical procedure performed in a hospital known as the ‘collection centre’. This usually means a night in hospital, before or after the operation; but some collection centres will schedule a same-day stay.
Each collection centre has its own hospital policies and procedures to perform a bone marrow collection. However, you will have a general anaesthetic and the doctors will use special, hollow needles to withdraw liquid marrow from your pelvic bones. Some doctors will make several small incisions through the skin on your lower back (no stitches should be needed). Others will simply insert a needle into the skin without making incisions. The amount of bone marrow collected depends on the patient’s needs, but a maximum of approximately 20 mL per kilogram of donor weight is usually extracted. So, for example, if you are 65 kg approximately 1300 mL may be taken.
Your body will replenish the donated bone marrow within about four weeks. Following the collection, the stem cells will be filtered to remove any unwanted particles and then mixed with an anti-clotting agent. The cells will then be placed in a sterile blood transfusion bag and transported to the patient’s hospital. The actual transplant is given intravenously to the patient, just like a blood transfusion.
After the procedure, and once the anaesthetic wears off, you may feel somewhat stiff and sore in the lower back region for a few days. Pain medication such as paracetamol (eg Panadol) is usually sufficient to relieve the discomfort. There may be some colourful bruising at the back of the hips in the week after the donation. Most donors recover well and are back in their normal routine within several days. Some individuals may take two to three weeks before they feel completely recovered. Donors may also receive a transfusion of their own previously donated blood to assist with iron replacement.
On discharge from hospital we recommend that you have a companion drive you home or take a taxi. If you are from the country you may be asked to stay in the vicinity overnight.
After your donation
Following your donation, we will keep in touch with you and see how you are. We will check on you at least weekly until you can resume your normal activities. Around three months after your donation, we will ask you to see your GP and have some tests done to make sure you have fully recovered. We’ll ask for a copy of the results for our records.
If you are a blood donor, you should be deferred from blood donation for six months after bone marrow donation and three months after PBSC donation.
You will also be removed from the registry’s active list for two years. This means that no patient other than the one you donated to can match with you in this time. The patient you donated to may still need additional cell products from you, depending on how their transplant progresses. At the end of the two years, you will automatically be re-activated for all patients, unless of course you decide otherwise.
We will keep in touch with you once a year with a follow-up health survey. All donor registries around the world collect long-term information on people who have donated. This long-term information provides reassurance to future donors about the long-term effects of donation.
Donating more than once
In some situations – e.g. if the transplant fails to ‘take” or the recipient relapses – their doctors may request a second donation. This usually occurs within a year of your collection and may involve a bone marrow, PBSC or leukapheresis donation. (Leukapheresis is a process in which the donor’s white cells are collected using an apheresis machine but which does not require G-CSF injections). A medical review panel will review any request for another donation to determine whether it is appropriate . If the panel approves the request you will be contacted and asked if you are willing to donate again for the same patient.