Choice of donor depends on disease, histocompatibility, availability, informed consent, and medical competence.10 Less than 30% of individuals have an HLA-identical sibling. In these circumstances, alternative donors, such as phenotypically matched, unrelated volunteers and partially matched family members, are considered.9
Approximately 75% of Caucasian individuals can locate a suitable matched volunteer donor. Minor ethnic groups have lower rates of success. Such matched unrelated donors (MUD) are associated with significant complications, such as GVHD and prolonged and profound immunodeficiency.9
Other factors considered after HLA typing are donor characteristics such as:8, 11
- number of pregnancies
- overall health
- Cytomegalovirus (CMV) negative serology (for CMV-negative recipients)
- ABO compatibility
- matched race.
Favourable donor characteristics are male gender, younger age, good size, and good health.8
In addition to assessment of the donor's physical suitability, the impact of the stem cell collection or harvest on the individual's lifestyle, and the relationship with the recipient should also be discussed. Unrelated donors also receive counselling prior to donation. A social worker may be involved to deal with stress and anxiety.12
Access a current text and National Marrow Donor Program HLA matching guidelines for unrelated adult donor hematopoietic cell transplants11 , and describe the reported potential implications of the following donor characteristics:
- Aged over 60
- Obesity (BMI greater than 30)
- Female with a history of three pregnancies.
Outline possible psychosocial issues that may impact on donors of haematopoietic stem cells:
- Identify screening and assessment process to identify potential issues
- Discuss the concept of 'survivor's guilt' and how it may manifest
- Discuss interventions to prevent and manage 'survivor's guilt'.
Discuss why ethnic groups have lower rates of success in locating a fully matched donor when compared with Caucasians.