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Bone marrow donation

Introduction

Bone marrow is the soft, jelly-like tissue that is found in the hollow centre of all large bones. It contains stem cells which produce red blood cells that carry oxygen around the body, white blood cells that fight infection, and platelets that help stop bleeding.

All the different types of blood cells that are produced by the stem cells are released into the blood stream through the veins and thin tissue surrounding the bone. Without bone marrow and stem cells, blood cannot be produced and we cannot survive.

Bone marrow transplant

If you have an illness or condition that affects your bone marrow such as leukaemia or requires treatment with chemotherapy or radiotherapy, your bone marrow may be damaged.

If this happens, you may need to have a bone marrow transplant. During a transplant, healthy bone marrow will be fed into your blood stream. If the transplant is successful, the new bone marrow will begin making healthy blood cells and you will start to get better.

Ideally bone marrow should be donated from a family member, such as a brother or sister, because there must be a close match between tissue types. If a suitable donor cannot be found from family members, doctors will try to find someone on the bone marrow donor register.

The bone marrow register

There are thousands of people on the bone marrow register, but someone must be a very close match to be able to donate. That is why it is important to have lots of people on the register, from all ethnic backgrounds.

Currently, certain ethnic communities are under-represented on the bone marrow register. This means that it is harder to find suitable donors for members of these communities who require a bone marrow transplant.

Registrations are particularly needed from the following ethnic groups:

  • African,
  • Afro-Caribbean,
  • Asian,
  • Chinese,
  • Jewish,
  • Eastern European, and
  • Mediterranean.
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Why is it necessary?

Bone marrow transplants are necessary when the bone marrow becomes so diseased or damaged  that it does not function properly. This may be due to a disease such as leukaemia (cancer of the bone marrow cells), non-Hodgkin's lymphoma, or a related cancer of the blood.

Other diseases that may require a bone marrow transplant include:

  • genetic diseases, such as sickle cell anaemia, where the bone marrow does not produce enough healthy red blood cells,
  • immune-deficiency illnesses such as aplastic anaemia, which causes the immune system to stop working properly, or
  • any other disease that affects the blood, such as multiple myeloma (a cancer that affects blood plasma cells).

Bone marrow transplants may also be necessary following certain treatments such as chemotherapy and radiotherapy, which tend to damage healthy stem cells at the same time as destroying cancer cells.

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How does it work?

Bone marrow donors must have a tissue type that is compatible with the person who is going to receive their bone marrow.

Tissue type

Tissue type (also known as HLA type or human leucocyte antigens type) helps the body fight infection. In order to check that the tissue type is compatible, doctors check how many proteins on the surface of the blood cells match. There are millions of different tissue types but some are more common than others.

Tissue type is inherited; we get three antigens from each parent. This means it is more likely that a relative will have a matching tissue type. If a suitable donor cannot be found from family members, doctors will try to find someone on the bone marrow donor register.

As there are so many different types of tissue, it is very important that there is a  large register of potential bone marrow donors (many thousands). The larger the register, the more chance there is of finding a match between donor and recipient.

Some tissue types are more common in particular ethnic backgrounds. As well as matching a donor and patient's tissue type their ethnic backgrounds must also match. This will increase the chances of the transplant being successful.

The British Bone Marrow Registry (BBMR)

The British Bone Marrow Registry (BBMR) is run by the National Blood Service and holds details of bone marrow donors from England, Scotland, North Wales and Northern Ireland. The BBMR works alongside other UK donor registries, including the Welsh Bone Marrow Donor Panel. The Welsh Bone Marrow Donor Panel is a register of blood donors fom South, West and Mid Wales whose white cell groups have been voluntarily tissue-typed for the purposes of bone marrow donation.

If you would like to register as a potential bone marrow donor on the British Bone Marrow Registry or Welsh Bone Marrow Donor Panel you must also be a regular blood donor. Alternatively, you may join the Anthony Nolan Register, who do not require that you be a blood donor.

Registering as a bone marrow donor

When you register you will need to supply a blood sample so your tissue type can be identified. This can be done through your GP. You can join the register up until the age of 40, or 46 for the Welsh Bone Marrow Donor Panel and your details will be held on the registry until the age of 60.

From the time you join the register up until the age of 60 you could be contacted as a potential match for someone who needs a transplant. When you donate bone marrrow, you cannot choose who will receive your bone marrow; the donation is anonymous.

To join the register you should inform the staff the next time you donate blood. They will provide you with a consent form which you will need to complete and sign. Upon registering, your details will be held in compliance with the Data Protection Act (1998). Any samples that you provide will not be used for any other tests, and your DNA will not be shared with any other organisation. You can also request to be removed from the BBMR at any time by contacting the donor helpline on 0845 7711711.

Under European law, personal details regarding the recipient of your bone marrow donation must remain anonymous, and you will not be able to meet, or talk, to them. However, in some cases, the BBMR may be able to arrange for a 'thank you' card to be sent on behalf of the donor to the person who provided their transplant.
 

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How is it performed?

If you are on the bone marrow register and you are identified as a potential donor, you may be asked to provide a blood sample. This is so that more checks on your tissue type can be made.

If your tissue type matches the patient who needs bone marrow you may be selected to donate. You will have a full medical examination and some counselling about the procedure.

There are now two ways that you can donate your bone marrow. The first, and most widely used method, is known as a peripheral blood stem cell (PBSC) donation. The second method involves donation of the bone marrow itself.

Peripheral blood stem cell (PBSC) donation

A peripheral blood stem cell donation (PBSC) is a procedure that allows you to donate stem cells without you having to directly donate any bone marrow.

Every day for four days before the PBSC donation takes place, a nurse will inject you with a medicine, either at your home, or at your local clinic, or hospital. The medicine will increase the number of stem cells you have in your blood.

On the fifth day, you will be connected to a special machine that can separate the stem cells from your blood. The stem cells are then collected for donation.

The advantage of a PBSC is that you do not have to have a general anaesthetic, and you will not have to stay overnight in hospital.

Bone marrow donation

Bone marrow is removed from your hip bone using a syringe. Though this is not a surgical operation, it is usually carried out under a general anaesthetic because the procedure can be painful.

After donating bone marrow, you may experience some discomfort at the site where the needle is inserted into your hip, but this should pass within a few days. You will usually be required to stay in the hospital for 48 hours in order to make sure that you have recovered fully from the general anaesthetic.

It usually takes five days for people to fully recover from the effects of the anaesthetic and to regenerate their donated bone marrow. It is recommended that you stay at home during this period and ensure that you get plenty of rest.

Both methods of bone marrow donation are very safe, and the risks of developing complications are small. However, possible complications include infection and an adverse reaction to the anaesthetics.

Financial reimbursement is available from the relevant health authorities for any travel costs, or loss of earnings, arising from your donation. This should be discussed during your initial medical examination and interview.

It is important for you to be aware that it is illegal to take money, or any other type of reward, from the recipient of your donation, or their family and friends.

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Who can use it?

If you would like to become a potential bone marrow donor, you must be:

  • between 18-49 years of age,
  • in good general health, and
  • weigh over eight stone (51kg).

The younger you are when you register, the better because you may be on the list for many years before you are matched with someone needing a transplant.

People with certain medical conditions such as rheumatoid arthritis, or those taking certain medication such as anti-epileptic medicines, or hormones, are not able to donate bone marrow. See the 'selected links' section for more information about this.

If you become pregnant, you will be temporarily removed from the register until your baby is 12 months old. Although no problems have been reported, the safety of donating bone marrow during, and shortly after, pregnancy has not been fully established.

Of the people currently on the BBMR register, 60% are female and 40% are male. Males are generally able to provide larger volumes of marrow, and are less likely to suffer from anaemia. Also, unlike female donors, males do not have to come off the register due to pregnancy. 

There is currently a need for more people, particularly those from the ethnic backgrounds listed in the introduction section, to join the bone marrow register. If you would like to become a potential donor you should contact the National Blood Service, the Welsh Blood Service or the Anthony Nolan Bone Marrow Trust. See the 'selected links' section for more details.

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