Bone marrow is used for...



The transplantation of bone marrow and its hematopoietic stem cells makes healing of serious diseases possible: leukemia, thalassemia, congenital errors (immunodeficiency, congenital disorders) and, more recently, also a few types of solid tumors.
Compatibility between patient and donor is found once in four cases among close relatives (siblings), but becomes very rare among blood-unrelated persons.



What is the bone marrow used for transplantation?



The bone marrow is not the spinal cord! The bone marrow is an organic tissue made of "hematopoietic stem cells". Those are able to produce and replace red and white blood cells, as well as platelets. This tissue is located at the centre of flat bones and, thanks to its "hematopoietic stem cells", is constantly regenerating.


What is a bone marrow transplant?



A bone marrow transplant is the substitution of a patient's sick bone marrow with healthy "hematopoietic stem cells" from a donor. Those are able to produce all blood cells in the patient.
The transplant is performed in two steps:
- destruction of the patient's own bone marrow cells using drugs and/or ionizing radiations;
- infusion, like a normal blood transfusion, of the donor's hematopoietic stem cells.
Transfused cells flow towards their natural location in the patient's bones, occupy it, and start to produce blood cells, which are identical to the donor's ones.



Who can apply as a bone marrow donor?



All individuals of age between 18 and 37 years (for strongly motivated candidates, the upper limit can be shifted to 40 years) weighing more than 50 Kg (approximately 110 lbs) can become donors of "hematopoietic stem cells". The candidate must not be affected by any disease to the main organs, nor by viral infectious diseases such as HIV, HBsAG, HCV, etc.
The donor is considered available until the age of 55 years.



What happens to the donor that is compatible with a patient?



The drawing of hematopoietic stem cells is performed according to one among two alternative procedures.
The choice depends, on the one hand, on the patient needs and, on the other, on the donor willingness.

The first possible procedure is the "classical" one. Bone marrow is harvested from the donor's iliac crests. The harvest is performed in the next registered medical centre, in general or epidural anaesthetic, and takes approximately 45 minutes.
This procedure has low risks connected to anaesthetic and the harvesting method. The amount of bone blood harvested depends on the recipient's weight (0,7-1 liter, approximately 25-35 fl.oz.) and is harvested with a puncture of the hip bone.
The donor is kept under medical observation in the 48 hours after the donation. A rest period of 4-5 days is suggested as a safety measure. The bone marrow regenerates naturally in 7-10 days. The donor feels only a weak pain; this disappears completely in a few days.

The second procedure is the donation through cell separators. The blood, drawn from the arm, flows through a sterile circuit into a centrifuge. Here, the cell component used for transplantation is isolated and collected in a sterile bag. The other blood components are re-infused into the other arm. In the 3-4 days before the donation, a drug is injected into the donor's blood. The drug is a "growth factor" that increases the production rate of stem cells and induces a flow of marrow cells from the bones to the peripheral circulation; it is given by subcutaneous injection.
In most cases, temporary disorders can be felt, such as: light fever, headache, bone ache caused by stimulation of the bone marrow, fatigue; those disorders disappear rapidly as soon as the drug treatment is suspended.
In the world, thousands of donors have already experienced this donation procedure. No cases of complications are known that could not be solved; however, the donor is kept under medical observation for some time, in order to avoid any possible, if currently unknown, consequence.
Subjects with difficult peripheral venous access cannot choose this procedure; furthermore, all contraindications described for the first procedure remain valid in this case as well.



How can I become bone marrow donor?



In order to become bone marrow donor, you need to take a blood sample. Before this, you can eat normally. No medical authorization is required, but you need to bring your Health Insurance number with you to the medical laboratory. After an informative meeting, signing the informed consent, and registration to the Italian Bone Marrow Donors Registry (IBMDR), the results of the HLA classification (genetic data essential for transplantation) are added to the digital database and communicated through the regional registry to the national registry. In turn, this is connected to 58 international registries. The right to privacy is fully respected. The donor is encouraged to freely join the Bone Marrow Donors Association (ADMO).
If the donor's genetic profile passes a first compatibility test with a patient that is waiting for transplant, the donor is recalled for more detailed blood analyses (second and third tests).
The initial consent has only moral value; the potential donor is always free to withdraw her/his consent (however, the consequences of such a choice on the waiting patient are sadly obvious). Clearly, the potential bone marrow donor is quite unconventional: it becomes an effective donor only in case of compatibility with a patient. Whenever it be. Whoever the patient. The donor's willingness, free and anonymous, knows no geographical borders. The donor enters the worldwide community of potential donors.

The bone marrow donor is among the few donors that, if called to face up to his responsibility, is fully aware that a certain, precise person's life is being saved, often a child's life.


Protection of the donor



The Italian Bone Marrow Donors Registry (IBMDR) has been acknowledged with law 52/2001. The law provides for payed leaves for completion of all exams connected to the donation, and protects the donor in all respects.
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