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Consulting clinic for related family donors in hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 41, pages 1073–1075 (2008)Cite this article

When patients with hematologic or other intractable disorders need to undergo allogeneic HSCT (hematopoietic stem cell transplantation), related family members are most often considered as candidates for the hematopoietic stem cell (HSC) donation. According to a nationwide questionnaire survey in Japan, 98.0% of family donors are informed about the HSC donation procedure only by the clinicians involved in the care of the HSC transplant recipient (‘recipient clinicians’). Moreover, when written informed consent for HSC donation was obtained, the recipient clinicians and the recipients themselves were present with the prospective donors in 89.3 and 70.7% of cases, respectively.1 We questioned whether in such situations the donors were truly agreeing to donate of their own free will, and whether their safety in terms of physical eligibility was considered sufficiently. There have been many studies on the safety and ethical issues facing unrelated volunteer HSC donors2, 3 and especially on issues regarding PBSC collection.4, 5, 6 However, surprisingly, few studies so far have addressed these issues with special reference to related donors.7 Therefore, we started a unique donor consultation program, ‘Consulting Clinic for Related HSC Donors (CRD),’ in which two clinicians (‘donor clinicians’) who are not directly involved in the care of the prospective recipients play a central role in securing the rights and safety of related family donors.

Between April 2003 and March 2007, a total of 70 donor candidates visited the CRD (Table 1). Two candidates were judged as ‘unqualified’ at the first medical interview. Sixty-eight qualification meetings by two clinicians were held to judge the eligibility of the candidates to undergo BM or PBSC donation; the initial decisions were ‘qualified’ in 43 cases (63%), ‘reserved’ in 21 (33%) and ‘unqualified’ in 4 (6%). The reasons for reservation were abnormalities in blood or urine examinations in 17 cases, suspicion of cardiovascular disease in 3 and suspicion of a neurological disorder in 1. The reasons for disqualification were suspicion of malignant tumors in three cases and presence of cardiovascular disease in one. Twenty of twenty-one candidates (95%) in the ‘reserved’ group were eventually judged ‘qualified’ after existing diseases were controlled and/or the donor was re-evaluated by another consultant physician or anesthesiologist. Three of four ‘unqualified’ candidates at the first CRD were reclassified as ‘qualified’ at the second CRD when the requested source of HSC was changed from PBSC to BM. Twelve of sixty-six ‘finally qualified’ donors (18%) did not actually donate HSCs due to various reasons, including death of the recipient before undergoing HSCT. To date, we have not observed any severe adverse events in the remaining 54 donors who actually donated HSC, with a median follow-up of 33 months (range, 5–51 months).

Table 1 Characteristics of donor candidates visiting our consulting clinic for related donors
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Acknowledgements

We are grateful to Dr Martin Körbling (MD Anderson Cancer Center) and Dr Yasunori Ueda (Kurashiki Central Hospital) for critical reading of the manuscript and helpful suggestions.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Kyoto University Hospital, Kyoto, Japan

    H Muramatsu, T Ichinohe, T Ishikawa & T Uchiyama

  2. Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan

    S Kimura, E Ashihara & T Maekawa

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  1. H Muramatsu
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  2. S Kimura
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  7. T Uchiyama
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Correspondence to T Ichinohe.

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Muramatsu, H., Kimura, S., Ichinohe, T. et al. Consulting clinic for related family donors in hematopoietic stem cell transplantation. Bone Marrow Transplant 41, 1073–1075 (2008). https://doi.org/10.1038/bmt.2008.42

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