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Answers to bone marrow donors’ questions

 

1. General Questions:

 
Q1:
How can I become a bone marrow donor?
 
A:
In order to be one of the marrow donors, you have to be 18-45 years of age, in good health condition with no blood vessel disorders(For example, hypertension, diabetes, heart disease, etc). If you qualify the above terms, then you can become part of the Tzu Chi Taiwan Marrow Donors registry by coming to one of our bone marrow donation drives.
     
 
Q2:
Whom should I contact if my file is already in the Tzu Chi Taiwan Marrow Donors registry, but I’ve immigrated to another country?
 
A:
You can contact us directly and inform us your new contact information. With your permission, we will then forward your updated information to your country’s marrow donor registry. Your blood test information can also be kept in our registry while you are away. If there’s a match, we will have local Tzu Chi volunteers contact you.
     
 
Q3:
If there’s a match, do I need to go to the patient’s place to donate my bone marrow?
 
A:
In order to protect the privacy of both the patient and the donor, Tzu Chi Bone Marrow Stem Cells Center will arrange you to do the bone marrow donation in one of our hospitals.
     
 
Q4:
Is there a weight limitation when I am doing the registration?
 
A:
For people who are willing to do the registration through one of our donation drives, other than to have a good health condition, males have to be above 45 Kg while females have to be above 40 Kg. Please also keep in mind that if you have blood vessel disorders, you are not suitable for bone marrow donation.
     
 
Q5:
When do you hold bone marrow donation drives?
 
A:
We hold the drives all over Taiwan without a fixed schedule. Please refer to the Tzu Chi Foundation website, http://www.tzuchi.org.tw, for an updated place and time of a drive suitable for you.
     
 
Q6:
Is there any fee for getting registered?
 
A:
No, you do not have to pay anything as the examination fee will be covered by Tzu Chi Foundation.
     
 
Q7:
Can I join the marrow donor registry just to donate my bone marrow to a specific person?
 
A:
The establishment of the Tzu Chi Bone Marrow Stem Cells Center is for altruistic purpose. With a belief in respect for life, we wish to provide a new life and hope for the blood disease patients. Thus, we do not recommend you join the marrow registry only for a specific person.
     
 
Q8:
I once did a match with a family member and have done the immune genetic tissue examination. What should I do if I would like to transfer my information to the Marrow Donors Registry now?
 
A:
Please fill out a Letter of Consent from our Center and send it to us with your immune genetic tissue examination report(indicating the name of the examination lab.)
   
 
Q9:
How do I know if I am still listed in the Marrow Donors Registry?
 
A:
Your information will be kept until you are 61 years old, provided that you have attended our donation drive even for potential marrow donors. Our volunteer will contact you if a successful match is made between you and a patient. A friendly reminder: please notify us if your contact information is changed. You can reach us at 886-3-8561825 Ext: 3517/3217/3616 Fax: 886-3-8574324 E-mail: btcscc@tzuchi.org.tw
     
 
Q10:
Why must a donor be at least 18 years of age? Can a person be a donor as long as he/she has acquired consent from his/her parents?
 
A:
According to the law, anyone under 18 years of age must acquire consent from his/her legal guardian. If you are under 18, you can get registered with consent from your parents. However, you must be at least 18 years old before you can donate bone marrow. If you are between the ages of 18 and 20, you must acquire consent from your parents or legal guardian before bone marrow donation.
     
 
Q11:
Why is donation not allowed at age over 61?
 
A:
The activity of bone marrow stem cells gradually decrease as one ages. Hence the maximum age to get registered in donation drive is 45. The information will be kept in the database until he/she is 61 years old.
     
 
Q12:
How do I participate in bone marrow donation drive or obtain more information from the Donors Registry?
 
A:
If more than 30 people are interested in marrow donation, our volunteers will come to you for detailed explanation and hold a marrow donation drive on site. Or you can visit our website http://www.tzuchi.org.tw, or call 886-3-8561825 Ext: 3517/3217/3616 for more information
     
 
Q13:
Can I refuse to donate if a match is made?
 
A:
You may say no at any stage between you are informed as a matched donor and asked to do general checkup. However, once you have gone through physical examination and the patient has begun the extermination treatment for transplantation, your refusal may be fatal to the patient.
     
 
Q14:
I have recently received calls from Tzu Chi volunteers claiming that a match has been made. How would I know if this is a scam or not?
 
A:
When a match has been made, you will be contacted by our volunteers who, dressed in Tzu Chi uniforms, will meet with you in person, and bring the appropriate credentials and pamphlets. Our volunteers will go over the procedures of donation with you and you will not need to pay any fee associated with the donation. Should you have any doubt, please call 886-3-8561825 Ext: 3517/3217/3616 to confirm.

 

2. Questions about the donation process

 
Q1:
What are the procedures for bone marrow donation?
 
A:
After you have been examined to confirm you are physically fit to donate, the Bone Marrow Stem Cells Center will arrange a donation date with you based on the request from the transplantation hospital. One month prior to donating, you will start taking iron supplement and folic acid prescribed by the doctor to stimulate the production of red blood cells. During this one month period, we will draw your blood 1-2 times, which will be later transfused back to your body during the donation surgery to prevent anemia. The surgery is conducted under full body anesthesia. The doctor will then insert sterilized needle (in size of lead refills for pencil) into the ilium and draw the bone marrow repeatedly. The surgery can be done within half an hour. The patient will stay in the recovery room until he is fully awake, and then he/she will go back to the patient’s room and lay on one’s back for 8 hours to stop the bleeding. Once the bleeding stops one can walk about the room, and get back to one’s normal daily activities after a week. It is recommended that one refrain from rigorous activities after donating bone marrow for 2-4 weeks.
     
 
Q2:
Are there any risks associated with bone marrow donation?
 
A:
Any medical procedures have their associated risks. The bone marrow is drawn from the ilium, not spinal cord, for avoiding the risk of damaging the nerves. However, there are risks associated with full body anesthesia. Therefore thorough physical examination and evaluation by doctors will be conducted to ensure one is physically fit to donate.
     
 
Q3:
Is it painful to undergo the surgery?
 
A:
Under full body anesthesia, one will not feel any pain during the surgery. Some will experience minor pain at the place of marrow harvest, which can be relieved by doctor’s prescribed pain killer.
     
 
Q4:
Where will the surgery take place?
 
A:
We will arrange an appointed hospital to harvest bone marrow.
     
 
Q5:
Is it possible to freeze the bone marrow stem cells beforehand and transfuse it to the patient later?
 
A:
There are a limited number of bone marrow stem cells in the bone marrow we’ve harvest. It is best to transfuse the bone marrow into the patient’s body within 36 hours. If freezing the bone marrow is necessary, it will be treated as a special case for the Center’s assessing and consent. This is out of respect to the donors and follows the international convention.
     
 
Q6:
Can I get a liposuction while undergoing the bone marrow harvest surgery?
 
A:
As bone marrow transplantation is a specific medical operation and the process is very different from liposuction, hence, these 2 operations can not be performed at the same time. However, donating bone marrow is surely can improve our metabolism.
     
 
Q7:
On the internet, there was a patient searching for bone marrow donor with AB blood type. If my blood type is AB, am I qualified as a donor
 
A:
Matching of bone marrow is performed on the basis of matching the donor’s HLA (Human Leukocyte Antigen) with the recipients. Matching the blood type is not the main requirement.

 

3. Questions about Peripheral Blood Stem Cells donation

 
Q1:
What is the procedure of peripheral blood collection?
 
A:
Donors must under a series of body check to ensure they are suitable for peripheral blood collection. Five days prior to the collection, donors will be injected with Granulocyte-Colony Stimulating Factor (G-CSF). Its function is to drive the hematopoietic stem cell out from the bone marrow into the peripheral blood. Donor's peripheral blood is drawn by two sterile needles, each in one arm, and passes through a machine that separates and collects hematopoietic stem cells. The blood drawn is, then, returned to the donor’s body. The whole procedure lasts approximately 6-8 hours. Depending on the amount of hematopoietic stem cells to be collected, donors might need to undergo additional collection processes (1 to 2 more times).
     
 
Q2:
What are colony stimulating factors?
 
A:
Colony stimulating factors (CSFs) are growth factors that stimulate the production of hematopoietic stem cells. They also increase the number of hematopoietic stem cells driven out from the bone marrow into the circulation, which thereby allows the collection through peripheral blood.
     
 
Q3:
Why does the peripheral blood donor require further monitoring?
 
A:
The use of Granulocyte-Colony Stimulating Factor (G-CSF) has become common in treatments for many illnesses. For example, cancer patients are given G-CSF after chemotherapy or bone marrow transplantation in order to increase the number of leukocytes. For healthy donor, it is used to drive hematopoietic stem cells out from the bone marrow into the peripheral blood. Many developed countries have already listed the use of G-CSF as a conventional treatment, though a few countries have yet to do the same. In order to protect the right of the donors and ensure that their health would not be affected by the administration of G-CSF, the Buddhist Tzu Chi Stem Cells Center will monitor peripheral blood donor by doing regular blood tests up to ten years.
     
 
Q4:
What are the risks involved with peripheral blood donation?
 
A:
Based on clinical results, donation of hematopoietic stem cells through collection of peripheral blood is generally more secure than bone marrow harvest. In addition, donors do not need to undergo general anesthesia and the painful sensations wear off faster. However, donors at risk of developing potential transient side effects due to individual condition and growth factor administration such as enlarged spleen, anaphylactic shock, arrhythmia or donors with any immune-mediated diseases such as rheumatoid arthritis, gout, and lupus erythematosus are not suitable for filgrastim administration. Through advance general checkup, the risks can be reduced.
     
 
Q5:
Will using G-CSF (filgrastim) increase the risks of getting cancers?
 
A:
Does injection of Filgrastim (a G-CSF analog) increase the risk of getting cancer? A: Almost everyone faces the risk of getting cancer (including Leukemia, lymphoma or other blood-related diseases) throughout his/her entire life. Filgrastim promotes normal hematopoiesis. For those with certain types of cancer or blood-related diseases, whether the risk of cancer increases or decreases with filgrastim administration stimulating the growth of blood cells is still not known. Based on the available data, correlation of administration of filgrastim to healthy individuals with any long-term risks is still yet to be found. Monitoring donors after peripheral blood donations will provide information to clarify whether administration of Filgrastim will lead to any long-term positive or negative effects.
     
 
Q6:
Is peripheral blood collection very painful?
 
A:
Prior to the collection of peripheral blood (approximately 5 days), donors are give an injection of growth factors. The administration of growth factors may cause bone sores, headache, or minor fever. Physicians can prescribe painkillers to relieve those symptoms. During the peripheral blood collection, donor’s blood is collected through sterile needles in both arms. Donor might feel a slight pain during the insertion of the needles. The pain can be relieved by applying local anesthetics.
     
 
Q7:
Where do I go for peripheral blood donation? How long will it take?
 
A:
The Tzu Chi Stem Cells Center will help to set up a time and arrange a hospital for peripheral blood collection. The whole process takes approximately 6 to 8 hours. Depending on the results, an additional collection may be required.
     
 
Q8:
How many people have undergone peripheral blood collection?
 
A:
Comparing with bone marrow donation, peripheral blood donation is relatively safer and donors can resume to normal activities immediately. Although bone marrow donation has been practiced longer, more people have chosen peripheral blood donation world wide in recent years. According to the international bone marrow registry, more than 9,000 people have donated peripheral blood.
     
 
Q9:
Are there side effects of peripheral blood donation?
 
A:
Because Granulocyte-Colony Stimulating Factor (G-CSF) is injected before peripheral blood donation, it may cause aches in bones, headaches, light fever, etc. These side effects can be lessened by doctor’s prescribed pain killer. Also, during peripheral blood stem cells collection, it may cause calcium ion loss, thus, produce numbness on the lips or finger tips. Should this happen, contact the medical team immediately to replenish calcium ion.

 

4. Questions about the donating operation.

 
Q1:
Is there difference between bone marrow donation and peripheral blood donation?
 
A:
Bone marrow donation is a type of surgery where donor undergoes a general anesthesia and needles are inserted through ilium of the pelvic girdle on both sides to draw bone marrow. Surgery lasts approximately ? hour. After the surgery, donor is sent to recovery room for observation until consciousness is regained. Donor should then lie flat for 8 hours to help stop the bleeding. For peripheral blood donation, Granulocyte-Colony Stimulating Factor must be injected into the donor to drive the hematopoietic stem cell out from the bone marrow into the peripheral blood. The stem cells are then collected using a procedure called apheresis where your blood is drawn through a needle. The blood is then passed through a centrifuge where the stem cells are separated from the rest of the blood. The remaining blood is returned back into the body through another needle. The process lasts approximately 6-8 hours. It is safer because it does not require anesthesia.
     
 
Q2:
How do I choose between bone marrow donation and peripheral blood donation?
 
A:
During physical examinations, the medical team will explain the procedures and differences between bone marrow and peripheral blood donations. The results of your physical examination will determine whether you can proceed with your choice. Also, if there is a need for specific type of donation, the medical team will inform you of the same, however, ultimately you make the final decision.
     
 
Q3:
Between bone marrow donation and peripheral blood donation, which one is simpler?
 
A:
There are advantages and disadvantages with both donations. Prior to bone marrow donation, donors need to take iron solution and folic acid medication to promote hematopoiesis. In addition, donor would be asked to go to a blood donation center to reserve his own blood 1-2 times for post-donation transfusion. It is a surgical procedure where donor will undergo a general anesthesia. After the surgery, donor will need to lie flat for 8 hours and rest for about 2 weeks. Within a week, the area where bone marrow is drawn could be sore and uncomfortable. It is recommended that donor refrain from strenuous activities for 2-4 weeks. For a peripheral blood donation, a donor receives injections of a granulocyte colony stimulating factor (G-CSF) for 5 days prior to donation. This may cause soreness in the bones or nausea. This can be lessened with painkiller or decrease the injection. The donation procedure is the same as plasmapheresis donation, except that it takes approximately 6-8 hours each time and it is usually done in 1-2 days. After collection, donor only needs to apply pressure on the puncture wound, ensure that bleeding has stopped before resuming to normal activities.
     
 
Q4:
Is there any risk in stopping the donation process?
 
A:
If donation process is stopped, it does not pose any risk for the donor. However, if the patient has begun the extermination treatment, your refusal may be fatal to the patient.
     
 
Q5:
Who pays for the donation procedure? How much does it cost?
 
A:
Fees for donation process is paid for by both the patient and the Center
1.
Donor’s examination expenses are paid for by the Center.
2.
Patient can request the Center to proceed with HLA (Human Leukocyte Antigen) immune genetic matching and the cost is $9000 NT.
3.
The entire fee that the Center charges from physical examinations to stem cells donation (including surgery, hospitalization, insurance, transportation for donor and his family members, administration, etc.) is $113,735 NT (approximately 10% of the total cost). If patient cannot afford such charge, he may request for financial assistance through Tzu Chi Bone Marrow Care Team. If approved, the Center will provide financial subsidy.

 

Update: Oct. 2009

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