Dear Editor:

Allogeneic stem cell transplant remains an important option in the treatment of hematologic diseases.¹ Finding an unrelated donor is important for patients who do not have related donors.² We present our evaluation of unrelated donors, seen between November 2015 and February 2018, from whom we were unable to collect stem cells. We also discuss the challenges involved in obtaining donors and a proposed solution.

Our center applies international quality standards (Joint Accreditation Committee-European Society for Blood and Marrow Transplantation and the International Society for Cellular Therapy certificate no. 644). The medical director of the apheresis unit is responsible for obtaining informed consent from unrelated donors and communicating with the bone marrow bank. The coordinator of the bone marrow transplant center organizes consultation appointments with cardiology and gynecology/urology depart­ments for donors. A specialist family physician is responsible for the general examination of the donors. Finally, test results of donors are evaluated, and the results are shared with the tissue bank. The medical director of the apheresis unit notes donor compliance, and the administration of granulocyte colony-stimulating factor is started.

At our center, 95 unrelated donors started the donation procedure during our study period. Between November 2015 and February 2018, stem cells were collected from 73 unrelated donors (76.8%): 10 donated bone marrow stem cells and 63 donated peripheral blood stem cells. Only one of the stem cell donors was registered in the Ankara University Donor Registry (TRAN), whereas the others were registered in the Turkish Donor Registry (TURKOK; Ministry of Health).

During the same period, no stem cells were collected from the remaining 22 unrelated donors (23.1%) directed to our center by TURKOK. After a retrospective review of their medical records, the 5 main reasons regarding why the planned donation did not occur were related to the patient (relapse, death of patient, or no need for cells) in 8 potential donors (8.4%), were related to the transplant center (transplant procedure abandoned or another donor chosen) in 1 potential donor (1%), because of withdrawal (withdrew consent for family, social, or religious reasons) in 8 donors (8.4%), were related to the collection center (health problems, travel history, advanced age, or uncontrolled diabetes or hypertension) in 4 donors (4.2%), and were related to the tissue bank (apheresis center changed for donor comfort) in 1 donor (1%) (Table 1 and Table 2).

The evaluation of unrelated donors and the donation process affected the informed consent of the donors. European Union Directives, international standards, and current guidelines on donor safety, informing the donors about the entire process, obtaining their consent, and performing the necessary investigations and consultations must be considered to ensure that the unrelated donation process is managed correctly and on time.3 We use 2 standard operating procedures (SOP) for donors at our center. One is about donor selection, evaluation, and safety (SOP no. KIT-KU-006), and the other is about the service level agreement with the Turkish Donor Registry (SOP no. KIT-TU-32).

The tissue, transplant, and collection centers must also work closely to reduce time loss and ensure faster follow-up during the process. In the treatment of patients with hematologic malignancies, it is especially important to reach unrelated donors early and to provide accurate and timely information. The results of our study showed that there is a donor-related reason for not making a donation in about 8% of potential transplants. The Ministry of Health should adopt a national policy for informing the public about the donation of blood and bone marrow in Turkey.

References:

1. Angelucci E, Polchi P, Lucarelli G, et al. Allogeneic bone marrow transplantation for hematological malignancies following therapy with high doses of busulfan and cyclophosphamide. Hematologica. 1989;74(5):455-461.
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2. Anasetti C. Use of alternative donors for allogeneic stem cell transplantation. Hematology Am Soc Hematol Educ Program. 2015;2015:220-224.
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3. Boga C, Kozanoglu I. JACIE accreditation from the perspective of an accredited centre. Bone Marrow Transplant. 2017;52(9):1352.
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