Finding a Donor
Unless you are using your own bone marrow or peripheral blood stem cells for your transplant, you will need to find a donor. Finding a suitable bone marrow, peripheral blood stem cell or cord blood donor is an important factor in the success of your transplant.
The donor’s stem cells must have similar genetic markers as yours. These markers are called human leukocyte antigens or your HLA type.
Since you inherited your HLA type from your parents, a brother or sister with the same biological parents is the most likely candidate to be your donor. Your doctor may also ask other family members to be tested, although the likelihood that they will be a match is small.
To determine whether a family member is a match, a DNA test is required. A sample of cells from the inner cheek or a sample of blood is sent to a special DNA testing laboratory. If the person is a match, he or she will undergo a physical examination to determine if he or she is healthy enough to be a donor. See Being a Related Donor for more details.
Finding an Unrelated Donor
If your siblings' HLA type does not match yours, the next step is to search for an unrelated donor. The Be The Match® registry coordinates unrelated donor searches in the U.S.
The Be the Match® registry has more than 7 million volunteer marrow or peripheral blood stem cell donors and nearly 90,000 cord blood units. A search of the Be the Match® registry will also include a search other registries worldwide, giving you access to more than 12 million donors and 300,000 umbilical cord blood units.
Your doctor or transplant center will initiate the search for an unrelated donor for you. Depending on your HLA type, the preliminary search may identify just a few or many potential matches. Your transplant doctor will select the most likely candidates and request that further testing be done.
You can get a preliminary look at the number of people in the registry who match you using the MatchView feature on the Be the Match web site. Although this does initial a formal search for donor, it can give you an idea of the likelihood of finding a match.
If a perfect match cannot be found, your doctor may select a mismatched donor or, if time permits, wait until a donor who is a closer match joins the registry. Mismatched donor transplants are very common, particularly for people with rare HLA types, and often lead to long-term success.
Cord Blood Transplants
A translant using blood stem cells from an umbilical cord is also an option for many patients and is sometimes the preferred option, particularly for children. Cord blood units do not need to match the patient's HLA type as closely as bone marrow or peripheral blood stem cells from an adult donor. They can also be made available more quickly for transplant, since they have already been collected and stored for later use.
If you are having difficulty finding a matched related or unrelated donor and must proceed to transplant quickly, your doctor may suggest a haploidentical transplant. This is a transplant from a related donor, such as one of your parents or your child, who only half matches your HLA type. Historically, the risk of complications is greater with a haploidentical transplant than with a transplant using blood stem cells from a well-matched donor, but new techniques are being developed to improve the safety of this procedure.
Donor Search Costs
Depending on your insurance plan, the donor search and testing may or may not be a covered expense. If it is not covered, the transplant center may ask you to pay for these services prior to proceeding to transplant.
Be the Match has a Search Assistance Fund to help patients with search costs if their insurance plan does not adequately cover this expense. Patients must be planning a transplant at a Be the Match affiliated transplant center. The transplant center search coordinator or financial representative will initate the request for these funds. Patients can get more information about this program by contacting a Be the Match patient services coordinator at 888-999-6743.
Although HLA type is the most important consideration when choosing a suitable donor, your doctor will also take other factors into consideration such as the donor's age, gender, and prior exposure to the cytomegalovirus virus