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Bone marrow donation Content Supplied by NHS Choices
Introduction

A bone marrow donation is a relatively straightforward medical procedure.

Diseased or damaged bone marrow can be replaced by donated bone marrow cells, which help treat and often cure many life-threatening conditions, including:

  • bone marrow failure (severe aplastic anaemia)
  • leukaemia - cancer of the white blood cells, which has several sub-types
  • non-Hodgkin's lymphoma - cancer of the lymphatic system
  • certain genetic blood and immune system disorders such as sickle cell anaemia, thalassaemia and some severe immune system diseases

Read more about the uses of a bone marrow transplant.

After the donation, as long as the transplant is successful, the new bone marrow will begin to make healthy blood cells and the person receiving the donation will start to get better.

What is bone marrow

Bone marrow is a spongy tissue found in the hollow centres of some bones. It contains stem cells which can grow into any of our normal blood cells.

Stem cells in bone marrow produce three important types of blood cells:

  • red blood cells - which carry oxygen around the body
  • white blood cells - which help fight infection
  • platelets - which help stop bleeding

The need for donors

Ideally, bone marrow stem cells are best donated from a close family member, such as a brother or sister, because there needs to be a close match between tissue types. However, only around one in three people have a close relative with a matching tissue type.

For this reason a number of bone marrow registers have been set up listing people who are willing to donate bone marrow stem cells if required.

When a donation is needed, doctors search the bone marrow register to try to find a donor with a matching tissue type.

In England, there are two bone marrow registers, which work closely together:

You can apply to join the British Bone Marrow Registry when you donate blood.

It is possible for most people to find a donor on the registers, but a small number of people with rare tissue types may find it very hard or impossible to find a suitable match.

How it is performed

Firstly you will be asked to provide a small sample of blood to determine your tissue type. This information is kept on the register.

You will be contacted if you are a potential match for a person requiring a transplant.

The most widely used method of donating bone marrow is known as a peripheral blood stem cell donation (PBSC). You will need to receive injections for four days in a row to increase the number of stem cells in your circulating blood before this type of donation.

You will have to visit the hospital or clinic for four days in a row to receive injections which stimulate the production of stem cells.

On the fifth day you will be connected to a cell-separator machine without the need for a general anaesthetic. The machine usually collects the stem cells from your blood through a vein in one arm, returning the blood to your body through a vein in your other arm. This takes about four or five hours and may need to be repeated the following day.

Read more about what happens during a bone marrow donation.

Who can donate bone marrow

If you would like to become a potential bone marrow donor, you must be:

  • 17 to 40 years of age to join the British Bone Marrow Registry
  • 16 to 30 years of age to join the Anthony Nolan Trust register
  • in good general health
  • over 7 stone 12 pounds (50kg) in weight
  • have a body mass index (BMI) lower than 40

It is best to join the bone marrow register at a young age. The younger you are when you join, the more chance there is of your tissue type being matched to that of someone who needs it.

Read more about who can donate bone marrow.



Why bone marrow donation is used

Bone marrow transplants are required when a person's bone marrow becomes damaged or diseased to such an extent that it stops functioning properly.

This may be due to certain cancers, such as:

  • leukaemia - cancer of the white blood cells
  • non-Hodgkin's lymphoma (cancer of the lymphatic system, which is part of the immune system), or a related cancer of the blood

Leukaemia has a few main sub-types:

Other diseases that may require a bone marrow transplant include:

  • certain genetic blood and immune system disorders - such as sickle cell anaemia, thalassaemia and some severe immune system diseases
  • bone marrow failure (severe aplastic anaemia)
  • other diseases that affect the blood, such as multiple myeloma, a cancer that affects blood plasma cells

Bone marrow transplants are also sometimes necessary following certain treatments, such as high-dose chemotherapy and radiotherapy, which are often used to treat cancer. These treatments tend to damage healthy stem cells as well as destroying cancer cells.

Read more detailed information about bone marrow transplants.



How bone marrow donation works

Bone marrow donors must have a tissue type compatible with the person who is going to receive their bone marrow.

Tissue type

Tissue type, also known as human leukocyte antigens (HLA) type, helps the body fight infection. To check if the tissue type is compatible, doctors check how many proteins on the surface of the blood cells match. There are millions of different tissue types but some are more common than others.

Tissue type is inherited, with these types being passed on from each parent. This means a relative will be more likely to have a matching tissue type. However, if a suitable bone marrow donor cannot be found from family members, doctors will try to find someone with a compatible tissue type on the bone marrow donor register.

Joining the register

You must be a blood donor to apply to join the British Bone Marrow Registry (BBMR) as a potential bone marrow donor. Alternatively, you could join the Anthony Nolan Trust register, which does not require you to be a registered blood donor. If you join one register, you do not need to join the other because your details will be automatically shared between registers.

When you apply to join a bone marrow register, you will need to supply a blood or saliva sample so your tissue type can be identified. If you are applying through the Anthony Nolan Trust, they can arrange for a saliva sample to be taken.

You must be:

Read more information about who can register as a bone marrow donor.

You could be contacted as a potential match for someone who needs a bone marrow transplant from the time that you join a bone marrow register until you reach 60 years of age.

Donations are provided to people both in the UK and overseas. You cannot choose who will receive your bone marrow and your donation will remain anonymous. However, over time and if both donor and patient want to, NHS Blood and Transplant can facilitate a written contact between donor and recipient. This can eventually result in face-to-face contact if both individuals are keen for this to happen.

When you join a bone marrow register, your details will be held in compliance with the Data Protection Act (1998). Any samples you provide will not be used for other tests, except those needed for donation and transplant purposes. Your DNA will not be shared with any other organisation.

You can ask to be removed from the BBMR at any time by contacting the donor helpline on 0300 123 2323 or from the Anthony Nolan Trust on 0303 303 0303.

Serious commitment

Most people who join a bone marrow register are never contacted because the chance of a person requiring a donation of your tissue type is relatively low (around one in 100).

However, there is a chance that you may be contacted at some point, so you need to understand that you are making a serious commitment by joining the bone marrow register.

If a person with a life-threatening condition thought that they were going to be saved as a result of your donation, and then you suddenly changed your mind and refused to provide a donation, it is likely to be very traumatic for that person and their loved ones.

Therefore, if you have serious doubts about whether you would be willing to go through with the donation process, it is probably better you do not join the register.



How bone marrow donation is performed

If you are on the bone marrow register and identified as a possible match for someone, you may be asked to provide a blood sample. This will enable further checks on your tissue type to be made.

If your tissue type matches the patient who requires bone marrow, you may be selected to donate. You will have a full medical examination and receive counselling about the procedure.

There are two ways of donating bone marrow. The first and most widely used method is known as a peripheral blood stem cell (PBSC) donation. The second method involves donation of the bone marrow itself.

Peripheral blood stem cell (PBSC) donation

Peripheral blood stem cell donation (PBSC) is a procedure that allows you to donate stem cells from your circulating blood without having to directly donate any bone marrow.

Every day for four days before the PBSC donation takes place, you will receive an injection of a medication called Granulocyte-colony stimulating factor (G-CSF). This will increase the number of stem cells in your blood. Stem cells produce a variety of blood cells, including red blood cells that carry oxygen around your body.

Common side effects of G-CSF include:

Less common side effects include:

These side effects are usually mild and should pass once treatment with G-CSF has stopped.

On the fifth day, you will be connected to a special machine that separates the stem cells from your blood. These are collected into a pack for use.

The advantage of having a PBSC is that you do not need to have a general anaesthetic, and you will not have to stay in hospital overnight. It takes around four or five hours to donate this way. Occasionally, a donation is also needed on the sixth day to top up the total number of stem cells.

Bone marrow donation

In bone marrow donation, a syringe is used to remove bone marrow from your hip bones. Although this is not a surgical operation, it is usually carried out under a general anaesthetic to stop you feeling any pain during the procedure.

After donating bone marrow, you may experience some discomfort at the site where the needle was inserted into your hip, but this should gradually settle. You will usually need to stay in hospital for up to 48 hours to make sure you have recovered fully from the general anaesthetic.

After the donation procedure, it usually takes about five days to fully recover from the effects of the anaesthetic. It is recommended you stay at home and rest during this period.

Risks

PBSC and traditional bone marrow donation are both extremely safe procedures that have a small level of associated risk.

Around one in every 100 people will experience a complication during or following PBSC and bone marrow donation. For example, an infection close to where the needle was inserted to collect stem cells. In rare cases, a person may experience a serious allergic reaction to the general anaesthetic used during a bone marrow donation.



Who can donate bone marrow?

If you would like to become a potential bone marrow donor, you must be:

It is best to join the bone marrow register at a young age. The younger you are when you join, the more chance there is of your stem cells being most suitable for someone in need.

People unable to donate

Having certain medical conditions may mean you cannot donate bone marrow. These include:

If you become pregnant, you will be temporarily unable to donate until your baby is 12 months old. Although no problems have been reported, the safety of donating bone marrow during and shortly after pregnancy has not been fully established.

If you don't live in the UK you may not be eligible to join the register.

Read more about who can join the register on the Anthony Nolan Trust website.



'It felt good to get rid of a big bag of medicine'

Bridie Burrell was diagnosed with acute lymphoblastic leukaemia during the Christmas school holidays in 2004. She had a bone marrow transplant the following year.

"During school term, I felt completely healthy. But during the holidays, just before the new year, I experienced dizziness and walking to the bathroom felt like I'd run a marathon. I thought it was a cold, but when I turned a bit greenish and didn't eat for a few days, my parents sent me to the GP."

Bridie's GP suspected flu, but because her grandfather had diabetes, he ordered a blood test. "During the testing, I fainted and ended up in the hospital for three weeks. I received three units of blood in the first 12 hours because my haemoglobin level was so low."

Bridie had acute lymphoblastic leukaemia, a blood disease that develops when the white cells of the blood go into overdrive, dividing too fast and overproducing.

Six months of intensive chemotherapy followed, which had a number of side effects. Bridie lost her hair and appetite, and she felt tired and sick all the time.

"The steroids I was on made me eat like a pig on some days. I also got upset very easily. If I woke up early in the morning and no one was up yet, I would cry."

Doctors then discovered that Bridie's chemotherapy was not working and told her she needed a bone marrow transplant. Nobody in her family was a match, so doctors searched the international bone marrow registers. Luckily, a match was found four months later and Bridie had her transplant in 2005.

But Bridie's recovery was not without its problems.

"Shortly after I was discharged, I had to go back into hospital for an emergency operation for septicaemia. Then I went to hospital again for two months to be treated for pneumonia."

Bridie lost not only her health but also her way of life while her treatment was going on. She could no longer take part in her much-loved netball or hang out with friends because her parents worried about her health. It was a lonely time.

Today, things are looking much better for Bridie and she's beginning to get back to her old life. She's catching up with friends and her father has built a swimming pool in the garden so she can start exercising again and build up her strength.

She was previously on a cocktail of 14 different drugs, but is now on three. "I was emptying a cupboard full of drugs with my dad and I said, 'This is such a milestone, we should have a party!' It felt good to get rid of a big bag of medicine."

"There's a video of me recorded after the transplant, and I looked miserable because I thought the illness should have ended, and it hadn't. Looking back, I really should have been more grateful that I got a match. Donors are heroes in their own right, and they probably don't realise what a big deal their act of giving is to those who receive it."

 
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