Donating to your relative

What to expect when you’re donating stem cells to a family member

Some blood cancers are treated with allogeneic transplant. This is a transplant of stem cells from a donor to a patient. An allogeneic stem cell transplant may also be called a bone marrow transplant. An allogeneic transplant is after chemotherapy and/or radiotherapy. Stem cells may be donated by a family member or unrelated donor. A donor may be a full match or a half match (haploidentical). Full siblings have a 25 per cent chance of being a match. It is common to use a haploidentical donor, or unrelated donor. Unrelated donors are registered on Stem Cell Donors Australia or overseas donor registries.

Tissue typing

To find out if you are a match a blood test called Human Leukocyte Antigen (HLA) typing is taken. The family member with blood cancer will also have HLA typing. Depending on where you live it may take several weeks for the results. The HLA types of family are compared to find the best match to donate.

Donor assessment

If you are the best match for your relative and willing to donate stem cells you will have a donor assessment/workup. This is to check your health and capacity to have a stem cell collection. A donor coordinator may arrange this process, which includes:

• Detailed information on the donation procedure and recovery, including risks and side effects. If you agree to donate, you will need to sign a consent form.
• A physical examination.
• Blood tests.
• Other tests – depending on your medical history. Like an electrocardiogram ECG or chest x-ray.
• A visual look at the veins in your arms to check if they are suitable for the procedure. If your veins are not suitable you may need a special line inserted into a large vein. A specialist will assess your veins and perform the procedure.
• You will be given information about the collection procedure and will need to sign a consent form.

Stem cell collection

There are two different ways to collect blood stem cells for donation. These will be discussed at the donor workup.

Peripheral blood stem cell collection

• The most common way to collect stem cells is through a peripheral blood stem cell collection. This is through a process called apheresis.
• You will receive injections of a medication called granulocyte colony stimulating factor (GCSF). These are injected under the skin (subcutaneously) for several days before the stem cell collection.
• The injections increase the number of stem cells made by your bone marrow. The stem cells then flow into your bloodstream.
• You may experience bone or muscle pain, fatigue, and/or headache while receiving injections of GCSF. Side effects and how to manage them will be discussed with you.
• On the day of stem cell collection, you may be seated in a bed or a recliner chair. A nurse will insert a cannula (intravenous tubes) into a vein in each arm. The cannulas are connected to tubes on the apheresis machine. Your blood is taken from one cannula, it goes through the apheresis machine. In the apheresis machine your blood is separated into different cells and the stem cells collected into a bag. The other blood cells are returned to you through the second cannula.
• The stem cell collection takes around 4 to 6 hours. Ask the nurse or donor coordinator what you can do during the stem cell collection. Like watch television, read a book, eat and drink.
• During the stem cell collection, you may experience nausea, a tingling feeling or chills. Tell the nurse if you experience these side effects so they can be managed.
• You may need to return for a second stem cell collection the next day. This depends on how many blood stem cells have been collected on the first day.

Bone marrow donation

• The stem cells are collected from the bone marrow in large bones for a bone marrow donation.
• The procedure is done under general anaesthetic in an operating theatre. You should not have any pain during the procedure.
• Needles are inserted into the back of the hip bones near the lower back. The stem cells are taken through a syringe attached to the needles.
• The bone marrow donation usually takes 1 to 2 hours.
• You will go to the recovery room for a few hours after the bone marrow donation. Generally, you will be able to go home that day. You will need someone to drive you home and stay with you overnight.
• You may feel stiff and sore in the lower back area for a few days after the procedure. Most people find that resting, eating well, and keeping up fluids is helpful. You may have some bruising around the procedure site the week after the donation.
• Your body usually replenishes the donated bone marrow within four weeks.

Recovery and follow up

• Recovery times vary depending on the individual and type of stem cell collection.
• Most donors return to their usual activities within days to weeks after stem cell collection.
• Donor safety is important. Ongoing monitoring and research show stem cell collection is safe for donors.
• You will have follow up with a donor coordinator after the stem cell collection. Information on what to expect and contact details if you have any questions/problems will be provided.

Common challenges for related donors

• Feeling anxious about the stem cell collection and your family member’s transplant.
• Feeling lonely, isolated, or unimportant.
• Side effects of the injections and procedure.
• Family member transplant delays.
• Feeling responsible for the transplant outcome.
• Dealing with loss if the transplant is not successful.

Things that might help

• Express your feelings, talk to someone you feel comfortable with.
• Ensure you have a carer that can support you.
• Get the information you need, ask questions.
• Talk to the treatment team about your concerns and what to expect.
• Contact your donor coordinator.
• Talk with your GP, a social worker, counsellor, or psychologist.
• Give your body time to rest and recover after the procedure.

Read Donating to your relative

This booklet provides in depth information on what to expect when you are donating stem cells to a family member. It delves into the emotional side of being a family donor and provides donor quotes on their personal experience.

Download Donating to your relative now.

References

This webpage information is adapted from “Donating to your relative – What to expect when you’re donating stem cells to a family member” developed by The University of Queensland in conjunction with Metro North Hospital and Health Service, Queensland Government.

1. Early cessation of calcineurin inhibitors is feasible post–haploidentical blood stem cell transplant: the ANZHIT 1 study. Blood Advances. American Society of Hematology (ashpublications.org)
2. HLA Typing: Origins, Innovations, and Ongoing Questions. ASH Clinical News. American Society of Hematology (ashpublications.org)
3. Relationship of donor age and relationship to outcomes of haploidentical transplantation with posttransplant cyclophosphamide. Blood Advances. American Society of Hematology (ashpublications.org)
4. Zomerdijk, N., Turner, J., Hill, G.R. Gottlieb, D. Experiences and unmet needs of family members requested to donate haematopoietic stem cells to an ill relative: findings from a prospective multi-centre study. Support Care Cancer. 29, 635–644 (2021). https://doi.org/10.1007/s00520-020-05520-y
5. Zomerdijk N, Turner J, Gottlieb D, Barnes A, Butler JP, Markey KA, Hill GR. Supporting family members requested to donate hematopoietic stem cells to a relative: development and pilot testing of a psycho-educational resource. Journal of Psychosocial Oncology Research and Practice. 2023 Jan 1;5(1).