Turkey is quite behind in terms of stem cell donation. Dr. Barış Malbora, the physician responsible for stem cell transplantation, states that a large portion of donor candidates back out when they are asked to be a donor for a patient, and he notes that the public is not adequately informed about stem cell donation.
Prof. Dr. Barış Malbora explains that anyone between the ages of 18 and 50 who doesn't have a chronic or infectious disease (such as Hepatitis B, C) can be a donor. "For some diseases, unfortunately, the only solution with today's knowledge and technology is a stem cell transplant. The first diseases that come to mind are mostly leukemias, or in other words, blood/bone marrow cancers. However, in addition to this disease, bone marrow transplantation is also the only definitive solution for other organ cancers, congenital metabolic diseases, immune system deficiencies, and congenital anemias like Mediterranean anemia."
'CANDIDATES ARE GIVING UP ON DONATING'
However, Malbora states that bone marrow is not the only source of stem cells. "Bone marrow transplantation, as we are all used to hearing it, is a stem cell transplant. Our people are quite sensitive about becoming a bone marrow donor. But a large portion of donor candidates back out when it is determined that their tissue type is a match and they are asked by TÜRKÖK to be a donor for a patient," he said.
'THE PUBLIC IS NOT SUFFICIENTLY INFORMED'
Malbora says that there is more than one reason why citizens back out. "Our people are not sufficiently informed about this issue. If they clearly understood that the procedure would not endanger their own lives, I believe that those who tend to back out would run to give their stem cells when a request for a bone marrow donation comes in."
DONOR AND PATIENT DO NOT MEET FACE-TO-FACE FOR 2 YEARS
Malbora also points out that the donor candidate's relatives sometimes do not give permission for them to donate bone marrow. "Sometimes, the donor candidate can also have financial expectations from the patient and their relatives. The laws prevent this from happening. For example, the donor and recipient cannot meet face-to-face for up to 2 years after the transplant. The identities of the patient and the donor are kept strictly confidential. It is possible for them to meet after 2 years, provided that both sides consent."
'THERE SHOULD BE NO LUXURY OF SAYING, SORRY, I'VE BACKED OUT'
Malbora emphasizes that it is a terrible situation to not give the bone marrow to a patient who is waiting for it, even after a tissue match has been found. "For patients who don't have more than one donor, this is the line between life and death. This is such a clear and tragic situation. Of course, let's all be donor candidates; this is a very beautiful feeling. But the real process begins when you learn that your tissue is a perfect match with a patient. The emotional burden of this is very heavy. What's even worse is to agree to be a donor after a tissue match and then back out after we have started chemotherapy for our patients, about 1 week to 10 days before the transplant. The chemotherapy we give to the patient at this stage irreversibly eliminates the patient's bone marrow. At this point, we medically do not have the luxury of saying, 'Sorry, I've backed out.' If the donor backs out at this point, it is not a distant possibility that we might lose the patient due to bone marrow failure. The laws on this issue protect the donors to the end. I believe we should not have the luxury of saying 'I've backed out' after the patient's preparation regimen has started, and sanctions should be imposed on donors through legal regulations at this point."
THERE ARE THREE SOURCES OF STEM CELLS
Malbora explains that our stem cells have three sources in our body. "The first is the stem cells in the umbilical cord blood when a baby is born. This is a tissue that is very rich in stem cells, but it is often not sufficient in volume. In babies and small children with low body weight, cord blood can be a good source of stem cells. The second is bone marrow. That is, the soft tissue in the middle of our bones. If we are going to use bone marrow as a stem cell source, our donor is put under general anesthesia in the operating room after a 12-hour fast the night before. Without feeling any pain, we collect the stem cells from the back protrusions of the pelvic bone with the help of special needles in a time frame of 30-40 minutes. After a one-day observation, our donor leaves the hospital with ease. The most common complaint they might have is the soreness at the needle entry points. It is possible to solve that with simple painkillers," he said.
Malbora continued, "The third method is to collect stem cells circulating in our veins. This is also the most common method used by TÜRKÖK. The stem cells in our veins in their natural state are not enough for donation. To increase the number of these stem cells, booster shots are administered starting 5 days before the collection procedure. On the day of collection, the person is connected to a machine that operates with a closed and completely sterile system. The blood taken from one arm enters the machine. The stem cells are separated in the machine. All other remaining blood components are returned to the donor. This procedure takes an average of 2-3 hours. If the patient's arm veins are not suitable for this procedure, a temporary catheter is inserted into the donor and is removed immediately after the procedure."