Every year on September 18th, on 'World Bone Marrow Donor Day,' awareness is created to support the treatment of various diseases, especially inherited metabolic disorders and some types of cancer, through bone marrow transplantation. You, too, can give three tubes of blood and become a beacon of hope for thousands of patients waiting to cling to life.
There are some diseases on Earth for which the only solution, with current knowledge and technology, unfortunately lies in stem cell transplantation. The first disease that comes to mind is often leukemia, 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.
Prof. Dr. Barış Malbora from the Bone Marrow Transplant Center at Yeni Yüzyıl University Gaziosmanpaşa Hospital, drew attention to important points to be aware of regarding 'bone marrow transplantation and the transplant process.'
Bone marrow transplantation, as we all know it, is a stem cell transplant; however, we know that bone marrow is not the only source of stem cells. Since bone marrow is frequently used as a stem cell source, stem cell transplant and bone marrow transplant are often used synonymously.
Donors, Don't Give Up on the Transplant Process
The total number of voluntary donors in global banks is 41.3 million, and our people are quite sensitive about becoming bone marrow donors compared to many advanced countries. However, when tissue compatibility is identified and TÜRKÖK requests a donor for a patient, a large number of donor candidates give up on donating. This is truly a very sad situation. At the same time, some of our patients waiting for bone marrow can have more than one fully compatible donor candidate, and these patients are luckier. If one donor candidate gives up, we can immediately turn to the other; however, sometimes only one individual in this vast world can be a match for a patient. In this case, this single volunteer giving up on being a donor creates a complete disappointment for us and for our innocent children and their parents.
What are the reasons for donors to give up on the transplant?
One of the reasons for donors giving up can be fear. This is due to the fact that a large part of the public does not have enough information about bone marrow transplantation. If a person knows clearly that the procedure will not endanger their life, the likelihood of such situations happening will be quite low.
It's hard to believe, but unfortunately, another reason is that spouses or parents do not give permission for the donor candidate to donate bone marrow.
Sometimes, the donor candidate may also have financial expectations from the patient and their relatives; however, the laws have built very strong walls to prevent this. Today, TÜRKÖK, which is 8 years old, is also taking very positive steps in this regard. First of all, the donor and recipient cannot meet face-to-face for up to 2 years after the transplant, and the identities of the patient and donor are absolutely kept confidential. It is possible for them to meet after 2 years, provided that both sides consent.
If a donor gives up on a bone marrow transplant, this can result in the patient's death.
There can be people who become bone marrow donors and then give up; however, not donating the marrow to a patient waiting for it, despite tissue compatibility being identified, is the most tragic situation. For patients who do not have more than one donor, this is the line between life and death. The patient feels either that the donor will give them bone marrow and they will hold on to life, or that the ropes of life will be taken from their hands. This is such a clear and tragic situation, and it is something that should not happen.
Of course, let's all become donor candidates; this is a wonderful feeling. But the real process begins when you learn that your tissue is a perfect match with a patient. If you give up at this stage, the individual waiting for the donation will continue to wrestle with a serious illness and may even lose their life. The emotional burden of this is very heavy, and what's worse is agreeing to be a donor after a tissue match and then giving up a week to 10 days before the transplant, after we have started chemotherapy for our patients. The chemotherapy we give to the patient during this period irreversibly destroys the patient's bone marrow. At this point, we medically do not have the luxury of saying, 'Sorry, I changed my mind.' If the donor gives up at this point, it is not a distant possibility that we might lose the patient due to bone marrow failure.
Is there a legal obligation for a donor who gives up on bone marrow donation?
The laws regarding this issue protect the donors to the end. Since donating is based on volunteering, it can perhaps be understood to a certain extent. But after the patient's preparation regimen has started, we should not have the luxury of saying, 'I changed my mind,' and at this point, sanctions should also be imposed on donors through legal regulations. You have the right to give up at every stage, but please never back out when you are very close to the transplant date!
What is the bone marrow transplant process like, and how is the transplant performed?
The marrow, or rather, 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 tissue is very rich in stem cells, but most of the time, the volume is not sufficient. In babies and small children with low body weight, cord blood can be a good source of stem cells.
The second is the bone marrow, which 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. We collect the stem cells from the back protrusions of the pelvic bone with the help of special needles in a 30-40 minute time frame, without the donor feeling any pain. After 1 day of observation, our donor can leave the hospital very comfortably. The most they might complain about is the feeling of soreness at the needle entry points, which can be solved with simple pain relievers.
The third method is to collect stem cells circulating in our veins. This method is also the most common one used by TÜRKÖK. The stem cells in our veins are not sufficient for donation in their natural course. To increase the number of these stem cells, booster shots are given starting 5 days before the collection procedure. On the collection day, 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, and the stem cells are separated. All other remaining blood components are returned to the donor, and this process takes an average of 2-3 hours. It is worth noting here that if the donor's arm veins are not suitable for this procedure, a temporary catheter is inserted and removed immediately after the procedure.
It must be emphasized that: please come to the Red Crescent, to TÜRKÖK, and give three tubes of blood to be a source of hope for thousands of people waiting to cling to life. And don't stop there; if your tissue type matches a patient, don't give up on being a donor. Especially, do not back out close to the transplant date. Because at that point, you would not only be extinguishing people's hopes but also reaching an irreversible point that would endanger their lives. Anyone between the ages of 18 and 50 who does not have any chronic or infectious diseases (such as Hepatitis B, C) can be a donor.