Bone Marrow Donation

What is bone marrow donation?

Bone marrow donation, or bone marrow harvesting, is the procedure healthcare providers use to obtain blood-forming cells (stem cells) for stem cell transplant (bone marrow transplant). The bone marrow donation process begins when someone agrees to donate bone marrow. Donating bone marrow doesn’t hurt and may cure someone who has blood cancer or a blood disorder. To do the procedure, healthcare providers use large hollow needles that pull bone marrow from donors’ hips (pelvic bones). Anyone can volunteer to donate bone marrow, but all donors must meet certain health requirements.

How common is bone marrow donation?

Bone marrow donation is one of three ways healthcare providers obtain healthy stem cells. Most stem cell transplants involve peripheral stem cell or cord blood transplants. Peripheral stem cells are immature stem cells in your bloodstream. Cord blood comes from umbilical cords. People who have recently given birth can choose to donate their umbilical cord blood afterward.

People in need can receive donated bone marrow from family members (related donors) or from people they don’t know (unrelated donors). According to the U.S. Health Resources and Services Administration, 20% of related donor transplants and 14% of unrelated donor transplants completed in 2020 were bone marrow transplants.

Why do people need donated bone marrow?

Your bone marrow is the soft and spongy liquid tissue in the center of some of your bones. Every day, your bone marrow makes more than 200 billion new blood cells, including red blood cells, white blood cells and platelets. Bone marrow transplants may help people who have certain diseases, such as the blood disorder aplastic anemia or a blood cancer such as non-Hodgkin lymphoma. In a bone marrow transplant, stem cells from healthy bone marrow replace unhealthy bone marrow.

Each year, about 18,000 people learn they have a bone marrow disease that a bone marrow transplant or other stem cell transplant could cure.

The challenge is finding a match. The best possible match is a healthy donor who has human leukocyte antigens (HLA) that are a close match to the person needing the bone marrow transplant. HLA are blood proteins. Healthcare providers identify HLA by comparing results of blood tests done on prospective donors and recipients. This is HLA typing.

To find good matches between donors and recipients, providers evaluate donor stem cells for antigens that match recipients. High numbers of matching antigens help the donated stem cells produce new blood cells to replace the unhealthy blood cells.

About 30% of all people who need a transplant find a matching donor from someone in their immediate family. The remaining 70% rely on finding matching donors from someone other than a close family member.

Does a donor’s ethnic background make a difference?

Yes, it does. There’s a link between race and matching bone marrow. Certain genes manage immunity. Those genes may be different based on race or ethnicity. Fewer people of color donate bone marrow, limiting the number of people who can receive donated bone marrow.

For example, the Be the Match© registry in 2021 had more than 9 million bone marrow donors. A person who is white who needed a bone marrow transplant had a 79% chance of finding a donor.

In comparison, a person who is Black who needs a bone marrow transplant has a 29% chance of finding a donor. Healthcare and transplant organizations are working to increase the number of bone marrow and other stem cell donors from groups of people from different racial and ethnic backgrounds.

Where do healthcare providers find bone marrow donors?

In the U.S., the National Marrow Donor Program (NMDP) keeps a registry of potential donors. You can join the registry by:

• Contacting the NMDP online or through a donor center. You can find a donor center by calling 1.800.MARROW2.
• You can choose to go to a donor center or request a mail-in kit. The test involves swabbing the inside of your cheek with a cotton swab to obtain a tissue sample. The NMDP analyzes your sample to determine your HLA type and adds that information to the registry.
• The NMDP will contact you if your HLA type is a close match to someone who needs healthy bone marrow.
• Next, healthcare providers at the donor center will take a sample of your blood. They send your blood sample to the transplant center caring for the person who needs a transplant.
• The transplant center team confirms the HLA match.They also decide if the person who needs a transplant should receive stem cells from donated bone marrow, cord blood or peripheral blood cells.
• If the transplant center team decides a bone marrow transplant is appropriate, you’ll meet with an NMPD counselor who will explain the procedure, including any risks involved in donating bone marrow.
• If you agree to go forward with a bone marrow donation, the counselor will ask you to review and sign an informed consent document. Signing the document means that you understand and accept the risks of donating bone marrow.

What disqualifies you from being a bone marrow donor?

Many things may disqualify you from donating bone marrow. For example, people age 60 and older can’t be donors. Transplant organizations set this age limit because many people develop medical conditions as they grow older that could disqualify them as donors. Medical conditions that disqualify potential donors include:

• HIV/AIDs.
• Severe arthritis such as rheumatoid arthritis.
• Autoimmune diseases that affect your whole body.
• Bleeding disorders or conditions such as hemophilia or deep vein thrombosis.
• Brain injury.
• Cancer. People who had chemotherapy or radiation therapy or who had cancer treatment within the past five years may not be able to donate bone marrow.
• Chronic hip, back or spine pain, if you’re receiving treatment, such as medication for it.
• Chronic Lyme disease.
• Diabetes. If you need insulin for your diabetes, you can’t donate.
• Heart disease.
• Hepatitis B or Hepatitis C.
• Kidney disease.

This list represents just a few of the reasons why you may not be able to donate bone marrow. If you want to donate bone marrow but aren’t sure you’ll qualify, talk to a healthcare provider. They can review the medical guidelines and your health history.

What happens before the bone marrow donation procedure (bone marrow harvest)?

Healthcare providers will do a final check of your overall health. They’ll give you information about preparing to have general anesthesia. They may do tests to confirm you can donate bone marrow.

Blood tests

Blood tests may include:

• Complete blood count (CBC).
• Comprehensive metabolic panel (CMP).
• Pregnancy test. All women who could become pregnant receive a pregnancy test.
• Prothrombin time test (PTT). This test measures how quickly your blood forms a clot.

Infectious disease tests

You may have tests for:

• HIV/AIDS.
• Cytomegalovirus (CMV). This is a form of the herpes virus.
• Toxoplasmosis.
• Hepatitis.
• Epstein-Barr virus (EBV).
• Human T-cell lymphotropic virus Type 1 and Type 2. These viruses affect your T cells, white blood cells that are part of your immune system.
• Chickenpox (varicella).
• Syphilis.

Other tests

Additional tests may include:

• Electrocardiogram. This test evaluates heart function.
• Chest X-ray.

What happens during the procedure?

• You’ll be taken to an operating room, where you’ll receive general anesthesia.
• You’ll lie on your stomach. Healthcare providers will insert a tube in your throat to help you breathe.
• Healthcare providers place a special needle through your skin into the narrow cavity of your hipbone. (Healthcare providers choose hipbones for bone marrow donation because hipbones contain the most marrow and the largest number of healthy stem cells.) Your healthcare provider may need to insert the needle several times to collect enough bone marrow.
• They’ll collect about 1 to 2 pints of liquid bone marrow. This may sound like a lot of bone marrow but it’s only about 10% of all of your marrow cells.
• Bone marrow donation (bone marrow harvest) typically takes about an hour.
• Healthcare providers may also take red blood cells as part of the procedure. If that happens, you’ll get your red blood cells back once you’re in the recovery room.

What happens after bone marrow donation?

• You’re taken to the recovery room. You’ll need to stay there for about an hour.
• A recovery room nurse will help you wake up. They’ll check your vital signs — blood pressure and pulse — every 15 minutes until your blood pressure and pulse are stable. They’ll also check the bandage on your hip for any signs of unusual or excessive bleeding.
• You’ll have an intravenous (IV) tube in your arm during recovery. If healthcare providers took red blood cells during the procedure, the IV will deliver those cells back to you. The recovery room nurse will remove the IV when you’re able to tolerate fluids.
• Your recovery room nurse will encourage you to take deep breaths, cough and change positions to help you recover from anesthesia.

How will I feel after donating bone marrow?

You may have the following side effects right after donating bone marrow:

• You may feel tired.
• Your throat may be sore and dry from the breathing tube.
• You may feel nauseated.
• You may feel weak and need help if you need to go to the bathroom. You’ll be able to go home once you’ve recovered from the procedure. You won’t be able to drive yourself home.

What happens to the bone marrow that is collected?

Healthcare providers filter your donated bone marrow to remove any fat or bone particles. Your donated bone marrow is processed in a laboratory so it can be infused into the person receiving the donation.

What are the risks or complications of bone marrow donation?

Most donors recover completely after donating bone marrow. It’s important to remember that bone marrow donations are surgical procedures that carry the following potential risks:

• Reaction to anesthesia.
• Nerve or muscle damage.
• Infection.
• Hip injury where the needle was inserted.

What are the benefits?

The greatest benefit is the knowledge that your bone marrow donation may save a life. The life you may save could be a family member, friend or someone you don’t know and may never meet.

How long does it take to recover from donating bone marrow?

Most donors can get back to work or other normal activities after resting for a few days. It can take a few weeks before donors completely recover from donating bone marrow. During your recovery, you may have the following side effects:

• Your lower back and the back of your hips may ache or feel sore for a few days after the procedure. You may have bruises. Healthcare providers may recommend over-the-counter pain-reducing medication.
• Some people still feel weak or have trouble walking for several days afterward. In that case, healthcare providers may recommend they take iron supplements. Taking supplements may help red blood cell levels to return to normal. Your healthcare provider will monitor your red blood levels and let you know if you need to keep taking supplements.

When should I see a healthcare provider after donating bone marrow?

Contact a healthcare provider if you have symptoms that might be signs of infection. Symptoms may include fever and tenderness or redness in the spot on your hip where your healthcare provider inserted a needle to withdraw bone marrow.

Do bone marrow donors and recipients ever meet?

Yes, but those meetings only happen when both donor and recipient want to meet. Healthcare and transplant organizations that coordinate bone marrow donations also facilitate donor and recipient meetings.