Bone marrow donation is a life-saving medical procedure that provides healthy blood-forming stem cells to patients fighting blood cancers and other diseases. These cells can be collected directly from the bone marrow or from the peripheral blood (PBSC donation) and must be a close genetic match to the recipient. Donor health and safety is the primary concern for all donor registries because the donation is a medical intervention. Therefore, strict eligibility criteria are in place to ensure the process is safe and effective for everyone involved.
Understanding Donor Health Requirements
Before registration, potential donors must satisfy general health and demographic criteria established by major registries. Most programs require donors to be within a specific age range, often between 18 and 40, because younger donors generally provide cells that lead to better patient outcomes. Registries also enforce body mass index (BMI) guidelines, often declining individuals whose BMI is over 40, as obesity increases the risks associated with the donation procedure.
Prospective donors undergo an initial screening to confirm overall physical wellness and the absence of chronic conditions. These criteria are standardized to protect the donor from complications and ensure the donated cells are of high quality.
Diabetes and Donation Eligibility
Whether a diabetic can donate bone marrow depends heavily on the type of diabetes and how well it is managed. Most donor registries have specific rules regarding diabetes because the condition introduces complexities that can compromise donor safety during and after the procedure.
Individuals with Type 1 diabetes, who are dependent on insulin injections, are almost always ineligible to donate stem cells. Type 1 diabetes is classified as an autoimmune disease, and registries are concerned that a donation could transfer components of that autoimmune predisposition to the recipient. Additionally, the procedural risks associated with insulin dependence are too high to justify the donation.
For Type 2 diabetes, eligibility is often determined on a case-by-case basis, depending on the level of control and medication regimen. If the Type 2 diabetes is well-controlled through diet, exercise, or oral medications that do not include insulin, the individual may still be considered after a thorough medical evaluation. However, if Type 2 diabetes requires insulin therapy or has led to serious related health issues, such as kidney, heart, or eye disease, the individual will be excluded.
Risks to Diabetic Individuals During Donation
The medical exclusion of many diabetic individuals is rooted in the increased physiological risk the donation process poses to their health. A main concern involves managing blood glucose levels during the procedure, especially if general anesthesia is required for a traditional bone marrow harvest. Maintaining stable blood sugar is significantly more difficult when the donor is fasting for surgery or recovering immediately afterward.
For the more common peripheral blood stem cell (PBSC) donation, the donor receives daily injections of filgrastim to mobilize stem cells into the bloodstream. This growth factor medication can cause fluctuations in blood sugar levels, which is dangerous for individuals with pre-existing glucose regulation issues. Uncontrolled diabetes can complicate this mobilization phase and the subsequent apheresis process.
Diabetes also affects the body’s ability to heal and fight infection, increasing the risk of complications at the harvest site or IV insertion points. High blood sugar levels impair immune function and slow wound repair, making a diabetic donor more susceptible to post-procedure infections. Additionally, diabetes often involves underlying cardiovascular issues, and the stress of the donation process can strain the heart and vascular system.