Bone marrow donation, more accurately known as hematopoietic stem cell transplantation (HSCT), is a life-saving medical procedure that replaces a patient’s diseased blood-forming cells with healthy ones from a donor. These stem cells, found primarily in the bone marrow, can generate all types of blood cells, including those of the immune system. HSCT treats various life-threatening conditions, such as leukemia, lymphoma, and other blood and immune system disorders.
A successful transplant relies on a close match of human leukocyte antigens (HLA) between the donor and the patient, which are proteins the immune system uses to identify which cells belong to the body. Because only about 30% of patients find a match within their family, the global need for volunteer, unrelated donors remains high. Joining the registry offers patients a chance at a new immune system, free from their previous disease.
Joining the Donor Registry: Eligibility and Steps
The first step in becoming a donor is to join a national registry, which catalogs your specific HLA markers for potential matches worldwide. To register, you must generally be between the ages of 18 and 60 and meet certain health guidelines. Because stem cells from younger donors lead to better long-term survival rates for patients, most registries focus recruitment efforts on individuals between 18 and 35.
The registration process is straightforward and typically begins by ordering a free home kit online. The kit contains a cheek swab used to collect a cell sample from the inside of your mouth. This sample is mailed back to the registry, analyzed to determine your unique HLA tissue type, and added to the database.
Joining the registry is a commitment to potentially donate if matched, but it does not guarantee you will be called upon. You must also be in good general health, as certain chronic or infectious diseases can disqualify a person to ensure the safety of both the donor and the recipient. Once registered, you remain in the system until you reach age 61, and keeping your contact information current is important.
Understanding the Two Primary Donation Methods
If you are identified as a match, the medical team determines the best collection method based on the patient’s specific disease and needs. There are two main ways to collect hematopoietic stem cells: Peripheral Blood Stem Cell (PBSC) donation and Bone Marrow Harvest. The donor must consent to the specific procedure chosen.
PBSC donation is the most common method, accounting for approximately 80% of all donations. The procedure requires the donor to receive daily injections of a drug called Filgrastim for five days leading up to the collection. Filgrastim is a synthetic protein that signals the bone marrow to release a large number of stem cells into the bloodstream.
The collection is performed through a non-surgical process called apheresis, similar to donating platelets. Blood is withdrawn from one arm and passed through a machine that separates and collects the stem cells, with the remaining blood returned to the donor through the other arm. This outpatient procedure typically takes between four and six hours and may occasionally require a second day to collect the necessary cell volume.
The second method is a Bone Marrow Harvest, a surgical procedure performed under general or regional anesthesia. The liquid marrow is collected directly from the back of the donor’s pelvic bone (iliac crest) using specialized needles. This method is less common and typically takes about one to two hours to complete.
The Donor’s Journey: Preparation, Safety, and Recovery
Once a potential match is identified, the journey proceeds with a thorough health evaluation to confirm suitability for donation. This preparation phase includes an extensive health questionnaire, a physical examination, and blood tests to confirm the HLA match and rule out infectious diseases. The donor also receives an educational consultation to discuss the procedure, potential risks, and to provide informed consent.
The safety of the donor is the first priority, and the donation is entirely voluntary at every stage. The most significant risk associated with a Bone Marrow Harvest is related to the use of anesthesia; the procedure site may be sore afterward. For a PBSC donation, the main side effects are temporary bone or muscle aches, headaches, or fatigue caused by the Filgrastim injections, which cease once the drug is stopped.
Recovery time varies based on the donation type, but most donors can return to their normal routines quickly. Following a PBSC donation, flu-like symptoms usually disappear within one to three days. For a Bone Marrow Harvest, donors may feel soreness at the collection site similar to a bruised feeling. While some may be discharged the same day, a full return to normal activities typically takes a few days to a week.