The search for a compatible donor
1. Start of the application
The José Carreras Foundation, through its REDMO program, acts as the coordinating center for the whole donor search process. The REDMO is not only responsible for the administration of the Spanish Bone Marrow donor registry but also for the whole process of the search for unrelated donors for the Spanish patients.
Any application to initiate a search for a donor must reach the REDMO/José Carreras Foundation through the medical center in charge of the patient and with the complete consent of the doctor treating the patient. The first stage is to record all the details of the patient (age, diagnosis, medical history, etc) and specifically the characteristics of their HLA typing*, which needs to be verified by an accredited laboratory. The application to initiate a search in Spain should be authorized by the Transplant Coordinator of the relevant autonomous community.
REDMO conducts donor searches for both Spanish and foreign patients. In the case of the latter, the application will be received through the national registry of the patient's country or occasionally in countries where there is no national registry it will be received through an authorized hospital. REDMO has established links with the main global registries which facilitates the processing of all searches, both sent and received.
*HLA Typing: Laboratory technique that facilitates the identification of HLA (antigens) molecules in the lymphocytes (and also in the platelets) of a person. The beginning of the reaction is relatively simple, but its execution requires several hours and the interpretation of the results is a delicate matter. The human leukocyte antigens (HLA) are molecules found in the white blood cells (or leukocytes) of the blood and in the surface of almost all tissue cells of an individual. The HLA distinguish between familiar and alien entities in the body and ensure a response of the immune system. They have the capacity to defend the organism against foreign agents that could cause infections.
2. Control of the application
Once the application to start a search has been received, it is thoroughly reviewed by the Coordinator of the Bone Marrow Donor Registry at the José Carreras Foundation. If any necessary details for the search are missing then the Coordinator will directly contact the Doctor responsible. If the characteristics of the patient do not meet current standards (related to the diagnosis, or age, etc) the doctor should receive authorization from a committee of experts through the National Organisation of Transplants. After this process has been approved, the application will pass to the search coordinators in the REDMO.
The relationship between doctors and REDMO personnel during the search process should be frequent and flexible. REDMO attempts to facilitate regular contact by participating in different medical congresses and meetings at a national and international level.
3. Launch of the search
The launch of the search refers to the start in earnest of the search process. The personal information of the patient is registered in the REDMO data base and sent directly to the international registry. Since 1995, the REDMO has formed a part of the global network of registries (EMDIS), which allows access to more than 34 million bone marrow donors and more than 700,000 umbilical cord blood units around the world*. Contact with countries that have a lower number of donors is carried out through fax or email.
The REDMO includes the data of all Spanish voluntary donors and manages a sophisticated search and comparison algorithm. It lists, in order from highest to lowest compatibility, all the potential Spanish donors and umbilical cord blood units with the patient in the search.
*You can consult the list of global registries at the WORLD MARROW DONORS ASSOCIATION.
4. Evaluation of the results
Generally, the international results of the search for a specific patient are received in no later than three days, taking into consideration the automatic online responses and those received by other means. In every case, the bone marrow donors and the umbilical cord blood units are listed in order of their compatibility with the patient, which assists their subsequent evaluation by the search coordinators.
The evaluation process is governed by official regulations and is principally based on immunological criteria. In this way, it is possible to identify the donor who has the closest typing match to the patient. If there are several possible donors with similar characteristics then other factors such as gender, age, etc are taken into consideration.
This preliminary stage allows for a group of suitable or potentially suitable donors to pass on to the next stage: activation.
5. The activation of the search
In the activation stage, the search coordinators ask for samples from the donors that have been considered suitable. In cases where a donor is not registered as high resolution*, it is necessary to resolve this step before the sample is taken. The Registry (REDMO in the case of a Spanish donor) will send the donor's sample directly to the hospital laboratory where the patient is located. The laboratory will then send the results to REDMO.
If the donor is registered as high resolution, REDMO will only decide whether or not to request the donor's sample, when they have the resolution results.
After the REDMO has received the analysis of the donor samples, the most suitable donor will be selected and the proposal will be sent to the Doctor that will carry out the transplant.
*TYPING IN HIGH RESOLUTION: Typing carried out through DNA technology.
6. Donation process
The final decision regarding the suitability of the donor rests with the doctor who will carry out the transplant, taking into account the physical state of the patient, etc. If REDMO's proposed donor is deemed to be a suitable match then the application form of the donor's request is completed with a proposal of possible dates and other relevant aspects, with respect to obtaining, conserving and transporting the stem cells.
The Registry subsequently agrees the details with the donor and arranges a medical consultation. If the donor is Spanish, then the REDMO will manage this step. Upon the receipt of the medical examination results, if the donor is found to be in a suitable condition and they reaffirm their commitment to the process, the transplant center will begin to prepare the patient.
If the donor is foreign, some registries including REDMO offer the transplant hospital with the option of an external courier service in order to transport the bone marrow to its destination. Every import of hematopoietic progenitors must receive permission from the Ministry of Health in order for the cells to enter the country.
Following the donation, REDMO continues to monitor the progress of the patient for a period.