Bone marrow transplantation is a complex procedure, the outcome of which is almost never completely clear. After all, even material taken from a relative and suitable in many respects may not take root. And then everything will have to start again. Moreover, unlike finding a suitable donor, in this matter it is much more difficult, because the connection between the tissues of the patient and the potential donor (especially a random person) often turns out to be incompatible.
Doctors say that to find the most ideal donor, it is necessary to check several thousand, or even tens of thousands of people for compatibility.
In this case, all examined donors are entered into a special database of future donors, in which they can be found if necessary.
Contraindications to bone marrow donation
Before you go for a bone marrow examination, carefully study the information on contraindications. So, a person who has a history of hepatitis B or C, tuberculosis, malaria, malignant tumors (even if they are treated), mental disorders, or HIV infection cannot obtain bone marrow.
Also, donors suffering from autoimmune diseases, problems with the respiratory system and the cardiovascular system will not be accepted into the database. It will not be possible to give the materials to those who are intolerant.
Ideally, a person between the ages of 18 and 55 can become a donor, preferably without bad habits or chronic diseases. Only this type can easily tolerate apheresis (i.e., removal of part of the blood or bone marrow).
Naturally, if we are talking about a critical and hopeless situation, someone who has some minor problems can also become a donor. chronic diseases. The remaining contraindications will remain, even if there is no way out at all.
How to become a donor
First, you will have to donate blood. Your samples will be taken for research and genes, antibodies and other components that may be important when selecting a donor for a particular component will be determined. This analysis is called HLA typing.
Once you pass this check, you will be asked to fill out a questionnaire, an agreement to add you to the register of potential donors, and a full medical examination to confirm that you are healthy.
Remember that participation in the bone marrow transplant procedure is voluntary. And you can always refuse; inclusion in the register does not oblige you to go all the way. But just remember that if you agreed, you can suddenly refuse to participate in the operation no later than 10 days before the appointed date.
True, in this case it is worth taking into account the psychological state of the patient, to whom you have already given hope of receiving donor bone marrow, and then taken it away.
Who becomes a bone marrow donor? Now let's look at this issue. But first, let's look at the indications for using the material.
Application
Bone marrow donation is necessary for the treatment of cancer. Therapy is used for the following diseases:
- Leukemia.
- Diseases of the lymphatic system.
- Neuroblastoma.
- Aplastic anemia.
- Hereditary blood diseases.
Description of the procedure
There is a misconception that a sick person's bone marrow is replaced with foreign bone marrow. In fact, stem cells from a healthy person are injected into the patient. This procedure is performed through a vein. Hematopoietic stem cells, which are received by a sick person, provide the function of hematopoiesis. Their peculiarity is that they can transform into erythrocytes or leukocytes. It is also possible for them to transform into platelets.
In our country, these cells began to be used at the end of the last century, namely in the 90s. If a person being treated for cancer receives radiation therapy, their blood production may become suppressed. In this case, the use of stem cells will help to establish the recovery process.
There are cases when the introduction of stem cells is the only way that can help a person survive. But you should know that there are certain risks. It is possible that the body of a sick person recognizes donor cells as foreign. In this case, the rejection process will begin.
How to become a bone marrow donor?
It is worth saying that a person can become a donor to himself. This method eliminates the risk of cells being rejected. The main thing is that the patient’s bone marrow is not affected by cancer cells. In this case, stem cells are taken from the patient before starting chemotherapy or radiation. Then, after a course of treatment, they are administered to the patient through a vein.
But there are also cases when it is not possible to take bone marrow from a sick person. In this case, a third-party donor is needed. Before collecting bone marrow, it is necessary to do a special study to determine the compatibility of the patient and the donor. In order for people to be compatible, certain sets of genes must be present in their bodies.
Usually brothers and sisters are compatible. Less often parents and children. But it is possible to find an ideal donor who will have a high degree of compatibility with the sick person. It may turn out that one is located in another part of the world. There is a possibility of detecting it through special registers.
What are donor registries?
Databases or registers in America and Europe began to be created in the eighties of the last century. There are several large potential donor registries around the world:
- Anthony Nolan Foundation, England.
- Stefan Morsch Foundation, Germany.
- National NMDP Registry, USA.
- National DKMS, Germany.
- International registry IBMTR. It contains information from all national registers and private foundations.
Compared to the world, there are very few registered donors in our country. Their number is only forty-three thousand people. Although the country's population allows us to create a large register of potential donors.
This number is not enough to select a suitable person. Although searching in the national system is inexpensive and affordable way find a person who can become a donor to a patient.
Is it possible to become a bone marrow donor in St. Petersburg? Yes. But where exactly?
Currently in our country there is a national fund, which includes the following registers:
- Petersburg register.
- Chelyabinsk.
- Samara register.
- Rostovsky.
- Ekaterinburg register.
How is the procedure carried out?
There is an opinion among doctors that bone marrow collection is a much more gentle procedure than surgery. The person who donates it receives punctures in the upper part of the pelvic bones. They are made using a hollow needle. Next, the liquid is drawn into the syringe. Several punctures are needed in order to collect a sufficient amount. After this procedure, the person is under observation in the hospital for a couple of days. It is also worth knowing that bone marrow collection is carried out using anesthesia. It can be either local or general.
The body recovers quite quickly after bone marrow donation. Hemoglobin levels return to normal after a few days. And the pain from the punctures goes away after two days. The bone marrow recovers within a month.
There is another way to become a donor - to donate blood from a vein. The donor is given a special drug in advance that releases the bone marrow into the blood. Then the material is collected. The blood is forced through a special device that breaks it down into its components. The desired cells are separated and the remaining blood is injected back to the donor through the other arm. In order to collect the required number of stem cells, it is necessary to pump blood through the device more than once. Typically this procedure lasts up to six hours. After the cell selection ends, the donor feels unwell. Usually he feels nauseous, his body temperature rises, and his joints ache.
What interferes with the procedure?
How to become a bone marrow donor? Let's figure it out now. Any person who is 18 years of age and not older than 50 can become a member of the register. Also, a potential donor should not have the following diseases:
- Hepatitis B or C.
- Diabetes.
- AIDS.
- Malaria.
- Tuberculosis.
Documentation
Who becomes a bone marrow donor? In order to enter your data into the register, you need to donate nine milliliters of blood.
This quantity is needed for typing. Next, you should write an agreement to join the register. If a potential donor's gene set is needed for a patient, he will need to be tested before becoming one. You will also need to give another consent for donation.
How to become a bone marrow donor in St. Petersburg, Moscow? In which Russian centers can BMT be performed?
Currently, there are only three centers where the procedure can be performed. They are located in Moscow, St. Petersburg and Yekaterinburg.
There is a limitation on the free procedure and the number of equipped beds. This quantity is not enough. You should know that a paid procedure will cost 40,000 rubles per day per bed. The entire course will cost around 2 or 3 million rubles.
For comparison: in clinics in Israel and Germany, this procedure will cost 250 thousand euros. Finding a donor through an international registry costs another 21 thousand euros. If you look for a donor in our country, then his search will be paid for by charitable foundations.
Peculiarities
Unfortunately, in our country the register of potential donors is very small. Therefore, cancer patients have to seek help abroad.
Charities are urging people to join a stem cell donation registry. The population of our country is large, but the situation in this area of medicine is not developed to the required extent.
There are special promotions that are held to attract donors to the register. The fact is that the genetics of Russian people differs from the population of the USA or Europe. Therefore, it is easier for a Russian person to find a donor among Russian people than to search in foreign registries. Many people in our country do not know how to become a bone marrow donor or about the existence of registries. If they are informed about this and told about the problems that every inhabitant of the planet may face, then more people will appear. The main thought of such people will be: “I want to become a bone marrow donor.” If they not only want, but also become, then they will make their contribution to the patient’s health. It is possible that such a person can even save the life of a sick child.
Some people think: what if I become a bone marrow donor for money, will I be able to make money?
In fact, this procedure is considered charitable, anonymous and free of charge all over the world. These are the basic principles for creating donation registries. Therefore, remember this before you decide to take any such actions.
Conclusion
Now you know how to become a bone marrow donor in Moscow and other cities Russian Federation. We hope that our recommendations will help you.
Donation is, of course, a noble and necessary cause. But everything that concerns human body It's not nearly as simple as it seems. Each type of donation carries its share of risk, both for the donor and for the recipient (recipient). There are still many misconceptions around donation.
Risk for the recipient Many people worry that when donating blood they may be infected with some kind of disease. In fact, the risk of being infected belongs to the recipient of the blood. After all, disposable instruments are used to draw blood. And the water recipient receives blood, he should be much more afraid of infection. During difficult births, donor blood can be used; few people know that only the blood of a non-smoker and a person who has not drunk alcohol for at least two days is suitable for newborns. Otherwise, the little citizen risks getting poisoned. The greatest risk is for those who have a weakened immune system, even the presence of antibodies in donated blood can cause illness.
Risk to the donor It should be noted that if blood is donated correctly, the negative consequences for the donor are minimal. Many donors, on the contrary, believe that donating blood improves their immune system. Weakening can only be caused by frequent blood donations. But when taking blood, health workers pay attention to both the frequency of donation and the weight of the donor. 99% of contraindications for blood donation are associated precisely with the risk for the recipient.
Organ donation
Heart and cornea transplanted only from a dead person. Therefore, the risk exists only for the recipient. The problem that doctors are struggling with is the rejection of foreign tissue. Even a seemingly ideally selected organ can be rejected by the body as a foreign body. To reduce the risk of rejection, the patient is given immunosuppressive drugs, which increases the risk of contracting any disease. In addition, the transplanted organ may have been poorly examined. Despite all the risks of surgery and further engraftment, transplantation for many patients is the only option.
Kidney donation
For the recipient, the risks are no different from those of other organ transplants. For the donor, the main risk is associated with the operation itself. The kidneys are a paired organ, so the functions of one kidney are easily taken over by the other. A person with one healthy kidney lives as long as he would with two, but statistics recent years disappointing. Finding someone with healthy kidneys is becoming more and more difficult. For transplant operations, a close relative is usually taken as a donor, then the chances of success of the operation are higher.
Bone marrow donation
Siblings are best suited for bone marrow donation, but sometimes a donor must be found through donor services.
Risk to the donor Only 2-5% of stem cells are taken from the donor. This amount is enough to provide new system hematopoiesis in the recipient. This procedure is quite painful, and afterward it may be accompanied by pain in the pelvic bones for several days. But the donor’s life is not in danger; moreover, the donor can return home in the evening. The vast majority of complications are caused by the donor's reaction to the anesthesia, rather than the bone marrow harvesting process itself.
Risk to the recipient A bone marrow transplant is a complex procedure for the recipient. Before the transplant, the patient undergoes chemotherapy and radiation to destroy his own bone marrow and cancer cells. The main task of the hospital staff is to prevent the recipient of donor bone marrow from contracting the slightest disease. The patient is also prone to bleeding. Frequent blood transfusions are necessary during recovery. The donor risks less than the recipient.
Today, the number of people who need organ transplants is simply off the charts. After all, diseases requiring transplantation are diagnosed in a variety of categories of the population: young children, adolescents and able-bodied citizens. Only a small number of patients with such problems receive new organs and a chance at a long life without drugs or surgery. Therefore, transplantation issues in our country concern many people. So many patients with leukemia and other similar diseases require a bone marrow donor. Let's talk about whether every person can claim to be called a “bone marrow donor”, what consequences for the donor from the removal of part of his brain may be, as well as how to become a donor and how bone marrow cells are collected?
In bone marrow donation, a person provides a small amount of their own bone marrow for transplantation (transplantation) into a patient. Bone marrow itself is a semi-liquid substance inside the bones of our body, it plays a key role in the synthesis of blood cells. may be needed in the treatment of a number of serious illnesses, such as leukemia, other tumor diseases, aplastic anemia and some genetic diseases.
Bone marrow donor - how to become one?
Bone marrow donation throughout the world is free, voluntary and anonymous. The creation of special registers of possible donors is based on these principles. No country in the world pays for donating its bone marrow cells for transplantation, considering such a decision as a “gift” that saves lives. Thus, in order to have the opportunity to one day become a donor, you need to take care of entering your data into the Register. To do this, the volunteer only needs to sign an agreement for his voluntary entry into the register of hematopoietic stem cell donors. Next, he should donate twenty milliliters of venous blood.
Once entered into the registry, it may take a long time before bone marrow cell collection is required. After all, there are a significant number of gene combinations in the world, so the probability of a coincidence is quite small. Once information about compatibility with a patient is received, the person will need to make the final decision whether to be a real donor.
Every healthy and capable person, whose age ranges from eighteen to fifty-five years, can become a bone marrow donor. Unfortunately, our country does not yet have one registry of possible donors, but information about them is being actively collected, and the data is combined in private registries.
How is bone marrow collected from donors?
Hematopoietic stem cells needed for transplantation can be obtained from a donor in two different ways: from the bone marrow or from the bloodstream. The donor can choose the method, but in some cases it is determined by medical necessity.
When donating bone marrow directly, doctors under anesthesia puncture the pelvic bone; for this, four to nine small incisions are made in the pelvic area. Their size is so small that they do not require stitches. Next, the required amount of bone marrow is collected using a surgical needle. The whole procedure takes literally half an hour. And bone marrow recovery occurs in about a few weeks. It is worth noting that after the collection, the donor needs to be under the supervision of a doctor in a hospital for a couple of days.
If the donor decides to donate peripheral blood cells, he needs to take the drug Leucostim for several days before collecting the material. This drug stimulates the release of stem cells from the bone marrow into the blood. The collection of material for transplantation is carried out during apheresis, when blood from the donor’s vein in one arm passes through a special device in which hematopoietic stem cells are separated, then the blood is returned to the bloodstream through the vein in the other arm. The entire procedure is sterile and takes five to six hours, during which time the donor must remain relatively motionless. Anesthesia and hospitalization are not needed, and the taken cells are restored by the body in one to one and a half weeks.
Consequences for the bone marrow donor from the collection of his cells
Bone marrow donation is a surgical procedure that carries minimal risk. Donation extremely rarely causes serious complications; they can be triggered by the body’s individual reaction to anesthesia. Infections and reactions to the insertion of a surgical needle are also rare. After undergoing bone marrow collection, the donor may experience pain in the operated area of the body for some time.
Taking Leukostim may cause painful sensations in the area of bones and muscles, and also cause nausea, sleep problems and excessive fatigue. Such unpleasant symptoms disappear after the collection of hematopoietic stem cells. Directly during apheresis, donors occasionally experience tinnitus, which gradually goes away after the procedure.
Folk remedies
In order to support the body during a difficult period for it after the collection of bone marrow cells, you can use the following: traditional medicine. They will add vigor and strength, and also improve immunity.
For this purpose, you can take regular tea. Brew three or four crushed flowers with a glass of just boiled water and take it as tea soon after a meal. The reception can be repeated several times a day.
A medicine based on galangal (erect cinquefoil) has excellent general strengthening qualities. Grind the roots of this plant to a powder, pour five grams of this raw material with fifty milliliters of alcohol (70%) and leave for one week. Strain the finished medicine and take thirty drops of it two or three times a day.
The decision to become a bone marrow donor is a responsible and noble step that allows you to save the life of another person.
Ekaterina, www.site
A bone marrow transplant is a complex procedure for implanting stem cells, the need for which arises in one of a number of diseases. Bone marrow is a vital organ of the circulatory system that performs the function of hematopoiesis.
Without a bone marrow transplant, it is impossible to help patients with severe damage to the immune system. Most often, the need for transplantation occurs in cases of blood cancer.
Malignant lesions
Most often, the decision to carry out an urgent operation is made when this terrible disease, which leaves virtually no chance for the patient to recover, is popularly called leukemia. The pathology is characterized by a disruption in the process of formation and renewal of blood: cells, without having time to mature, immediately begin to divide. No further stages of development occur. When the number of immature cells exceeds the permissible maximum, they displace healthy cells. Leukemia can occur as:
- acute myeloblastic type;
- acute lymphoblastic type;
- chronic myeloid leukemia;
- plasmacytomas.
Transplantation of healthy cells is extremely necessary for lymphoma, a blood pathology characterized by the accumulation of tumor lymphocytes. A type of lymphoma is Hodgkin's disease, as well as non-Hodgkin's types of the disease.
Other pathologies as indications for transplantation
In benign pathological processes, a bone marrow transplant may be recommended due to the high risk of the disease becoming malignant. Diseases of a non-oncological nature, for the treatment of which the use of donor biomaterial is used, include:
- Ailments associated with metabolic disorders. First of all, these are Hunter syndrome and adrenoleukodystrophy. The latter disease is characterized by an excessive concentration of fatty acids in cells. Hunter syndrome is a pathology in which there is an atypical accumulation of fats, proteins and carbohydrates in tissues.
- Immune disorders. First of all, we are talking about HIV infection and congenital immunodeficiency. This treatment method cannot provide a 100% guarantee of recovery, but it helps prolong the patient’s life.
- Bone marrow pathologies (Fanconi anemia, aplastic anemia), which occur with inhibition of hematopoietic functions.
- Autoimmune diseases, including lupus erythematosus and rheumatoid arthritis. The specificity of these diseases lies in the damage to connective tissue and small blood vessels.
Not so long ago, the only way to treat the above pathologies was radiation and chemotherapy. However, each of these methods of fighting cancer helps to destroy not only cancer cells, but also healthy ones. Today, the tactics of treating blood diseases have taken a different turn: after courses of intensive anticancer therapy, the affected hematopoietic cells are replaced by healthy ones during transplantation.
Who can act as a donor
Such an operation requires the voluntary consent of a person whose genetic material is fully suitable for the recipient in need. Judging by the reviews, people often think about bone marrow transplantation and donating their stem cells to patients, but many are frightened by lack of awareness on this issue and ignorance of the likely consequences of such a complex manipulation.
You can obtain material for blood cell transplantation:
- From the patient himself during the period of remission of the disease. If the symptoms of the disease have subsided and the test results are normal, tissues are collected from the patient, which are replanted in the event of a relapse. This type of transplant is called autologous.
- From his twin (identical). This type of transplantation is called syngeneic.
- From a blood relative. It is worth noting that not all people who are related to the recipient may be suitable as a bone marrow donor due to differences in the genetic code. More often, the biomaterial is the same among brothers and sisters - the probability is approximately 25%. At the same time, genetic compatibility with parents is almost never found. Engraftment of stem cells from a relative is called allogeneic.
- From a stranger (unrelated) person. If there is no person with suitable genetic data among the relatives, they turn to national or foreign donation banks for help. We are talking about allogeneic tissue transplantation from a foreign donor.
Main contraindications for donors
It also happens that a person who is ready to donate his tissue to save another is not allowed to undergo transplantation. A number of requirements are put forward to potential donors; if at least one of them does not meet, the donation application is rejected. First of all, only an adult can provide their stem cells. The bone marrow transplant donor must be absolutely healthy. The absence of the following diseases is especially important:
- autoimmune disorders;
- severe infectious pathologies;
- hepatitis B and C;
- syphilis;
- tuberculosis of any form;
- congenital or acquired immunodeficiency;
- any type of oncology;
- mental disorders.
A pregnant woman cannot be a donor. Biomaterial is not collected from people over 50 years of age.
No chance of transplantation
By the way, stem cell replacement is also not recommended for physically weak and elderly patients. Transplantation surgery is not performed on persons suffering from complex diseases of internal organs. Contraindications for bone marrow transplantation include long-term antibacterial or hormonal therapy.
And even with excellent health indicators of the donor and recipient, the only serious obstacle to the procedure is considered to be incompatibility of the biomaterial. The chances of finding a donor ideal for a bone marrow transplant are slim. Most often they resort to autologous and allogeneic tissue transplantation.
Bone marrow transplant surgery is the most difficult intervention for the body. In addition, the procedure is very expensive. Since the majority of patients are unable to pay for treatment on their own, the state often comes to help in this matter. But since it is impossible to provide all patients with the necessary services, a certain quota for stem cell transplantation has been established. Thanks to the introduction of a quota system, patients in need get the chance to undergo treatment absolutely free of charge in the best clinic, but, in fact, this is the main obstacle for patients due to the huge queue that has formed. In addition, the search for a donor itself takes a lot of time, and for patients with this diagnosis, every week is precious.
Collection of donor material
You will learn about how a bone marrow transplant occurs after a description of the procedure for collecting donor biomaterial. Manipulation can be carried out in two ways. It is chosen by doctors, depending on the medical indications for a particular donor.
The first option is to extract required amount tissues from the pelvic bone. To carry out the manipulation, a test is taken in advance, the results of which will show whether the person can tolerate anesthesia. Hospitalization of the donor is required several days before the procedure. The required cells are collected under anesthesia using a syringe, which is injected into an area of high concentration of the desired biomaterial. As a rule, several punctures are made at once to obtain the required volume of fluid for a bone marrow transplant. How does the procedure work? Almost painless and quick - the manipulation requires no more than half an hour, but for the donor’s body to fully recover, it will take almost a whole month.
The second method involves collecting venous blood from which stem cells are extracted. During the week before the scheduled date of the manipulation, the donor must take Leucostim, a specific drug that provokes the active release of stem cells into the blood. Blood is taken from the donor, the necessary elements are separated from it and returned back through the second hand. This method of collecting biomaterial takes several hours, and recovery will take no more than two weeks.
How is the operation performed?
In case of leukemia, a bone marrow transplant must necessarily be preceded by a course of powerful chemotherapy or radiotherapy - the so-called preparatory regimen. It lasts as long as required in each individual case. The duration of the courses is determined by the doctor.
Before performing a bone marrow transplant, doctors must make sure that the recipient is ready for this type of intervention. A couple of days before the operation, repeated tests are taken from the donor and the person requiring stem cell implantation. During the procedure, donor stem cells are administered parenterally to the patient.
After a bone marrow transplant, during the first month the patient is under close supervision of doctors, waiting for the implantation of foreign tissue. This period must necessarily be accompanied by the use of antibiotics, which are necessary to prevent infection. In addition to antibiotic therapy, the recipient is given another infusion into the blood - this time it is enriched with platelets in order to prevent internal bleeding, the risk of which increases several times after stem cell implantation. Along with antibiotics, the patient is prescribed immunosuppressive drugs to prevent the body from rejecting the transplanted tissue.
What happens after transplantation
The consequence of a bone marrow transplant is often long-term weakness; in severe cases, bleeding may develop and malfunctions of internal organs may occur. At acute reaction The immune system on the transplant is most often affected gastrointestinal tract, liver and skin. Patients may complain of the following symptoms:
- nausea, sometimes with vomiting;
- the appearance of small ulcerations in the mouth;
- instability of psycho-emotional state;
- pustules on the skin of the back and chest;
- diarrhea mixed with blood;
- damage to the lacrimal and salivary glands.
The staff of medical institutions where bone marrow transplants are performed for lymphoma, leukemia and other blood diseases must be sufficiently competent and able to create comfortable conditions for the rehabilitation of patients. In addition, the participation of relatives and friends is no less important in this matter.
Taking immunosuppressants, which were mentioned above, inhibits the functioning of the hematopoietic organs, while significantly weakening the immune system. During the rehabilitation period after a bone marrow transplant, the body becomes very vulnerable to pathogenic microflora. If the patient has already been infected with cytomegalovirus, it is likely that the infection will intensify against the background of immune susceptibility. In severe cases, pneumonia develops, which is fatal.
Russian clinics
In our country there are several medical institutions specializing in such operations. Bone marrow transplantation in Russia is carried out by highly qualified specialists in the field of hematology, oncology, transfusiology, etc.
Among the 13 clinics operating in the Russian Federation, it is worth noting:
- Raisa Gorbacheva Institute of Pediatric Hematology and Transplantology in St. Petersburg, which is one of the largest departments. People come here in the most hopeless cases.
- ON Clinic is an international medical center with several representative offices in Russia. Branches of the clinic diagnose hematological and oncological diseases requiring bone marrow transplantation.
- FSBI NMITs DGOI im. Dmitry Rogachev of the Russian Ministry of Health is a budget clinic located in Moscow. This institution has many years of experience. Bone tissue transplants are performed here for patients of different ages.
Survival prognosis
Recovery of the body after stem cell implantation lasts at least a year, and its success is largely determined by:
- type of transplantation;
- degree of compatibility of donor material;
- the course and malignancy of the disease;
- patient's age;
- general condition of the patient;
- the intensity of radiation or chemical therapy performed before transplantation.
Recipients suffering from hereditary pathologies of the hematopoietic system have the highest chances. In oncology, predicting the future outcome is quite difficult, since the chances of recovery depend on the likelihood of relapse. If it does not arise over the next five years, then an insignificant probability of its development in the future becomes obvious. This survival rate is observed in approximately half of the cases.