Bone Marrow Transplant Donor

May 6, 2024 
This page was reviewed under our medical and editorial policy by Leslie Popplewell, M.D., Hematologist and Medical Director of Hematology and Blood and Bone Marrow Transplant, City of Hope Atlanta

Some cancer patients need a bone marrow transplant as treatment, and certain bone marrow transplants require someone to donate stem cells to be used for the transplant. These stem cells may come from donor blood or donor bone marrow.

What Is Bone Marrow Donation for a Transplant?

A bone marrow transplant that uses donor blood or marrow is called an allogeneic transplant. When using a donor’s blood or marrow, the donor’s blood proteins — called human leukocyte antigens (HLA) — must closely match the patient’s.

With a haploidentical transplant, stem cells from an immediate family member — parent, child, brother, sister — are used. The HLA-typing is a 50% match and, due to advanced conditioning techniques, is increasingly appropriate for a transplant.

With an umbilical cord transplant, stem cells come from umbilical cord blood from a newborn. Cord blood may be donated at birth. There are also cord blood banks with stored units available for transplantation.

What Is the Process for Bone Marrow Transplant Donation?

Prior to bone marrow or stem cell transplant donation, there are several steps the donor must take.

Tests Before You Donate

Before people can donate their stem cells, a number of medical tests are performed on their vital organs to ensure they’re an appropriate candidate. Testing may be done on the potential donor’s:

• Heart
• Lungs
• Kidneys

A potential donor may be required to undergo certain tests, such as:

• An EKG to measure heart function
• A pulmonary function test to measure lung function
• A chest X-ray to check for lung infections or other problems
• Blood and urine tests to measure:
  • Blood counts
  • Kidney function
  • Liver function
  • Exposure to infectious disease in the past
• Tests to check disease status
• A full physical, including a health history
• Dental exam

Before patients may receive an allogeneic transplant, donors whose HLA closely matches theirs must be located via the following process:

• A test kit is provided that includes a cotton swab.
• The potential donor will swab the inside of their cheek to obtain a tissue sample.
• They will then mail the sample to a registry of potential donors called the National Marrow Donor Program^®(NMDP).
• When potential donors are determined to be a match, they must then undergo a blood test.
• The center where the transplant will be performed will test the blood sample from the donor to confirm the HLA match.
• If the match is confirmed, the donor will be asked to sign an informed consent document.

The Donation Procedure

Potential donors are tested to ensure they don’t have infectious diseases — including, among other viruses, human immunodeficiency virus (HIV) and West Nile virus — before they may donate stem cells or bone marrow.

The procedure depends on whether the donor is donating stem cells from blood circulating in their body or from bone marrow.

Donating Peripheral Blood Stem Cells

Peripheral blood donation is a procedure similar to donating platelets and doesn’t require surgery. The procedure typically entails these steps:

• The donor goes to an experienced blood center or outpatient facility that participates in collections for NMDP.
• For five days before donating, the donor will be given injections of the drug filgrastim, which is designed to increase the number of stem cells in the donor’s bloodstream.
• On donation day, blood is collected through a needle placed in one arm.
• The needle is attached to a machine that collects only stem cells.
• The donor’s remaining blood is returned to the body through a needle placed in the other arm.
• It may take up to eight hours to donate these blood-forming cells.
• It may be done in one session or divided into two.

While many donations are performed in one session, about 10% are divided into two sessions lasting about four to six hours each, according to NMDP.

Donating Bone Marrow

Donating bone marrow is a surgical procedure and performed in a hospital operating room. Donations are performed at experienced hospitals that participate in marrow collections for NMDP. During the donation surgery:

• Liquid marrow is withdrawn using needles from both sides of the back of the pelvis bone.
• Donors are given anesthesia so they feel no pain during the procedure.
• Donor patients are usually at the hospital from early morning until later in the day.
• Infrequently, donors stay overnight for observation.

Recovery

Leading up to the donation, filgrastim injections may cause some donors to experience headaches and bone or muscle pain, among other symptoms.

These side effects typically subside once the injections are complete and the donation is collected. Over-the-counter anti-inflammatory medications may help alleviate these symptoms.

Post-procedure, discomfort and side effects vary from patient to patient. While some donors find the procedure more painful than they expected, others find it less painful than they anticipated. Those who find it painful liken it to a falling on their bottom or to having an achy hip. While reactions vary for each individual, many experience some form of side effects.

Nearly all bone marrow donors recover fully. According to NMDP, 20 days is the median time it takes to fully recover, and the following breakdown demonstrates the percentage of all donors who are fully recovered in each timeframe:

• Within two days: 5%
• Within seven days: 18%
• Within one month: 71%
• Within six months: 97%
• Within one year: 99%

Some of the most common side effects reported two days after the donation procedure include:

• Hip or back pain: 84%
• Fatigue: 61%
• Throat pain: 32%
• Muscle pain: 24%
• Insomnia: 15%
• Headache: 14%
• Dizziness: 10%
• Appetite loss: 10%
• Nausea: 9%

As only a small fraction of the donor’s total marrow is donated — typically totaling less than a quart — the amount donated does not weaken the donor’s body or immune response. The body typically replaces the donated marrow in about four to six weeks.

What Are the Risks of Bone Marrow Transplant Donation?

Bone Marrow Donation Risks

Bone marrow donation is a surgical procedure, and no medical or surgical procedure is free of risk. However, the majority of donors recover completely within a few weeks and don’t have lingering issues.

Approximately 2.4% of donors experience serious complications, such as an anesthesia complication or damage to bone, muscle or nerves in the hip region.

The risks from anesthesia are no different from other surgical procedures, and serious side effects are unlikely. Precautions are taken to help ensure donors’ safety.

Stem Cell Donation Risks

As with marrow donations, side effects are rare. Less than 1% of peripheral blood stem cell donors experience side effects. Some donors — 19% of women and 3% of men — who don’t have suitable arm veins will need to have a central line placed into one of these larger veins:

• Femoral vein
• Internal jugular vein
• Subclavian vein
• Trouble placing the catheter
• Blockage of the catheter
• Infection caused by the catheter
• Infection where the catheter enters the vein
• Lightheadedness
• Chills
• Muscle cramps

Who Is Eligible to be a Donor?

Patients must be between the ages of 18 and 60 and meet health guidelines. The NMDP Registry recruits donors between the ages of 18 and 35, as research shows younger donors provide an improved chance for transplant success.

Healthy people who are willing to donate are encouraged to join the registry, regardless of sexual orientation. People with these well-controlled conditions or symptoms are permitted to register to donate, though they may require further evaluation:

• Life-threatening allergies to medications or latex
• Maintained sobriety or overcome a chemical dependency for at least 12 months
• Mild allergies
• Mild to moderate osteoarthritis or degenerative arthritis
• Autoimmune conditions that affect one organ system — and are mild and well controlled or fully recovered — including:
  • Rheumatoid arthritis (RA)
  • Celiac disease
  • Crohn's disease
  • Graves' disease
  • Guillain-Barré syndrome
  • Hashimoto's thyroiditis
  • Mild psoriasis
  • Ménière's disease
  • Raynaud's syndrome
  • Ulcerative colitis
  • Vitiligo
• Elevated blood pressure that’s well controlled
• History of precancerous cells
• The following cancers that didn’t require chemotherapy:
  • Cured, local skin cancer (basal cell or squamous cell)
  • Healed melanoma in situ (known as stage 0)
  • Healed cervical cancer in situ
  • Healed breast cancer in situ
  • Healed bladder cancer in situ
• Any other type of cancer (with the exception of blood cancer), if the donor meets all these criteria:
  • More than five years since diagnosis
  • No recurrence or metastases
  • No chemotherapy or radiation therapy (unless localized bead radiation treatment for breast cancer or prostate cancer or radioactive iodine treatment for thyroid cancer)
• Chemical dependency history and/or mental health issues
• Attention deficit disorder (ADD)
• Attention deficit/hyperactivity disorder (ADHD)
• Bipolar disorder
• Depression
• Common back problems, such as sprains, strains and aches
• Cold/flu
• Diabetes
• Epilepsy
• Congenital defects surgically corrected in childhood
• Mitral valve prolapse (MVP)
• Successful cardiac ablation
• Fully recovered hepatitis A
• History of jaundice due to mononucleosis or cytomegalovirus (CMV) infection
• Hospitalized, past surgery or injury (fully recovered)
• Common immunizations
• Tick-borne diseases (recovered) such as:
  • Lyme disease
  • Ehrlichiosis
  • Human anaplasmosis
  • Rocky Mountain spotted fever
• Transplants of:
  • Bone (including bone powder for dental procedures)
  • Ligaments
  • Tendons
  • Skin
  • Corneas
• Ear/body piercings
• Some sexually transmitted diseases, including:
  • Herpes
  • HPV
  • Chlamydia
  • Syphilis
• Tattoos
• Traveling
• Treated tuberculosis

Because of potential dangers, patients aren’t eligible to donate if they have been diagnosed with or experience the following conditions:

• HIV/AIDS
• Severe arthritis, including, among others:
  • Rheumatoid arthritis (RA)
  • Reactive arthritis
  • Psoriatic arthritis
  • Advanced stages of some other types of arthritis
• Asthma requiring regular use of oral steroids
• Autoimmune diseases that affect the entire body (those that are mild or well controlled are not disqualifying), including:
  • Rheumatoid arthritis (RA)
  • Multiple sclerosis
  • Sjögren's syndrome
  • Ankylosing spondylitis
  • Addison’s disease
  • Chronic fatigue syndrome
  • Fibromyalgia
  • Systemic lupus erythematosus (SLE)
• Deep vein blood clot
• Requiring anticoagulant medications
• Aplastic anemia
• Bleeding problems, including:
  • Hemophilia
  • Factor V Leiden
• Von Willebrand disease
• Significant brain injury or surgery on the brain
• More than six concussions
• Certain mental health conditions, including:
  • Schizophrenia
  • Schizoaffective disorder
  • Delusional disorder
• Ongoing significant or chronic pain in the neck, back, hip or spine that:
  • Prohibits daily activities AND
  • Requires daily prescriptions OR
  • Requires regular physical therapy OR
  • Requires regular chiropractic treatments
• Requiring insulin to treat diabetes or have diabetes-related health issues, such as those that affect the kidney, heart, nerves or eyes
• Heart attack or stroke
• Bypass surgery
• Heart valve replacement surgery
• Pacemaker
• History of stroke
• Transient ischemic attack (TIA)
• Intracranial hemorrhage (epidural, subdural, subarachnoid)
• Other significant brain injury or surgery in the brain tissue
• Hepatitis B or C, or exposure to these viruses in the last year
• Serious or chronic kidney problems
• Serious liver disease, including cirrhosis
• Wilson’s disease
• Heart, lung, liver or kidney transplant recipient
• Marrow or blood-forming cells transplant recipient
• Recipient of live tissues from animals
• Pregnant or planning to become pregnant (you may register and donate after you deliver and fully recover)

Learn more about blood and platelet donation qualifications

How to Become a Donor

According to the American Society of Clinical Oncology, about 30% of people who need a transplant may find a donor whose HLA matches in their own family. This is known as a patient-directed donation. According to Cancer Research UK, there is a one in four chance that cells from a sibling will match. Donors can’t donate to relatives if they’re not an HLA match.

For patients who don’t have a patient-directed donation, the NMDP Registry lists potential marrow donors and donated umbilical cord blood. To donate, start by signing up for the Registry. In order to register for NMDP:

• You must be a resident of the U.S. or Puerto Rico.
• You must register online or in person at a donor center

For more information, interested donors may call 1-800-MARROW2.

If the patient needs a donor, the registry will work to find one from among those who have registered. The donation center contacts the patient to tell him or her that a donor has been found. 

Learn more about how to become a donor