Hematopoietic Cell Donors

Confer, Dennis L.

doi:10.1002/9780470987070.ch42

Cited by 10 publications

(11 citation statements)

References 107 publications

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“…Hemopoietic stem cells are aspirated from the hips, which requires general or regional anaesthesia and a brief hospitalization for the donor [4, 43]. The main risks are those related to anaesthesia, but postdonation deaths have been described, due to cardiorespiratory arrest, pulmonary embolism, sickle cell crisis, and stroke [44]. Although the incidence of severe and fatal adverse events is very rare [4], severe blood loss, wound infection, and pain at the site of puncture have been reported as potential morbidity risks [45].…”

Section: Donor Selectionmentioning

confidence: 99%

Donor Selection for Allogenic Hemopoietic Stem Cell Transplantation: Clinical and Ethical Considerations

Riezzo

Pascale

Russa

et al. 2017

Stem Cells International

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Allogenic hematopoietic progenitor cell transplantation (allo-HSCT) is an established treatment for many diseases. Stem cells may be obtained from different sources: mobilized peripheral blood stem cells, bone marrow, and umbilical cord blood. The progress in transplantation procedures, the establishment of experienced transplant centres, and the creation of unrelated adult donor registries and cord blood banks gave those without an human leucocyte antigen- (HLA-) identical sibling donor the opportunity to find a donor and cord blood units worldwide. HSCT imposes operative cautions so that the entire donation/transplantation procedure is safe for both donors and recipients; it carries with it significant clinical, moral, and ethical concerns, mostly when donors are minors. The following points have been stressed: the donation should be excluded when excessive risks for the donor are reasonable, donors must receive an accurate information regarding eventual adverse events and health burden for the donors themselves, a valid consent is required, and the recipient's risks must be outweighed by the expected benefits. The issue of conflict of interest, when the same physician has the responsibility for both donor selection and recipient care, is highlighted as well as the need of an adequate insurance protection for all the parties involved.

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Section: Donor Selectionmentioning

confidence: 99%

Donor Selection for Allogenic Hemopoietic Stem Cell Transplantation: Clinical and Ethical Considerations

Riezzo

Pascale

Russa

et al. 2017

Stem Cells International

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“…BM harvest, for example, requires general anaesthesia and is associated with a number of uncommon complications, including nerve, bone and tissue injury 11 . Although the risk of death from BM donation is low (less than 1 in 10 000 donations), 12 this risk is not insignificant in otherwise normal children. BM harvest is also associated with a small but significant risk of post‐operative morbidity, including pulmonary emboli, sickle cell crises, fatigue, localised pain at the donation site, headache, nausea and behavioural problems 13 …”

Section: Risks and Benefits To The Bmt Donormentioning

confidence: 99%

Ethical issues in bone marrow transplantation in children

Bendorf

Kerridge

2011

J Paediatrics Child Health

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Abstract:In the 50 years since the first successful human bone marrow transplant (BMT) was performed in 1959, BMT has become the optimal therapy for a wide variety of life-threatening paediatric haematological, immunological and genetic disorders. Unfortunately, while BMT generally provides the only possibility of cure for such afflicted children, few (25%) have a matched sibling available, and suitably matched unrelated donors are often not identified for many children in need of BMT. And even where BMT is possible, treatment is complex and arduous and associated with significant mortality and morbidity. The issues raised when either or both the donor and recipient are children and lack the capacity to make informed and rational decisions relating to BMT pose great challenges for all involved. This paper examines some of the ethical dilemmas that confront patients, families and medical practitioners when considering bone marrow transplantation in a child.Key words: bone marrow; ethics; paediatrics; stem cell; transplant.Born of the fallout from the most destructive force known to man, bone marrow (BM) transplantation (BMT) sits directly on an interesting ethical juncture between harm and cure in human history (haematopoietic stem cell transplant, haematopoietic progenitor cell transplantation and haematopoietic cellular transplant are all terms used to describe BMT; in this paper, we use the term BMT). Despite several early attempts to use transplanted BM therapeutically in the early 1940s, 1 it was not until radiation from the world's first nuclear tests began exposing human subjects to severe forms of radiation injury that focus was placed on developing the therapeutic potential of BMT. 2Despite extensive backing from the US government, early studies with BMT yielded only very limited success and led to the deaths of over 200 patients. It was not until 1959, when the French doctor Georges Mathé successfully restored haematopoiesis in six adult Yugoslavian victims of a radiation accident that the first partially successful BMT took place.1 BMT became a recognised therapy for other forms of BM failure, and in 1968, the world's first successful BM transplant was performed on a child with severe combined immunodeficiency syndrome. In the 50 years following Mathé's pioneering work, BMT has become the preferred treatment for a diverse range of fatal and debilitating diseases, including BM failure syndromes, immunodeficiencies, haematological malignancies, haemoglobinopathies and congenital metabolic disorders.There are two different types of BMT -autologous BMT and allogeneic BMT. In autologous transplantation, the stem cells are collected from and later re-infused into the same individual following the administration of high-dose chemotherapy. In allogeneic transplantation, the donor and recipient are different individuals. Allogeneic transplantation is further categorised according to: 1 The relationship between the donor and the recipient, which can be • syngeneic (identical twin),• related, and • unrelated. 2 T...

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“…Most of these events were mechanical (59%; nerve, bone or tissue injury) or related to anesthesia (39%; pulmonary, cardiac, fluid management). Between 9 and 11 deaths associated with BM harvest have been reported worldwide for an estimated incidence of 1 death per 10 000 donations [17]. In an European survey, data of 27 700 allogeneic BM donors, collected between 1993 and 2005 were presented.…”

Section: Side-effectsmentioning

confidence: 99%

Stem cell harvesting and transplantation

Worel

Mayr

2009

ISBT Science Series

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Allogeneic haematopoietic stem cell transplantation is an accepted treatment for a variety of malignant and non‐malignant diseases. Today, peripheral blood progenitor cells (PBPC) are increasingly used instead of bone marrow (BM) as stem cell source. Additionally, umbilical cord blood (UCB) has been established as an alternative source of donor cells. Many differences between the distinct stem cell sources do exist. PBPC contain a higher amount of CD34 + cells compared with BM and UCB, leading to more rapid engraftment with the disadvantage of a higher incidence of chronic graft‐versus‐host disease. In contrast to adults, children seem to have a better outcome after BM than PBPC transplantation. Therefore, especially patients with non‐malignant diseases and children should be transplated with BM. The disadvantage of the significantly lower CD34 + cells count in UCB products can be overcome by transplantation of two different units. The risk for allogeneic BM and PBPC donors is considered negligible. Lethal and serious side‐effects because of the harvest procedure are rarely reported with an incidence of 1/10 000 and 7·25/10 000, respectively. Granulocyte colony‐stimulating factor (G‐CSF) is widely administered to PBPC donors, but questions have been raised about its safety in respect of development of haematologic malignancies. To evaluate this concern, more long‐term safety data from larger prospective studies are needed. In the therapy with adult stem cells, a genotypic human leucocyte antigen (HLA) class I and class II identity between donor and recipient for the loci HLA‐A, HLA‐B, HLA‐C, HLA‐DR and HLA‐DQ is optimal; for UCB, HLA matching seems to be less important because of the relative low number of mature T cells in cord blood. The influence of other HLA‐linked or not HLA‐linked loci in stem cell transplantation (HLA‐DP, killer cell immunoglobulin receptor, …) is under investigation.

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Hematopoietic Cell Donors

Cited by 10 publications

References 107 publications

Donor Selection for Allogenic Hemopoietic Stem Cell Transplantation: Clinical and Ethical Considerations

Donor Selection for Allogenic Hemopoietic Stem Cell Transplantation: Clinical and Ethical Considerations

Ethical issues in bone marrow transplantation in children

Stem cell harvesting and transplantation

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