Remuneration of hematopoietic stem cell donors: principles and perspective of the World Marrow Donor Association

Abstract

Hematopoietic stem cell transplantation is a curative procedure for life-threatening hematologic diseases. Donation of hematopoietic stem cells (HSCs) from an unrelated donor, frequently residing in another country, may be the only option for 70% of those in need of unrelated hematopoietic stem cell transplantation. To maximize the opportunity to find the best available donor, individual donor registries collaborate internationally. To provide homogeneity of practice among registries, the World Marrow Donor Association (WMDA) sets standards against which registries are accredited and provides guidance and regulations about unrelated donor safety and care. A basic tenet of the donor registries is that unrelated HSC donation is an altruistic act; nonpayment of donors is entrenched in the WMDA standards and in international practice. In the United States, the prohibition against remuneration of donors has recently been challenged. Here, we describe the reasons that the WMDA continues to believe that HSC donors should not be paid because of ethical concerns raised by remuneration, potential to damage the public will to act altruistically, the potential for coercion and exploitation of donors, increased risk to patients, harm to local transplantation programs and international stem cell exchange, and the possibility of benefiting some patients while disadvantaging others. (Blood. 2011;117(1):21-25)

Human mesenchymal stem cells (MSCs) for treatment towards immune- and inflammation-mediated diseases: review of current clinical trials

“…The most exciting aspect of these unique cells is their potential therapeutic impact for regenerative medicine [1, 2]. The best studied type of stem cell is the hematopoietic stem cell (HSC), and transplantation of these tissue-specific stem cells have now become standard-of-care for numerous indications [3]. Over 50 years in the making, the success of HSC transplantation is illustrative of the paradigm for stem cell therapy: replacement and regeneration of pathological endogenous tissue with autologous or 3rd party/allogeneic stem cells.…”

Risk of complications during hematopoietic stem cell collection in pediatric sibling donors: a prospective European Group for Blood and Marrow Transplantation Pediatric Diseases Working Party study

“…Pain was reported at the collection site, including lumbar stiffness, in 28 (9%) donors and sore throat related to general anesthesia in 22 (7%) donors. Pain persisted for a median of 1 day (range, 2 hours-14 days) and was treated by a median of 2 doses of nonnarcotic analgesic (range, 1-20) for a median of 1 day (range, [1][2][3][4][5]. No severe mechanical injury after BM collection was observed.…”

“…[1][2][3][4] HLA-matched siblings are considered to be the best donors for both medical and biological and economic and logistical reasons, including availability before and after transplantation. 1,[5][6][7][8][9] Worldwide, children under the age of 18 years are not allowed to donate hematopoietic stem cells (HSCs) for unrelated recipients. To date, sibling donors have been recruited in 39%-48% of all childhood transplantations.…”

A review of the haematopoietic stem cell donation experience: is there room for improvement?

“…Thus, any harm that might result will not be offset by a benefit to the donor, except for the potential sense of satisfaction derived from an altruistic act. 4 Therefore, care must be taken to minimize the potential of harm and donor registries should have donor safety as their first priority. In addition, stem cell donation requires us to balance the inherent tension between ensuring sufficient donors are registered while protecting the safety of donors.…”