Donating bone marrow: a day on the other side of the wire.
Subject: Donation of organs, tissues, etc.
Author: Wood, Ryan
Pub Date: 10/01/2012
Publication: Name: Journal of Perioperative Practice Publisher: Association for Perioperative Practice Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2012 Association for Perioperative Practice ISSN: 1750-4589
Issue: Date: Oct, 2012 Source Volume: 22 Source Issue: 10
Accession Number: 309315287
Full Text: As a medical student I remember being approached as I left a lecture by some of my fellow students, more senior than me, asking that I place my name on a bone marrow donation register. All that it would take was a quick questionnaire and a single blood sample - good practice for some of my colleagues. Why not? The thought of being on a register for all forms of tissue donation has always been something that I have seen as important. I had donated blood and carried a donor card so this did not seem to be any more of an imposition that that. It is always hard to imagine anything ever coming of it anyway. I sign up for the odd prize draw and competition and never win so why would this be any different?

Years later, in 2012, I was contacted by Anthony Nolan, the charity with whom I had registered all those years ago. I had been identified as a match for a potential bone marrow donation. This was not the first time that this had happened over the years. Once previously I had similarly been identified as a match but after a few more blood tests was told I was no longer required. Having received a letter informing me of the match, I dutifully contacted the donor centre as requested and arranged to have the blood bottles for some further testing sent down to me. A colleague kindly then took some blood and it was couriered back to Anthony Nolan. I still didn't think that anything would come of it. Looking back though they had presumably already done some detailed tissue typing the previous time I had sent off additional blood so maybe they already had a fair idea that I would be a close match. Sure enough, within a few days I received correspondence that I had been indentified as a match and would be asked to donate bone marrow.

What is Anthony Nolan?

Anthony Nolan is a pioneering charity that aims to save the lives of people with blood cancer. Every day, they use their register to match volunteers willing to donate their blood stem cells (or bone marrow) to people in desperate need of a lifesaving transplant. There are nearly 1,600 people in the UK in need of a blood stem cell transplant that may be their last chance of survival. 70% of these patients will not find a matching donor from within their families. There are currently over 440,000 people on the Anthony Nolan register, but still, a match is only found for around half the people who need it.

The process

Having been identified as a match for donation, a number of processes need to be followed. 80% of the donations that are arranged by Anthony Nolan are in the form of peripheral blood stem cell collection (PBSC). PBSC is an outpatient procedure that initially involves a course of injection of GM-CSF, a stimulating factor that drives your bone marrow to increase the number of circulating haematopoetic stem cells in the circulating blood. The donor then attends one of a number of London centres on an outpatient basis to donate blood - much like for simple blood donation - from which the stem cells are then harvested. The side effects are similar to those from blood donation and are similarly minimal.

The remainder of the donations are by direct bone marrow harvesting. This involves a short hospital inpatient stay and general anaesthetic. Prior to my donation I was informed that the transplant centre had specified a preference for stem cells donated by this method. I was clear in my own mind that, having accepted that I was going to donate, I would do everything that the transplant centre wished to maximise the chances of a successful transplant. I then attended a centre in London for my pre-operative assessment and some more blood tests. I was well looked after and seen by the professor and felt well prepared for the day of my procedure.

The procedure

I was fascinated by my day as a surgical patient. As an orthopaedic registrar, my work clearly revolves around the anaesthetised patient but I had never given much thought to what it would be like to be the other side of the fence. The things that stick in my mind are the caring faces of all of the anaesthetic staff from consultant down to the theatre tech who was chatting about his new car. Postoperatively, the recovery staff were equally superb and the blurred face of the nurse practitioner seen through my glasses-less eyes, reassuring me that all had gone well, was the most important thing in the world at the time. Overall I was acutely aware of how scared and vulnerable patients about to undergo an operation, particularly one involving a general anaesthetic, can be. The fact that it was, for me, a very stress free and almost pleasant experience was very much down to all of the staff, from surgeon down to porter, who joined me for part of that journey and it is a role that we all need to be aware of.

Postoperatively, I had a day in hospital to recover. Other than an overwhelming tiredness and slight ache in my lower back, the recovery process was remarkably swift and, quite literally, pain-free. A representative from Anthony Nolan visited me on the postoperative day and made arrangements to contact me again in a week or so as part of their ongoing follow-up of all donors. I was given the option of being kept up to date in the future about the progress of my recipient and sincerely hope that all goes well.

Now, two months down the line, I feel as though the whole process has been an extremely positive one. Not only have I been able to try and make a difference for someone else less fortunate, I have also gained a valuable insight into the perioperative journey that patients endure and the small things that all involved can do to make this a less traumatic one.

* Ryan Wood

Specialist Registrar (ST3) in Trauma and Orthopaedics, Norfolk and Norwich University Hospital

For more information on Anthony Nolan and on how to join the bone marrow register visit www.anthonynolan.org

Thoughts and reflections on issues of interest to perioperative practitioners

KEYWORDS Donation / Bone marrow / Anthony Nolan

Provenance and Peer review: Unsolicited contributed; Peer reviewed; Accepted for publication July 2012.
Gale Copyright: Copyright 2012 Gale, Cengage Learning. All rights reserved.