What happens during a bone marrow donation? Should you be afraid of the pain during the operation? How do you become a donor? The director of the Registry France Greffe de Moelle at the Agence de la biomédecine answers us.
You may have already donated blood or plasma. But did you know that it is also possible to donate bone marrow? National Bone Marrow Coupon Mobilization Week, April 1-7, 2019, is a time to remember what bone marrow donation is all about and what it is all about.
First important point: “bone marrow and spinal cordshould not be confused,” explains Evelyne Marry, director of the France Marrow Transplant Registry at the Biomedicine Agency. There is no such thing as a spinal cord harvest! Bone marrow is harvested from the bone marrow, which is a kind of maternity ward that makes blood.”
Bone marrow seen under a microscope. // Source: Wikimedia/CC/Andrjusgeo
What is the goal of bone marrow donation? The procedure involves “harvesting stem cells to regenerate the marrow. These cells will colonize the bone of the patient who receives thetransplant,” says the specialist. This transplant is intended for people with a blood disease: these “are bone marrow diseases. They first affect the bone marrow and translate into theperiphery,” Evelyne Marry adds.
There are two methods of retrieval;the choice does not depend on the donor. A first technique, used in 20% of cases, consists of taking a sample by intraosseous puncture. “It must be understood that we have marrow everywhere in the body. At the basin level, we have a bulge that is particularly rich inmarrow,” explains our contact person. This is where the puncture is performed. Since the donor must lie on his stomach during this procedure, general anaesthesia is preferred in order to avoid an uncomfortable position.
This first sampling method requires a 48-hour hospital stay. As for the “scar” left by the operation on the donor’s body, it is actually a small hole a few millimetres in size. Evelyne Marry wants to dispel any doubt: “We do not take samples from the column, but at 10 centimetres around. »
These are the marrow stem cells that are harvested. // Source: Bone Marrow Donation via Facebook
This collection method is said to be “blind“: this means that caregivers cannot sort the bone marrow stem cells, but “theirenvironment” is also aspirated. This graft is particularly intended for children and certain adults who need a complete marrow transplant.
The second method is the harvesting of stem cells alone: it is said to be apheresis harvesting. It consists of taking cells from the donor’s blood: to do this, you have to be able to get these cells out of the marrow. “The bone marrow is particularly vascularized: if we take the stem cells out of these vessels, we can retrieve them in theperiphery,” explains our interviewer.
The bone marrow is highly vascularized…
To achieve this, the donor takes a biomedication – which uses elements present in the human body – 4 to 5 days before the procedure. This stimulates the production of bone marrow cells, which will pass into the bloodstream. During blood collection, the donor is connected “closed circuit” with a machine that extracts stem cells from blood collected from a vein. The blood is returned to the donor in another vein in his body.
The sampling takes about 3 hours. During this time, the donor can relax and read, for example. “It’s not at all painful,” says Evelyne Marry. Meanwhile, the machine retrieves the stem cells from a pocket and forms the graft. In some cases, if the graft is not complete, the donor must return.
The prospect of one day becoming a bone marrow donor raises many fears, including “the fear ofharvesting” and the pain associated with it, says Evelyne Marry. No matter which method is used, the donor will quickly regenerate new bone marrow cells.
How do you proceed when you want to become a donor? You have to register on the national registry, like the 290,000 people who have done so before you. “I emphasize that this inscription is a commitment. After this step, wait until you are compatible with a patient. This is a deferred gift. There are people who come out of the register without ever having given,” explains Evelyne Marry.
To become a potential bone marrow donor, you must be between the ages of 18 and 50. Registered persons may remain in the register until the age of 60, after which they may no longer give. In addition, anyone wishing to donate must be in good health. “People who take daily medications, such as antidepressants, cannot donate bone marrow. With the exception of people taking birth control pills, for whom donation is possible“, completes our interlocutor.
A bone marrow donor card. // Source: Bone Marrow Donation via Facebook
The last step consists of a medical questionnaire and a blood (or saliva) test. You are then added to the list of people who are willing to donate bone marrow if needed.Today, 1.5 per 1,000 people registered in France giveeach year,” says Evelyne Marry. As the number of registrants increases, so do the chances of giving.»
You will then be contacted the day you are compatible with a person waiting for a transplant. “The donor must share certain genetic characteristics with the recipient,” says the specialist. This compatibility is estimated thanks to one element: human leukocyte antigens (abbreviated to HLA).
The donation doesn’t happen “overnight.”
In France, bone marrow donation is reimbursed, anonymous and free of charge. Above all, “does not happen overnight” once you have been notified that someone is waiting for a transplant. The recipient must receive therapy, which Evelyne Marry describes as “heavy“: this is why it is important for the donor to understand that his choice is engaging. “Almost all of the patient’s diseased cells are removed, at the lowest possible level so as not to kill,” she explains. Once transplanted, healthy bone marrow cells destroy diseased cells, allowing the recipient to heal.
For the donor, the date of collection is on average 6 to 8 weeks. For the donor, this is an opportunity to carry out a complete check-up to verify that he or she is fit to make this donation. If there is the slightest doubt that the intervention could harm the health of the donor, it does not take place, the specialist assures us.
Is bone marrow donation painful? // Source: Bone Marrow Donation via Facebook
Currently, men under 35 years of age are the least represented among those on the registry. Yet their presence is important. Although compatibility between donors and recipients is not assessed on the basis of gender, but on the basis of HLA, there is a special situation for women.
“When choosing a donor, the youngest person is preferred first. If you still have a choice between a man and a woman, you may prefer the former. A woman who has had a pregnancy (including an early miscarriage, without her realizing it) has developed antibodies that may interfere with the transplant. If we have a choice, we prefer to take a graft from aman,” explains Evelyne Marry. Yet men now account for only 35% of those registered to become donors.
The Biomedicine Agency has also chosen to focus this new week of mobilization for bone marrow donation on this theme: transgressing one’s fear of giving, by comparing the reality of this act to other risks taken in our daily lives.