Fortunately, we do not need to inject the bone marrow into the recipient’s bones. The actual transplant is very anti-climatic. Bone marrow is transported to the recipient in blood bags. In fact, it is indistinguishable from blood by its outward appearance – same consistency, same color.
The transplant involves simply introducing the marrow into the recipient’s blood stream. This is done with the familiar intravenous drip. After the marrow enters the blood stream, the marrow cells migrate to the recipient’s bones. The marrow cells then penetrate the bones and move into the interior cavities of the bone. Nothing short of a miracle, IMHO.
If all goes well, by 3-4 days there should be a measurable amount of “donor-origin” blood cells in the recipient’s circulating blood. (The marrow’s role in the body is to manufacture all three types of blood cells: red blood cells, white blood cells, and platelets.) Doctors measure a recipient’s progress by measuring the percent of donor-origin blood cells in the body. That means the blood cells have the tissue type of the donor, not the recipient.
I don’t know how recipients “feel” the results of their transplants, other than having more energy and by having a stronger immune system (due to having a higher white blood cell count). But that reminds me, recipients assume the blood type (A, B, AB, or O) of their donors, a fact that some mystery writers have exploited to give their novels a “surprise” ending. And there are cases where recipients have also “inherited” the food preferences of their donors, e.g., hating broccoli before transplant, loving it post-transplant.
Coincidentally, all the volunteer couriers in our office are having their annual OSHA-mandated review tomorrow, where we learn proper handling techniques. This is required because there is a very slight (but still not zero) chance that some of the marrow we handle may have infectious diseases, and OSHA has determined that we must all be trained how to handle possible bio hazards.
This is severe overkill, IMHO, because the marrow we handle has been thoroughly tested for HIV, hepatitis, syphilis, and a whole laundry list of nasty stuff. So we learn about gloves and bags and what to do if a bag breaks in transit (fortunately, this has never happened).
Most of our training can be broken into two categories. First, we learn proper procedures on how to process the paperwork that is generated whenever a marrow collection is made. We must follow very specific steps when the marrow is handed to us – most important is checking the donor ID number and the recipient ID number on the marrow bags to see that they correspond exactly with the ID numbers we (the couriers) are expecting. We do this so we will never be in the position that Duke University was in a few months ago when they transplanted a heart and lungs with the wrong blood type into a teen-age girl.
The other aspect of this part of the training is learning the proper way to pack the cooler and learning the rules about transporting the marrow (keep it in your possession at all times, always wear seat belts when traveling with the marrow in a taxi, never put the cooler in an overhead bin, etc.).
The second major component of training is to learn the ins and ours of traveling efficiently by air. We learn stuff like how to ask for “lifesaver” status for a flight if it is delayed because of a bottleneck (we can move up in the takeoff line). And like how to get the cooler through airport security quickly (the cooler has to be hand checked — no X-rays allowed).
Yes, we do umbilical cord blood transplants too. When a physician searches the NMDP Registry on behalf of a patient, the results sent back to him/her include the matching cord blood units that are in the inventories of the dozen or so cord blood banks affiliated with us. If a doctor selects cord blood for a transplant, it is shipped to the patient’s hospital still frozen. These are transported in liquid nitrogen “dry shippers,” which go in the cargo hold of an airplane as it’s much too big to be in the passenger section.
BTW, in a previous answer, I said that a marrow collection would leave you with a sore butt for a day or two. In case anyone’s confused by this, I should state that marrow is extracted from a donor’s pelvic (hip) bones.
Has the increase in airport security impacted your job in a serious way? Are airlines informed beforehand that you’re coming, so you can get off the plane first?
Is that your usual transport to/from airports? Do they ever send ambulances or hospital shuttles? What was the worst/most unusual transport you had to take while on a mission?
What is the scariest/most unnerving thing that’s happened while on a donor assignment? What about the funniest?
And finally, do you ever learn the status of patients whose marrow you’ve delivered?
I’m glad you clarified. I thought I saw the same thing on the website, and of course the rodent in my brain was spinning crazily on his wheel until a synapse clicked on and I thought, “Heeyyyyy… does that mean it comes from the butt?”
How does one go about donating cord blood? I looked this up the last time I was pregnant and only found information on banking it for myself or my family at a cost to myself. What are the restrictions on donating cord blood? We had a home birth, would it have even been possible to donate?
When I was young my dad had cancer and they talked of giving him bone marrow. My mom said that the procedure involved drilling into the donors bone and therefore was extremely painful. Is this not how it is done, or was it done this way in the past?
It has not affected the transport of marrow in any major way. However, the travel agents who book our flights (we have a travel agency on site with three full-time agents to do this) must now take into consideration that it will take longer to make transfers.
So, for example, pre-9/11 they might have booked two connecting flights with 40 minutes for the courier to make the transfer. Now, they wouldn’t book connecting flights unless there were an hour or to make the transfer. So it does cut down somewhat on the leeway we have to construct itineraries for our couriers.
Airlines receive electronic notification at the time we purchase tickets that the ticket-holder is a bone marrow courier. Because that information does not always get transferred to the ticket agent at the airport, we always mention it again at check-in time. We always fly coach, but we request tickets as close to the front of the plane as possible so as to get off the plane as quickly as possible. Once in the plane, I tell the head flight attendant of my situation and ask that I get any empty seats closer to the front.
Once, I thought I’d have plenty of time to make my next flight, but as we approached Heathrow, the flight attendants notified everyone that there was a passenger on board requiring immediate medical attention. So every one was told to stay seated until the paramedics arrived.
Twenty minutes after landing and with still no sign of the paramedics, I was MUCH more nervous about making my connecting flight and so I told an attendant of my situation (I should have told her this sooner). She allowed me to get off the plane right away.
You asked these questions when I mentioned in a previous post about using taxis.
Taxis are our major form of ground transportation, but I’ve carried marrow on trains in the Netherlands and in Germany, and even on the London Underground.
Twice, I’ve been in the front seat of a ambulance. In both cases, the marrow collection was seriously delayed and I needed to get to the airport right away. In both cases, my nervousness about missing my first flight was magnified tenfold by the adrenaline rush I received from whipping around other vehicles and blowing through red lights at a very high rate of speed …
And once, I was delivering marrow to Italy, and when the plan landed, I saw a police car on the tarmac. I thought the cops were getting ready to bust some guy on our flight. Imagine my surprise, then, when the cops intercepted me as I was walking from the plane to the terminal.
All I knew was that I was to meet the transplant doctor at the gate, but apparently in Italy the national police must be involved in transporting marrow. I almost caused an incident when I refused to give them the cooler. I was afraid they’d mistaken me for someone else, like a drug smuggler or something. Well, eventually they escorted me to the gate and the doctor (who spoke English) was able to convince me that all was O.K.
The scariest thing I’ve personally experienced was the tarmac standoff I had in Italy that I described above. However, one of my colleagues in the office had a situation where a drug-sniffing dog got a whiff of the marrow while it was out of the cooler for a hand inspection at the X-ray machines. The dog lunged at the bag of marrow and got it in its mouth. Fortunately, the dog’s handler was able to get it out of the dog’s mouth before its teeth punctured the bag.
I’ve never experienced anything ROFLMAO funny, but I always get a kick out of how some airport security guys get freaked out by seeing me casually pull out a bag of marrow and show it to them. Buncha pansies!
I always have the opportunity to do so, because the folks who coordinate the transplants work just around the corner in the office where I work. It’s easy for them to punch in the recipient’s ID number on their computers and tell me his/her status. But I just don’t want to know, so I’ve never asked.
If I could just sneak in a little encouragement to tanookie regarding iron levels – this used to be a problem for me. I bought liquid iron supplement and took it several days before my donation, with orange juice. I also scheduled donations early in the day, when your iron levels tend to be higher. I did all these things on the advice of the blood center. So you might want to check with them to see if they concur. They also suggested I eat liver (not an option, even though I wasn’t a vegetarian then!). You can also eat iron-rich plants, like lentils and green leafies.
I’m not sure why (though I suspect it’s that I’m a little healthier overall now) but I don’t have trouble with iron now. I do take a children’s iron-fortified vitamin a couple times a week. But now my eating habits are better. I think the years I was pregnant or nursing I improved my eating habits and it stuck for life.
(I’m also very glad to see this thread bringing attention to an issue very near and dear to my heart!)
The center gave me a whole list of stuff to try. I was working on it
I started taking iron pills in addition to my regular vitamins but they made me awfully sick to my stomach. I will have to try the liquid iron supplements.
Can’t eat liver (cholesterol without medication is about 500ish) But I have been a lot more conscious of the iron in the food I eat. (among all the other nutrients
Of course I need to wait a while to try as I’m pregnant again. I’ll keep that advice until then though!
Any woman wanting to donate her baby’s umbilical cord blood must first choose whether to donate it to anyone who might need it (the public bank model) or to store it for her family’s private use (the private bank model).
If you donate to one of these NMDP-affiliated cord blood banks, it will be entered into our database and a physician searching on a patient’s behalf may use the cord if it comes up as a match in a search of the NMDP Registry.
Using cord blood for transplants is still somewhat experimental, and so some major university hospitals collect cord blood just for patients in their own transplant units. You can find some of these university-affiliated cord blood banks at the NMDP link above. Other cord blood banks operating on the public-banking model are run by the American Red Cross, and you can find out about these at the ARC Web site. http://www.redcross.org/news/bm/cord/010209a.html
Commercial, for-profit cord blood banks will store your baby’s cord blood for a hefty collection fee and annual dues. In return, you get exclusive rights to the cord blood unit. These are a waste of time, IMO, and they make money by preying on the fears of expectant mothers and fathers.
**
There are several health restrictions. You must complete a family history health questionnaire to identify any inherited diseases that might be transmitted by the cord to the transplant recipient. In addition, the mother must pass the same embarrassing health/sexual lifestyle questionnaire that blood banks give their potential blood donors.
The cord blood is tested to see if it contains any infectious disease markers, and is tossed if it fails any of them. If there is even a hint of a complication at birth (such as eclampsia, or a fever in the mother or child), then the cord cannot be used. Some cord blood banks are less strict in this regard than others; the NMDP is very strict.
I’ve never heard of cord blood being collected after a home birth, but that doesn’t mean that it can’t or doesn’t happen. I’d think that the odds are against it though, because you’d have to get a OB/GYN nurse or a medical technician trained in cord blood collection out of the hospital and into your home.**
Nobody drills into the donor’s pelvis, but the collection doctors do use very sharp 6” hollow needles to punch through the bone. As I mentioned in an earlier post, the donor is anesthetized, so s/he doesn’t feel a thing during the collection – but may have a sore butt for a day or two afterwards.
Thank you so much for your answer. Yes, I think my mother told me what she did about the procedure because I asked if I could give my dad some marrow. She said that bones can’t be numbed and therefore it hurt alot! No, she is not a doctor, and neither am I. It is the one fear that has kept me from doing something like this though. I think the pain was her fear and the reason she didn’t get tested (though being his wife she probably wouldn’t have matched). I do try to donate blood when ever I can, but I too, have low iron and rarely am able to donate. I am trying to eat better to help with this, but I can say that my husband, Mtgman, is a gallon donor. He gives more often, and seems to have the chance more often. I, OTOH, have been pregnant 4 times in the last 8 years. Men don’t seem to have that problem.
Melissa
Tanookie - if you had problems with iron, you may have been taking ferrous sulfate, which is rather well known for that. Try the carbonyl form instead.
And if you can take the idea, heart and gizzard meat are just as high in iron as liver without the cholesterol
Hi Spiff!
Another bone-marrow donor here… Well, signed-up and ready, anyway. I’ve been in the Canadian registry for around 10 years but have never been called to donate. I think I got to the second stage of selection once though; a couple of years ago I was asked to go for more detailed blood tests, but nothing more came of it.
I have another question on the cost of registering.
The webpage says, “The cost for the tissue typing ranges from $70 to $96, depending on the Donor Center, the level of testing performed and the laboratory that completes the test.”
This is indeed a cost that the donor has to pay for, no?
Is there any way to waive the cost?
I’d love to sign up to donate but I am a poor college student and don’t have that kind of money.
You are correct regarding who pays the cost to register. It is an unfortunate fact that the laboratory work needed to register potential donors is not cheap.
However, many of our donor centers regularly solicit donations from individuals and corporations to help pay these costs, so I would advise you to contact your local donor center and ask to be put on their waiting list (if they have one, and most of them do).
Then, when funds are available to pay for the laboratory work, you’ll be called in to register (when you’re at the top of the waiting list, of course).
