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stem cell donation

definition

A stem cell donation is a measure used in leukemia (blood cancer) in which the patient is transferred stem cells from a healthy donor, who are to take over the production of healthy blood cells in the future.

Previously, the stem cells must be recovered from the body of the donor.

Sequence of stem cell donation

In order to successfully perform a stem cell transfer, a suitable donor must be found in a first and complex step. For this purpose, typing actions are carried out at regular intervals.

The likelihood that the exact characteristics of a potential donor will fit the recipient is very low. For example, about 14, 000 matches must be appropriate in order to qualify as a donor.

To be typed as a donor, you first get blood taken. Alternatively, a mouth swab can be done with a cotton swab.
Due to the high costs, blood collection is almost always used.

If most of the components of the donor's blood match that of the recipient, further blood tests and further tests will be carried out in a second step.

In some cases, there are complete matches, which then entitles the donor to transplant.

There are two different ways to get stem cells.
One possibility is that the patient gets a drug injected. This then triggers the blood cell-producing cells, the so-called stem cells, out of the bone marrow and rinses them into the peripheral blood.

This is then removed from the donor and the stem cells isolated. In the meantime, chemotherapy and radiation almost completely shut down the recipient's immune system.
This is important so that the body of the recipient does not start an immunological backlash against the transfused stem cells.

During this time, the recipient is in complete isolation, as infection must be avoided at all costs.
If his immune system stops working, the donor's stem cells are transferred to him. These immediately seek a place in the bone marrow and start producing healthy blood.

Another possibility of stem cell production is bone marrow puncture. For this purpose, the donor is taken for about 5 days in the hospital and under local anesthesia it is drawn with a drill bone marrow from the iliac crest.
Again, the stem cells are then isolated and can be transfused to the recipient after appropriate preparation.
Bone marrow puncture is often more painful for the donor than the first method, but not associated with the use of medication.
For the intervention, the donor is released from the work, the costs are taken over by large transplant organizations, such as the DKMS, and by the health insurance.

Risk to the donor

Despite some trivial media advertising, some risks should be considered in a stem cell donation.

Bone marrow puncture is an operative procedure. There may be allergic reactions to the anesthetic, there may be sometimes severe bleeding during puncture of the bone marrow in the iliac crest.
There may be irritation or injury to the nerves during the procedure.
During and after the procedure, the infection is a dreaded complication that must be avoided.
Furthermore, the wound from which the bone marrow and the stem cells obtained have been punctured can lead to wound healing disorders, which must be treated further.

In drug stem cell production, a drug is administered to the potential donor to release stem cells from the bone marrow and rinse them into peripheral blood.
This can lead to allergic reactions to the drug. Probably the most crucial risk in drug stem cell production is the still unclear study on the long-term consequences.

Although the previous studies do not show a connection between drug stem cell rinsing and the occurrence of leukemia, no conclusive assessment is possible due to the lack of long-term observation.

Risk to the recipient

Before the recipient can get the stem cells transfused, switching off his immune system is urgently needed to avoid a rejection reaction against the foreign stem cells.

The immune system is almost completely eliminated by chemotherapy and radiation. This carries the great danger of infection, for which the body of the recipient is now very vulnerable.
For this reason, he is strictly isolated in hospital under regular blood tests.
Nevertheless, there is a risk of infection and represents a great risk.

In spite of the immune system being switched off, there is an additional risk of a rejection reaction to the infused stem cells, which would have serious health consequences for the patient's body and would have to be treated with strong medical measures. In extreme cases, the recipient may die due to extreme rejection of the body.

With a good response to the new stem cells, the patient has to stay in isolation for a few more days until his immune system is restored and working normally.

side effects

The stem cell donation has some side effects for both the donor and the recipient. In the case of medicinal stem cell rinsing, the donor is injected with a drug called G-CSF, which is intended to flush the stem cells into the peripheral blood circulation.
After administration of the medication, flu-like symptoms and bone pain, myalgia, nausea, vomiting or diarrhea may occur.

Furthermore, blood cell changes, infections of the lungs and respiratory tract and spleen enlargement are mentioned.
Patients with Sickle Cell Disease should not take this medicine, as it can lead to a life-threatening multi-organ failure here.

Bone marrow puncture from the iliac crest can lead to weakness, bone pain in the puncture area and pain during running after the procedure.

In the recipient, transplantation can also lead to high fever, severe weakness and general symptoms. It should not be forgotten in this context that the immune system of the recipient has been switched off and also the drugs used for it have a large number of side effects.

Minimum age for stem cell donation

Stem cell donors can be any healthy adult between the ages of 18 and 55 years. Also important are some exclusion criteria that should be considered. For example, a minimum weight of 50 kg is necessary.

All typified potential donors are stored in a file.
At the age of 61, each donor is removed from the card index because he is no longer considered a donor due to possible age-related illnesses.

DKMS

The German Bone Marrow Donation Card is a company that specializes in the typing of possible bone marrow donors.
The non-profit organization was founded in 1991 and is based in Tübingen. Since 1997 the DKMS is a foundation.
The main task is the organization of typing campaigns throughout Germany, where the population is called to submit to a blood sample.
The data will be sent to the Central Bone Marrow Donor Registry, which is based in Ulm. Here is the switchboard and the worldwide access point to all data.

The DKMS organizes its typing actions at the local level. Most of the time, a sick patient in a certain place is introduced and the population is asked to type out.
The data obtained are then not only intended for the named patient, but can lead to transplantation worldwide if the corresponding characteristics match.

DKMS is also active globally. She has representations in Spain, Poland, the USA and England.
In Germany, the DKMS file has reached a considerable size. Thus, about 4.3 million people are listed in this country and are potentially eligible for a donation. Approximately 6 million people worldwide are listed in the DKMS index.

By 2016, a total of 54, 000 stem cell transplants based on DKMS typing were performed.
The DKMS is meanwhile 100% financed by donations. In the past she was supported by the German Cancer Aid and the Ministry of Health with subsidies. DKMS works with numerous laboratories in Germany and worldwide.

Cost of stem cell transplantation

The costs for a typing amount to about 40 EUR, which are financed by DKMS through donations. Any potential donor can financially take over the typing and make this tax claim as a donation.

Complete stem cell production including transplantation is very expensive. So must be expected with around 100, 000 euros. The costs are covered by the health insurance.

If a stem cell donor has been found, it must be exempted from the employer. Each stem cell donor will be paid for this career loss as long as he is incapacitated for work (hospitalization).
Further funds are not paid for the patient. The donation is therefore free of charge. After about two days, the patient is discharged from the hospital after a bone marrow puncture. In case of complaints, it may be necessary for him to stay home for a few more days and be on sick leave. The costs are then covered by the health insurance.

Pain in stem cell transplantation

In drug stem cell production, a drug is administered to the donor for about 5 days.
Side effects also include bone pain, which can occur over the period of use and shortly thereafter, spreading throughout the body.

In bone marrow puncture, the iliac crest is punctured with a type of drill and bone marrow is obtained. This procedure may also be performed under general anesthesia.

After the procedure, the patient can be quickly mobilized again.
However, there is more bone pain in the area of ​​bone marrow puncture. The pain can occur during exercise, but also at rest, but should be no later than one week after the procedure disappeared.
Prolonged pain should be clarified by a doctor.

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