Overcoming donor hesitation in bone marrow donation for thalassemia

Dear Editor,

Hematopoietic stem cell transplantation (HSCT) remains the only curative treatment for patients with β-thalassemia major, a disorder that represents a significant public health burden in many countries, including India.^[1] However, only about 25–30% of patients have a human leukocyte antigen (HLA) matched sibling donor, leaving the majority dependent on unrelated donors registered in global stem cell registries connected through the World Marrow Donor Association.^[2,3] Retaining donors and encouraging them to proceed with donation when matched is a major challenge for stem cell registries, particularly in countries like India, where myths and misconceptions regarding bone marrow (BM) donation are prevalent.

Hematopoietic stem cells can be collected either from BM or from peripheral blood stem cells (PBSCs).^[4] Although PBSC collection is often preferred because it is less invasive, BM may be requested as the primary stem cell source in patients with thalassemia major due to the lower risk of graft-versus-host disease associated with BM transplantation.

To illustrate this challenge, we report two cases of successful BM donations facilitated by a stem cell registry in North India for matched-unrelated HSCT in children with transfusion-dependent thalassemia major. The donors were males aged 28 and 35 years who were identified as full HLA matches (10/10) for two pediatric recipients aged 3 and 7 years, respectively. One donor was identified approximately 1 year after registration, whereas the other was matched 7 years after enrolment in the registry. In both situations, the identified donors represented the only potential curative option available through global donor registries. Key donor and transplant characteristics are summarized in Table 1.

In both cases, the transplant center requested BM as the preferred stem cell source. During the initial counseling sessions, both donors expressed considerable apprehension regarding BM donation, particularly concerns related to general anesthesia, hospitalization, and recovery time. Much of this anxiety stemmed from incomplete or misleading information obtained from online sources.

To address these concerns, a structured counseling approach was implemented. Donors were provided detailed explanations of the donation procedure, associated risks, and expected recovery. They were also given the opportunity to visit the collection center and interact directly with the transplant and collection teams, allowing open discussion and clarification of misconceptions related to BM donation.

Following counseling, both donors agreed to proceed with BM donation. Donor evaluation included confirmatory HLA typing, infectious disease screening, and assessment of physical fitness. BM harvesting was successfully performed in both donors with a hospital stay of 1 day and no post-donation complications.

The recipients subsequently underwent HSCT and are currently doing well on follow-up with disease-free status. Donor follow-up also confirmed complete recovery without adverse effects. These cases highlight the importance of structured counseling and transparent communication in addressing misconceptions related to BM donation. In regions where awareness about stem cell donation remains limited, targeted educational interventions and early donor engagement may play a crucial role in improving donor participation and strengthening unrelated donor transplantation programs.