How does stem cell donation work?

In circa 85% of cases, stem cells are taken from the donor's blood (so-called PBSC donation). The patient's attending physician ultimately chooses the best treatment method. In preparation for the extraction of your stem cells, you must inject medication (G-CSF) for five days, with the final injection taking place on the morning before the donation procedure. This causes your body to produce more stem cells, which end up in your bloodstream. G-CSF is a bodily substance that your body typically produces when you have the flu. 

On the day of the donation, your stem cells are removed from your blood using an apheresis machine. This device filters the stem cells from the blood and returns the blood to the donor's body via an IV. Over the course of several hours, sufficient stem cells are collected. Your stem cells will be transported and administered to the patient (somewhere in the world) within 72 hours. 

The G-CSF injections may cause flu-like symptoms. Some donors experience a sore feeling in their lower back and upper legs, caused by the body's production of extra stem cells. These side effects are harmless and usually pass within a day after the extraction procedure. Note that you may feel fatigued for a few days after the procedure. 

Sometimes, it is better for the patient to receive stem cells taken directly from the donor's bone marrow. The patient's attending physician ultimately chooses the best treatment method. Donating stem cells from the bone marrow is painless, as this procedure is always performed under general anesthesia. 

This is not a difficult procedure. You arrive at the medical center in the morning and are put under anesthesia. 

Using a thick needle, the stem cells are extracted from the rear edge of the pelvis. This is the bone that you can feel at the top of your buttocks. The pelvis contains a lot of bone marrow. It is a large and strong bone, from which bone marrow can easily be extracted without complication. During a bone marrow donation, around 4% of the total volume of bone marrow is extracted. 

After the procedure, you may experience soreness or pain in the muscles in your lower back. These symptoms usually go away within 14 days. For a little while, you may also tire out more easily after physical exertion. As the bone marrow in the pelvis is highly vascularized, a relatively large volume of blood (up to a liter) is also extracted along with the bone marrow. This can cause mild anemia. Your body will produce new blood quickly and the anemia will go away after a few weeks. 

Step 1: potential match
If you are a potential match, an employee of Matchis Netherlands will contact you. We will first try to reach you by phone. If you do not pick up, we will leave a message and send you an email. During this initial interview, we will inform you as well as possible about the donation process and conduct a medical survey. We will also ask you up front if you are still willing to be a donor and if you have any vacation plans that we need to take into account.

Step 2: taking blood samples
After this phone conversation, we will ask you to have several blood samples taken. These tubes of blood are taken at the hospital on Aruba, after which they are sent to Matchis Netherlands.

Step 3: waiting
Once your blood arrives at Matchis Netherlands, it will be examined further. For example, a second and more detailed HLA typing is performed to verify whether you are truly the patient's best match. Additionally, your blood is tested for certain viruses, such as hepatitis and HIV. The patient for whom you were selected as a potential match may have other potential matches as well. In that case, the patient's transplantation center may need more time to select the best match. The waiting time is around three months.

Step 4: the best match
If it turns out that you are the patient's best match, Matchis Netherlands will contact you to discuss a date for the donation procedure and the donation method to be used. At the same time, we will schedule a thorough medical examination and a consultation with our donor physician. Do you want to know exactly how we determine if you are the best match? You can find more information here.

Step 5: medical examination & informational interview
The medical examination is partially conducted online by a physician in the Netherlands and partially at the hospital on Aruba. In some cases, it may be conducted entirely in the Netherlands. During the medical examination, your blood pressure is tested, your urine is examined and we take an ECG and a chest X-ray, among other things. As an added benefit, this also tells you how healthy you are! We will also conduct a thorough interview to discuss the pros and cons of stem cell donation and the possible long-term side effects. Lastly, we will discuss which donation method you prefer as a donor.

Step 6: preparation for the stem cell donation procedure
If you are to donate stem cells via your blood, you must administer a growth factor twice daily on the four days prior to the stem cell donation procedure. It is called G-CSF and it causes your body to produce more stem cells, which will end up in your bloodstream. G-CSF is a bodily substance that your body typically produces when you have the flu. As the stem cell donation procedure is performed in the Netherlands, you will travel to the Netherlands six days before the scheduled date of the procedure. You can return home five to seven days after your procedure. In total, you will spend around two weeks in the Netherlands.  

If you are to donate stem cells via your bone marrow, you will arrive at the hospital early in the morning on the day of the donation procedure. At the hospital, you will complete a brief survey and have a few more tubes of blood taken. The procedure of donating stem cells via your bone marrow is also performed in the Netherlands. You will travel to the Netherlands one or two days before the scheduled date of the procedure and can return home around seven days after your procedure. 

Step 7: the donation
The time has finally come! Today is the day that you will donate your stem cells. This is done in one of two ways: either via your blood or via your bone marrow. You can read more about these procedures via the tabs above.  

After your donation procedure, we will conduct several follow-up interviews by phone to check how you are doing. After four weeks, we will check your blood values to see if your bone marrow has fully recovered. You can have a blood sample taken on Aruba for this; there is no need to come back to the Netherlands.  

The patient's attending physician chooses the method that is best for their patient. As a donor, you can consent to the chosen method; after all, stem cell donation is always voluntary. If your choice does not match the attending physician's preference, that means you will not be a donor for that specific patient. 

Based on the type of patient and their condition, it is determined what donation method is best suited for them. There are differences in the properties of the donated ‘product’ between the two types of donation (via the bone marrow and via the blood). As a result of these different properties, the effect that the stem cell product has in the patient's body differs per donation method.  

Differences

When donating via the blood, the product contains a large number of stem cells, which means it can take effect more quickly and the new stem cells can start producing new blood cells faster. The product also contains many white blood cells, which can have a positive effect on the patient's leukemia. A downside of the presence of these white blood cells is that they can trigger so-called graft-versus-host disease (GvHD). That means that the donor's stem cells may start to attack the patient's body.  

When donating via the bone marrow, the product contains fewer stem cells and white blood cells. On the other hand, it does contain other components that make the product more effective against certain conditions. When donating via the bone marrow, GvHD is also less common. Bone marrow donation is currently used to treat specific conditions (e.g. aplastic anemia). Using a bone marrow product is also strongly preferred when the patient is a child.  

Besides the preference of the patient's attending physician and that of the donor, the donor physician also gets a say in choosing the donation method. If a donor is not eligible for a specific donation method, the alternative donation method may be chosen in consultation, even if this is not the preferred method of the patient’s attending physician.  

All expenses incurred during the stem cell donation process are covered by the patient's health insurance. The travel and accommodation costs for your trip to the Netherlands are covered by Matchis. You do not receive any remuneration for the actual donation, as stipulated by law.  

Stem cell donation via blood 

Side effects of G-CSF 
Administering the growth factor G-CSF may cause mild to moderate bone and muscle pain as a side effect, which is easily treated with paracetamol. Some people experience flu-like symptoms like fatigue, mild fever and/or headache. Some donors report that they have trouble sleeping or experience a slightly elevated body temperature while using G-CSF. Side effects such as nausea, night sweats and dizziness occur rarely. Occasionally, the injection site may become irritated. These symptoms generally pass within one or two days. 
 
One of the side effects of G-CSF is that it may exacerbate the symptoms of autoimmune diseases, asthma and allergies. 
 
The long-term effects of G-CSF 
Currently, no long-term adverse effects of G-CSF are known. Studies have focused primarily on a potentially elevated risk of conditions such as cancer. This substance has been used for this application in healthy donors since the early 1990s. 
 
Side effects of extracting stem cells from the blood 
The process of donating stem cells via blood may take up to six hours. For a number of hours, part of your blood continuously flows through the machine. As your blood cools down outside your body, you may feel cold during the procedure. In that case, a blanket can help. 
 
Along with your stem cells, the machine may also collect some platelets. This means the number of platelets in your body may decrease. Your platelet count is therefore checked both before and after the donation procedure. Generally, the number of platelets does not become low enough to be a problem. 

Stem cell donation via the bone marrow 

Is it painful? 
Donating stem cells from the bone marrow is painless, as this procedure is always performed under general anesthesia. For this method of donating stem cells, the standard risks of anesthesia pose the largest risk. After recovering from the anesthesia, you may still feel a bit drowsy. The ventilation tube that is used during the procedure may also cause a rough feeling or soreness in your throat. This will usually pass within a few days. 
 
You may also experience headache and/or nausea. These symptoms will generally pass by the following day. 
 
Extraction 
The stem cells are extracted from the rear edge of the pelvis using a thick needle. For the first few days, you may experience a sore, painful feeling at the puncture site. This is easily treatable with paracetamol. The pain will recede after a few days, although it may take up to several weeks for the feeling to go away entirely. 
 
Anemia 
As the bone marrow in the pelvis is highly vascularized, a relatively large volume of blood (around one liter) is also extracted along with the bone marrow. This can cause mild anemia, which can make you feel fatigued.  Your body will quickly produce new bone marrow and blood to replace what was taken and the anemia will pass after several weeks. If necessary, iron tablets can help.