The Search Process
Once a disease process has been identified and transplant is considered as a possible
therapy, an appropriate donor must be identified. The best possible match results in the
least complications. For allogeneic transplants, HLA histocompatability typing is
performed for immediate family members initially using serologic typing. Fully matched
family members provide the most compatible matches because they often share minor
HLA antigens not usually included in testing. Class I and class II HLA antigen
compatibility is tested and compared. Class I includes HLAA, HLA!, and HLAC.
Class II includes HLA"#, HLA"$, and HLA"%. A &of& match refers to testing of
HLAA, HLA!, and HLA"#, each of 'hich has ( alleles. #outine testing involves
chec)ing for these & antigens among family members.
If the donor and recipient are not a &of& match, they are said to be mismatched. *hen
only + of & mismatch, the term of haplotypic donor applies. ,nrelateddonor searches
generally loo) for &of& matches also, although information on all -( of the above
mentioned alleles is often provided.
This information helps the transplant physician determine the ris)s of nonengraftment
and ./H" 0for more information, see Hematopoietic 1tem Cell Transplantation2. In
addition, donor age 0younger is better2, se3 0female stem cells given to a male is less
favorable2, cytomegalovirus 0C4/2 serology 0C4/negative has better outcome2,
pregnancy and transfusion history, and body 'eight are considered.
Unrelated-donor search registries
*hen a related donor cannot be identified, a search for an unrelated donor is often
initiated. This usually consists of a search of marro' donor registries and cord blood
ban)s. The largest donor registry is the 54"$, 'hich is responsible for providing
marro' and stem cells for more than 6777 recipients to date. 4ore than (&7,777 cord
units are currently stored in ban)s 'orld'ide. The largest cord blood ban) in the ,nited
1tates is the 5e' 8or) Cord !lood !an), 'hich has collected more than +(,777 units.
The cord blood ban) in 1pain no' has more than (9,777 specimens collected and
processed, and the Australian cord registry has more than -:,777 specimens. 1everal
additional cord blood ban)s are organi;ed throughout the ,nited 1tates, <urope, and
Asia, 'hich are collecting units much li)e a blood ban) solicits volunteer blood
donations.
The 54"$ contains typing information on over = million potential donors. Also, the
54"$ can search more than -= international registries through cooperative agreements
'ith those registries. !one 4arro' "onors *orld'ide 0!4"*2 is a collective database
of 96 registries in =+ countries and +: cord blood registries from (- countries> --,+?&,666
potential donors and cord units 'ere available as of @uly (77:. $reliminary searches
through the 54"$ routinely also e3plore the !4"*.
In addition, private forprofit cord blood ban)s often solicit funds from e3pectant mothers
to pay for the collection and storage of cord blood follo'ing delivery. Typically, an
upfront processing fee and an ongoing storage fee are charged. To date, autologous stored
cord blood from private ban)s has rarely been used. Calculations suggest that, of the
individuals 'ho store cord blood, fe'er than - in (7,777 'ould use autologous stored
cord blood. Therefore, common recommendations suggest that individuals donate cord
blood to public ban)s, if that option is available.
Unrelated-donor search process
The process begins by performing "5AHLA typing of the recipient, a more accurate
method of typing than the serologic method. This is follo'ed by a preliminary search that
e3plores the registry databases. The preliminary search is performed free of charge, and
the results are usually available 'ithin (= hours. *hen a potential donor is reAuested, a
formal search is begun, including class II typing of potential donors and subseAuent
confirmatory typing of selected matches. This incurs a cost to the recipient or their
insurer. *hen donors are reAuested, they undergo a 'or)up that includes laboratory
testing and viral screening, physical e3amination, and an informational session.
*hen donor approval has been obtained, a date is set for the collection. !one marro' or
$!1Cs are harvested on the same day of transplantation 'ith the intent to infuse the
recipient 'ithin (= hours of the harvest. .enerally, cord blood is shipped to the transplant
center prior to the onset of the recipientBs conditioning regimen. "onors are )ept
anonymous from the recipient until one year after transplant. At this time, identifying
information can be e3changed if mutually desired.
