Any physician can investigate the potential hematopoietic cell transplant options for a patient through the National Marrow Donor Program® (NMDP). A preliminary search of the Be The Match Registry® (operated by the NMDP) for potentially matched donors and umbilical cord blood units can be done early, while developing a treatment plan or initiating other treatment.
The search process affects patient outcomes
An efficient and appropriately timed donor search process improves the chances that a donor or cord blood unit for transplant is available when the therapy has the best chance to succeed. To enable a patient to proceed to transplant at the optimal time, a patient's physician can:
- Refer the patient to a transplant center for consultation before the need for transplant becomes urgent — see Recommended Timing for Transplant Consultation.
- Begin an initial search for an unrelated donor or cord blood unit early to allow time for more challenging searches. (The median search time for a marrow or peripheral blood stem cell (PBSC) donor is 51 days, and less than 2 weeks for a cord blood unit.)
- Maintain communication with the transplant center about patient status and treatment before the transplant.
Steps of the search process
1. Referring the patient to an NMDP transplant center
Consultation with a transplant physician and/or patient referral to a transplant center is recommended for patients diagnosed with a disease for which transplant is a potential treatment.
Timing: Preferably soon after diagnosis, depending on a patient's diagnosis and prognostic factors. Steps 2-4 below may be carried out by the treating physician. An NMDP transplant center is responsible for selecting the donor or cord blood unit (step 5).
Responsibility: Referring physician.
Further information: Referring a Patient for Transplant, Recommended Timing for Transplant Consultation, NMDP Transplant Center Participation Criteria (PDF)
2. Tissue typing the patient
The NMDP recommends that a patient's human leukocyte antigen (HLA) typing be performed at high resolution (results reported at 4 digits) for HLA-A, -B, -C and -DR loci using molecular (DNA) testing. High-resolution typing of the patient from the beginning is the key to an effective search process. Because the search strategy is based on complete patient information, beginning with high resolution patient typing not only enables a transplant center to select the best-matched donor or cord blood unit, but also can reduce total search time and costs.
Timing: Soon after diagnosis.
Responsibility: Either the transplant center or the referring physician. It may be more efficient and less costly if the transplant center performs the typing, because:
- To ensure quality and consistency of results, the NMDP and nearly all transplant centers require the patient and potential donor or cord blood unit to be tested in the same laboratory.
- Some insurance companies cover the costs of tissue typing only when performed at a transplant center.
Further information: HLA Matching for Hematopoietic Cell Transplantation
3. Tissue typing family members
The patient's full biological siblings should be tissue typed to identify potential related donors. In addition, for some patients, tissue typing the patient's parents and/or children can provide additional information that can be useful in developing a donor search strategy.
Timing: At the same time the patient is typed.
Responsibility: Either the referring physician or the transplant center. HLA expertise (available at many transplant centers and from the NMDP) is critical to ensure potential donors in the patient's family are not overlooked. To request an HLA consultation from the NMDP, contact Be The Match Patient Services at (888) 999-6743 (toll-free in the United States) or (612) 627-8140.
Further information: HLA Matching for Hematopoietic Cell Transplantation
4. Initiating a free preliminary search
Any physician can complete a Preliminary Search Request Form to find out about potential marrow or peripheral blood stem cell (PBSC) donors or cord blood units on the Be The Match Registry. A preliminary search is a single "snapshot" of potential matches at a given time and does not include contact with or additional testing of a potential donor. Early preliminary searches can indicate how challenging the patient's search for a donor or cord blood unit may be and help in shaping the treatment plan.
- When the preliminary search yields limited results, physicians are encouraged to consult a transplant physician or coordinator to discuss transplant options for the patient. An HLA expert may be able to recommend a search strategy that will yield potential donors. HLA expertise is available at the transplant center or the NMDP — (888) 999-6743, toll-free in the United States, or (612) 627-8140.
- If the preliminary search yields a list of potential donors or cord blood units, a formal search (step 5) is still necessary to select the best match as well as confirm availability of potential donors.
Timing: Can be done as soon as patient's tissue typing is complete, and can be repeated at any time. Search results are available to the requesting physician the next business day after the NMDP receives the request.
Responsibility: Either the referring physician or transplant center. If the patient is referred for transplant, the transplant center will do its own preliminary search. To initiate a preliminary search of the Be The Match Registry, complete a Preliminary Search Request Form.
Patients and their families should be reminded that locating a donor or cord blood unit is the transplant center's responsibility. Though patient-sponsored donor drives may benefit other transplant patients over time, it is extremely unlikely that a patient will find a matched donor through his or her own efforts.
Further information: Preliminary Search Request Form
5. Identifying a donor or cord blood unit for transplant (formal search)
To identify a donor or cord blood unit for the patient, an NMDP transplant center requests a formal search. The formal search begins when an NMDP transplant center selects potential donors and/or cord blood units for testing on behalf of a patient. Further testing is needed to:
- Determine whether potential donors or cord blood units are matched at the level of resolution and at all HLA loci required by the transplant center's protocol.
- Confirm the original typing. For a potential marrow or PBSC donor, this requires a fresh blood sample.
Potential marrow or PBSC donors are also educated about the donation process, screened for any health problems and asked to confirm their availability and commitment to donating. The NMDP process of identifying an unrelated donor or cord blood unit is designed to provide a high quality of donated hematopoietic cells for transplant with minimal risk to the patient or donor.
Timing: Determined by the transplant physician in consultation with the referring physician based on the patient's diagnosis and treatment options. The time needed for a formal search varies greatly, depending on both patient and donor factors.
- For a marrow or PBSC donor, the median time from initiation of the formal search to the request of a donor is 51 days.
- For a cord blood unit, the average time from initiation of the formal search to the request for a cord blood unit is less than 2 weeks. The unit is typically shipped within 24 hours after being requested.
Factors that Affect Time to Find a Donor/Cord Blood Unit
- When and whether transplant becomes a potential treatment. (For example, physicians may initiate a donor search as a backup plan for a CML patient being treated with imatinib.)
- Urgency of patient's condition.
- Quality of the patient's initial HLA typing — high-resolution typing enables a more efficient search.
- Challenge of the search — rarity of the patient's HLA type and the strategy for requesting further donor testing.
- Whether cord blood is an option.
- Scheduling of donor appointments for testing, education and physical exams.
- Donors who are either permanently or temporarily unavailable.
Although the majority of donors on the Be The Match Registry are committed to donating if called upon, their participation is voluntary. Reasons donors could be unavailable include changes in health, personal situations, changes of heart about their commitment or changes in address that have made them difficult to locate.
Responsibility: The formal search is requested by an NMDP transplant center, which meets NMDP participation criteria for transplant experience and quality. The NMDP manages the search process and provides HLA expertise as well as support services for patients and their physicians throughout the process.
Further information: U.S. Transplant Centers, Key Roles in the Search Process (PDF), Likelihood of Finding an Unrelated Donor or Cord Blood Unit
6. Scheduling a transplant and collecting the cells for transplant
To facilitate the transplant, the NMDP:
- Ensures the quality of the cells provided for transplant through a complex system of checks and balances and the standards it sets for its network centers
- Works with the transplant center and donor center or cord blood bank to establish a transplant date
- For marrow or PBSC transplants, manages the logistics of scheduling the collection and arranges transportation of the cells by courier to the transplant center
- For cord blood transplants, arranges shipment of the cord blood unit to the transplant center
Timing: Scheduling of the transplant depends on the patient's condition and donor availability. Donated marrow or PBSC is transported by courier to the transplant center within 48 hours of donation. Cord blood units are typically shipped within 24 hours after being requested.
Further information: Key Roles in the Search Process (PDF), Maintaining Confidentiality and Network Standards