Step 2: Search Activation
The first request for additional testing of any donor constitutes a step known as “activation”. Only transplant centers can activate a search on behalf of a patient. These are accredited hospitals with sufficient experience in allogeneic transplantation, specialized facilities and staff. Larger centers may be designated Comprehensive Cancer Centers by the National Cancer Institute. If the patient has not yet selected a hospital to manage his / her search, this must be done before activation can take place. Patients should understand that they do have a right to transfer their search to another hospital at any time.

Most registries charge an activation fee to formalize a search. Patient can obtain this information from the transplant center’s unrelated donor search coordinator. Generally speaking, there are two types of test requests that will be performed at this stage: Class II (DR) typing and Confirmatory Typing (CT). Roughly 50 percent of the donors in the worldwide registries are not fully ABDR typed (Class I and II). If no fully ABDR matched donors are identified initially, coordinators must request DR typing of any potential matched donors who are only AB typed. In many cases, donors identified in the Registry are DR typed by low resolution DNA methodologies, and require high resolution DNA typing to obtain more definitive results.

Step 3: Donor Selection
The transplant center chooses suitably matched donors on behalf of their patients. Ideally, donors should match their patients on A, B and DR antigens, using DNA-based typing techniques. If no perfectly matched donors are identified, some centers may request mismatched donors (5 of 6 antigens). Other factors that are taken into consideration include matching on other loci (such as the C locus), the donor’s sex, number of pregnancies if female, transfusion history, age, size and availability. The Registry also takes several other factors into consideration before approving the donor selection, including recipient age, disease and stage, and transplant center qualifications.

Step 4: Donor Workup
All donors requested for workup attend an information session in order to receive a thorough education. After counseling, all donors must sign a form called the Intent to Donate before they can proceed further. This constitutes a moral obligation on the part of the donor, and represents the Registry’s assurance that “informed consent” has taken place. All donors receive a thorough physical exam, including a health history screening, blood work, electrocardiogram, chest x-ray and repeat Infectious Disease Markers. This is performed to protect the donor as well as the potential recipient. If the volunteer is cleared, the donation is scheduled.

Step 5: Bone Marrow or Blood Stem Cell Collection
For a description of the donation process, please read the Registry’s online brochure.