Important Dates &
Upcoming Meetings

 

For details of related meetings, a regularly updated list of all meetings and conferences taking place can be found here.

 

30 March- 2 April 2008
EBMT Annual Congress
Click here

 

  • 1-6 March, 2008
    Sofia, Bulgaria
    2nd ESO Masterclass in Oncology Nursing (European School of Oncology)
    Click here
  • 5-9 March, 2008
    Antalya, Turkey
    5th National Bone Marrow & Stem Cell Therapies Congress

    Included in the programme will be a joint certification course and examination with EBMT-NG called 1st Stem Cell Transplantation Nurse Certification Programme.

    Topics covered will be: Venous Access, Chemotherapy Administration, GVHD Care and Mucositis."
    Click here
  • 27-29 March, 2008
    Geneva, Switzerland
    6th EONS Spring Convention (European Oncology Nursing Society)
    Click here

    •  

  • 30 March- 2 April 2008
    EBMT Annual Congress, Florence, Italy
    34th Annual Meeting of the European Group for Blood and Marrow Transplantation
     
    24th Meeting of the EBMT Nurses Group
     
    7th Meeting of the EBMT Data Management Group
     
    2nd EBMT Patient & Family Day
    Click here
  • April 1, 2008
    EBMT NG Exchange Visit & Education Scolarship Deadline
    Applications for scholarships should be submitted to Erik Aerts
    Further information
    Click here
  • June 2-4, 2008
    Poznan, Poland
    6th Meeting of the EBMT Paediatric Disease Working Party

    1st Meeting of the EBMT Paediatric Nurses
    Click here
  • June 4-7, 2008
    Lugano, Switzerland
    10th International Conference on Malignant Lymphoma
    Click here
  • June 15 -19, 2008
    Ljubljana, Slovenia
    17th WCET Congress (World Council of Enterostomal Therapists)
    Click here
  • August 17-21, 2008
    Singapore
    15th ISNCC International Conference (International Society of Nurses in Cancer Care)

    Early registration deadline is 29th February, 2008
    Click here

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Donor Issues Article

Anonymity

The autonomy with which a related donor makes his/her decision to donate is questionable as there is no anonymity during related donor work-up.  Despite a possible fear of donation; there is inevitable obligation and possible coercion from family members.  As a result, related donors may be willing to take greater risks with their own health. 

Independent assessment

Volunteer registry donors undergo medical examination by a physician who is an independent assessor and who has no role in the care of the recipient.  This aims to limit bias and introduce fairness in potentially competing claims. 

In contrast, the care of related donors is usually managed within the same transplant centre as that of the recipient.   The separation of donor and recipient management may be handled in a variety of ways but is rarely fully independent.   

Confidentiality

Related donors are obliged to give informed consent and authorization in advance to release their health information to the transplant physician and recipient as appropriate.  The use of an ineligible donor requires urgent medical assessment and needs documentation, including the rationale for the donor’s selection and suitability by the transplant physician.  The documented, informed consent of the donor and the recipient is also required (FACT-JACIE 2007).  This results in sensitive information being made known to family members and privacy is no longer an option.

Evolving context for related donation

Expectations are changing in all healthcare settings with decreasing tolerance of risk, increased requirement of information prior to decisions and lower thresholds for litigation. Families are more disparate with complex emotional and genetic relationships. Transplantation is increasingly complex and can involve the donor over a prolonged period. Unrelated donors are protected from poor outcomes in a way that is not possible for the related donor.

Ethical issues in clinical practice

The ethical issues outlined above have a direct impact on clinical practice as reflected by the following case studies:

Case study 1

An allogeneic HSCT was indicated for a patient with bone marrow and kidney failure.  It was inevitable that an HLA-matched sibling would also be the favourite live kidney donor.  The case was presented to the hospital’s ethics committee and it was decided that the patient’s six siblings would receive full counselling about the implications of donation prior to HLA tissue-typing.  Counselling took place through telephone communication as the siblings were dispersed worldwide.  Through consultation, it was possible to discern (a) which siblings were not prepared to donate, (b) which siblings were prepared to donate stem cells, but not a kidney and (3) which siblings were prepared to donate both.  The learning points of this case study are that donors may initially be asked for one thing and only later realize the full extent of their obligations.  It is essential to fully counsel siblings prior to tissue-typing.  This allows for the early deferral of unsuitable or unwilling donors.
 
Case study 2

A patient’s HLA-matched sibling donor had a long-standing psychotic illness and a history of substance abuse.  Communication was a problem as English was not the donor’s first language.  Although willing to donate, the donor would frequently miss appointments due to the nature of his illness.  Arranging an independent interpreter for consultations was also an issue due to the donor’s poor attendance record. 

Although not ideal, a family member would often need to fulfill the role of interpreter.  With the donor’s permission, advice was sought from his family, general practitioner, psychiatric team and the hospital’s ethics committee.  Due to the donor’s circumstances, a bone marrow harvest was undertaken and the stem cells were cryopreserved to ensure the availability of the product prior to the recipient’s high dose conditioning therapy.  This case study showed that communication and comprehension is usually possible with the correct resources.  It is important to enlist the help of the relevant agencies for guidance and support.

Case study 3

As a result of reduced intensity conditioning regimens, HSCT are now being undertaken in older patients.  Consequently, the age of HLA-matched related donors is also increasing.  This was highlighted by the case of a related donor in his mid fifties, who presented with diabetes, obesity, depression and a history of cardiovascular disease.  He had been unemployed for long periods of time through ill health and had only recently achieved a quality of life with which he was satisfied.

He had agreed to donate due to a moral obligation towards his sibling, but was concerned about starting another potential cycle of ill health.   Through detailed discussion of increased risk of ill health with donation, the donor was able to give his informed consent to proceed.  This case study showed that related donors often present with co-morbidities and it is necessary to quantify risk in each case.      

Case study 4

A patient’s only HLA-matched sibling donor had a high risk lifestyle that included drug use, unprotected sexual intercourse and alcoholism.  With permission, a full explanation of the potential risks was given to the recipient.  A detailed history of the high risk activity was documented and additional microbiology testing was undertaken.  Following an open discussion, written consent was documented from both the recipient and the donor before proceeding to HSCT.  This case study showed the importance of a carefully documented risk assessment and that privacy is not always possible in the related donor setting.  It also showed that with careful management, ‘unacceptable’ donors can be confidently harvested.

 

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