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EBMT 2021 Annual Meeting - Donor attrition and back-up strategies

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Events

TSCD3 Transplant and Search Coordinators Day: Donor Attrition and Backup Strategies

Monday, March 15, 13:00 - 14:00, Auditorium 5

The third session in the Transplant and Search Coordinators Day program for this year focuses on donor attrition and back-up strategies, divided into three sections.

The first talk will be by Professor Bernice Elger, Head, Institute for Biomedical Ethics, University of Basel, Switzerland, who will discuss the ethics of donation and donor attrition at the search stage.

She explains: “Ethical issues related to donation include the questions how to increase recruitment and to prevent attrition of donors in safe and ethical ways. Patient outcomes and costs as well as donor typing related costs are negatively affected by delays caused by donor attrition. As the right to refuse donation is fundamental, studies have been undertaken to identify donor characteristics that are associated with attrition. This could enable registries to predict consecutive donor refusals.”

The presentation focuses, first, on ethical ways to increase recruitment of reliable donors in the context of unrelated allogenic haematopoietic stem cell (HSC) donation, such as tailored information about risks and benefits, non-monetary benefits and ethically appropriate advertising. Second, Prof Elger will discuss ethical issues related to suggestions to decrease donor attrition rates at the search stage by using scores that predict donor reliability, meaning the probability that the donor will participate in the confirmatory typing stage.

She concludes: “Combining donor reliability scores and the likelihood of donor selection aims to improve donor retention in a cost-efficient manner. We offer recommendations how to move forward the debate and to promote ethical practices in HSC donation that maximise benefits and avoid harms for recipients, donor registries and donors while respecting fully donor rights and avoiding unfair discrimination.”

The second talk is by Dr Juliana Villa, Deputy Director of the Spanish Bone Marrow Donor Registry (REDMO), Barcelona, Spain, who will focus on the urgent situation prompted by donor cancellation. “Donor cancellation has always been a very tricky situation for transplant search coordinators – and when you add a global pandemic on top of this, then the tricky situation becomes almost a nightmare,” she explains.

“In my speech I will show REDMO´s experience in this field exposing both the donor´s and the patient´s results and I will try to create an algorithm for the different scenarios they can encounter and the way to react to them. I will also explain the role of the donor registry on avoiding this situation at all, which is in the end, the best strategy to solve this issue.”

The final presentation is by Dr Irina Evseeva, Head of Special Services at the Anthony Nolan cancer charity, UK, whose talk is titled “back-up strategy along graft request”.

She explains: “Finding a good donor for a patient in need of a HSCT should include a necessary step of identifying and reserving a back-up option, should the original provision become disrupted for any reason. This presentation will give an overview of patient- and donor-related limitations in availability, and speed of finding an urgent back-up graft.”

The topics covered will include the chances of finding a well-matched donor based on patient HLA phenotype and CMV serostatus, the urgency of the case and other questions to be considered when planning a back-up strategy. Donor attrition and challenges of quick provision of verification typing samples, as well as unexpected medical and logistical problems at the work-up stage also determine the need for a well-planned back-up strategy. Dr Evseeva says: “UK experience in identifying a national alternative to the imported cells at the time of travel disruptions due to the COVID-19 pandemic will be presented.”