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Donor selection for hematopoietic cell transplantation

INTRODUCTION

The selection of a donor is a critical element contributing to the success of a hematopoietic cell transplant (HCT). There are several possible sources for these cells:

  • An identical twin (syngeneic)
  • A sibling or unrelated donor (allogeneic)
  • The patient (autologous)
  • Umbilical cord blood

This topic will provide an overview of the general issues involved in donor selection for HCT. The decision as to which donor source to utilize depends to a large degree upon the clinical situation and the approaches employed at the individual transplant center. (See "Sources of hematopoietic stem cells".)

GENERAL CONSIDERATIONS

Transplant donors must be in generally good health without other comorbid conditions. The donor must have a performance status that will permit the safe collection of the cells, either by bone marrow (BM) or peripheral blood progenitor cell (PBPC) collection [1,2]. (See "Sources of hematopoietic stem cells".)

Thus, the donor must be able to tolerate anesthesia (either general or regional) and have adequate cardiac, pulmonary, hepatic and renal function. Pediatric donors are only utilized for autologous collection or donation to siblings. Donors with ongoing malignancies or a history of a malignant condition other than minor skin cancers (eg, basal cell carcinomas) are generally excluded from further consideration.
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