Motivations, Experiences, and Perspectives of Bone Marrow and Peripheral Blood Stem Cell Donors: Thematic Synthesis of Qualitative Studies

Supportive Care of Hematopoietic Stem Cell Donors

Supportive care needs for hematopoietic stem cell recipients have been studied. Less is known about the care needs of stem cell donors. Care challenges arise at donor selection, preparation for the donation, the donation procedure and the immediate and long-term after-care. Care needs were analyzed for 1,831 consecutive bone marrow and peripheral stem cell donors at MedStar Georgetown University Hospital between January 2018 and August 2023 in support of a review of the current literature. During the selection, related donors may experience psychological pressures affecting their motivation, while donation centers may be willing to accept co-morbidities in these donors which might preclude donation in unrelated peers. For bone marrow donations, it is important to select donors not only according to optimal genetic matching criteria but also according to suitable donor/recipient weight ratios, to facilitate sufficient stem cell yields. During the donation preparation phase, side effects and complications related to stem cell stimulation must be anticipated and managed for peripheral cell donors, while the pros and cons of autologous blood donation should be evaluated carefully for bone marrow donors. The stem cell donation procedure itself carries potential side effects and complications as well. Peripheral cell donors may require a central line and may encounter hypocalcemia, thrombocytopenia, and anemia. Bone marrow donors face risks associated with anesthesia, blood loss and pain. Post-procedure care focusses on pain management, blood cell recovery and the psychological support necessary to regain a high quality-of-life existence. Hematopoietic stem donors are giving part of themselves to save another's life. They deserve comprehensive supportive care to accompany them throughout the donation process.

Assessing the cognition, attitudes and intentions of volunteers regarding unrelated peripheral blood stem cell donation: The UPBSC-DQ instrument in Chinese

Objectives

This study aimed to develop and validate the Unrelated Peripheral Blood Stem Cell Donation Questionnaire (UPBSC-DQ) (an instrument in Chinese) to assess the degree of cognition, attitude and intention of enrolled volunteers towards UPBSC donation.

Methods

The development process of the UPBSC-DQ was performed in a stepwise approach that included extensive literature retrieval, expert revision, and pretesting with 442 students. We conducted an online cross-sectional survey using the final version of the UPBSC-DQ among 336 participants. The reliability of the questionnaire was assessed by Cronbach's α and corrected item-total correlation (CITC), and the validity was evaluated by a correlation coefficient matrix, confirmatory factor analysis (CFA), and t-test.

Results

The UPBSC-DQ consists of four domains: basic information, cognitive, attitude, and intention. The Cronbach's α values were 0.88 and 0.86 for the attitude and intention scales, respectively, indicating strong internal consistency and good reliability. Correlation analysis and CFA showed good structure and content validity. Interitem correlations indicated that each item had only a weak correlation with the other scales.

Conclusions

The UPBSC-DQ is a reliable and valid assessment questionnaire for individuals' attitudes and intentions towards UPBSC donation. The questionnaire showed good to high reliability, content and construct validity.

Factors Influencing Individuals' Decision-Making Regarding Hematopoietic Stem Cell Donation: A Cross-Sectional Study in Saudi Arabia

INTRODUCTION

Hematopoietic stem cell transplantation (HSCT) is a vital medical intervention for treating various conditions. The preferred methods, i.e., bone marrow transplantation and peripheral blood stem cell transplantation, have saved lives and attracted attention. Saudi Arabia, with a high sickle cell disease and leukemia incidence, faces the challenge of matching donors for HSCT. Factors like knowledge, attitudes, cultural beliefs, and access to information impact donation decisions.

METHODS

In May 2023, a cross-sectional online survey was conducted in Saudi Arabia, targeting the general population. Data were collected through an online questionnaire, analyzing demographics, knowledge, attitudes, and factors influencing donation intention.

RESULTS

Demographic analysis showed that females, younger individuals (18-25 years), those with higher education, and healthcare workers had better knowledge. Attitudes toward donation varied: 42.4% were willing to donate, while 57.6% were not. Psychological barriers, health concerns, pain, and inadequate knowledge influenced donation reluctance. Of the participants, 3.5% were registered stem cell donors, with 58.8% expressing willingness but not registered. Donors' intent was influenced by family members' need for transplants and knowledge. A majority (56.6%) supported employer support for health programs, while 65.7% believed government funding should assist donors.

CONCLUSION

HSCT is vital in treating diseases like sickle cell and leukemia in Saudi Arabia. While many recognize its importance, knowledge gaps about its specifics and donation deter potential donors. Enhanced awareness campaigns and support from employers and the government could increase donor registrations.

Prospective donors' perspectives on hematopoietic cell donation for cell and gene therapy research and development

Aim: To explore prospective donors' attitudes and perceptions toward donating hematopoietic stem cells (HSCs) for novel treatments research and development (R&D). Methods: A survey was launched by Anthony Nolan (AN) to assess prospective donors' willingness to donate HSCs for novel therapies R&D, and their degree of comfort with the AN collaborating with and receiving payment from external organizations. Results: Most participants (87%) were willing to donate for novel treatment R&D and were comfortable with AN collaborating with external organizations and receiving payment (91% and 80%, respectively). Conclusion: Results reveal an overall positive response toward donating HSCs for R&D. These findings can support stakeholders and policymakers in outlining donation practices that uphold donors' safety and welfare.

Ethical and Analytic Challenges With Genomic Sequencing of Relapsed Hematologic Malignancies Following Allogeneic Hematopoietic Stem-Cell Transplantation

The implementation of precision medicine and next-generation sequencing technologies in the field of oncology is a novel approach being more widely studied and used in cases of high-risk primary and recurrent malignancies. Leukemias are the second most common cause of cancer-related mortality in children and the sixth most in adults. Relapsed leukemia represents a major component of the population that may benefit from genomic sequencing. However, ethical and analytic challenges arise when considering sequencing of biologic samples obtained from patients with relapsed leukemia following allogeneic hematopoietic stem-cell transplantation. Blood from the recipient after transplantation would include donor-derived cells and thus, genomic sequencing of recipient blood will interrogate the donor germline in addition to the somatic genetic profile of the leukemia cells and the recipient germline. This is a situation for which the donor will not have typically provided consent and may be particularly problematic if actionable secondary or incidental findings related to the donor are uncovered. We present the challenges raised in this scenario and provide strategies to mitigate this risk.

Moral Distress: Its Manifestations in Healthy Donors during Peripheral Blood Hematopoietic Stem Cell Harvesting

Hematopoietic stem cell donors (HSCDs) may have ambivalent feelings about donation. These feelings are related to moral obligation to help a sick relative and/or fear about the donation procedure. This ambivalence can produce moral distress (MD) and anxiety, which are usually unnoticed by the treating physician. The aim of this study was to evaluate the incidence of MD and anxiety in a group of related HSCDs for allogeneic transplantation. In this prospective observational study, to assess MD and anxiety, we applied 3 self-answered questionnaires-a questionnaire developed to assess MD (MDQ), State Trait Anxiety Index (STAI), and Edmonton Symptom Assessment System (ESAS)-before, during, and after hematopoietic stem cell donation. A total of 60 consecutive related HSCDs with a mean age of 38.2 years were included. Thirty-six were male. Hematopoietic stem cell collections were done by apheresis, performed as an outpatient process in all cases. The incidence of MD during the donation process was 56%. The proportion of HSCDs with moderate to high state anxiety decreased significantly from before donation (63%) to after donation (30%). Higher scores for MD correlated with higher scores on the STAI questionnaire (r = 0.448; P < .005). Thirty-seven donors (62%) had at least 1 physical symptom even before the stem cell mobilization process started, mainly anxiety (33%), difficulty sleeping (33%), and fatigue (30%). The number of symptomatic donors increased during donation (100%) and decreased after the procedure (80%). We conclude that MD and anxiety symptoms experienced by HSCDs are very common and can be explained by mixed feelings about the donation process. Providing comprehensive psychological support before starting the donation process and guaranteeing respect for the donor's autonomy are needed to decrease the negative impact of the donation experience.

Multimedia resources to support the recruitment of committed hematopoietic stem cell donors: Perspectives of the most-needed donors

BACKGROUND

Recruitment of committed unrelated hematopoietic stem cell donors from the most-needed demographics remains a challenge for donor recruitment organizations worldwide. Multimedia resources are gaining attention as a modality to support recruitment efforts; however, there is a lack of guidance for the development of such tools. This qualitative study explores the perspectives of eligible stem cell donors on an educational whiteboard video about stem cell donation, generating insights into how whiteboard videos and related multimedia may be optimized for donor recruitment.

STUDY DESIGN AND METHODS

Eight semistructured focus groups were conducted with 38 potential donors from the most-needed demographics (young, male, and non-Caucasian) after they had watched a 3.5-minute whiteboard video explaining key concepts in stem cell donation (https://youtu.be/V4fVBtxnWfM). Constructivist grounded theory was used to identify themes and to develop a framework for understanding participants' preferred features of recruitment multimedia.

RESULTS

Participants identified a range of features contributing to the effectiveness of recruitment multimedia, adding that the whiteboard video is an effective, integrated, and readily accessible format for supporting donor recruitment. Topics that participants felt are important to address include knowledge gaps regarding donation procedures, concerns about donor safety, and the particular need for specific donor demographics. Suggested avenues for improvement include the addition of donor/recipient/patient personal experiences, attention-grabbing hooks, and a call to action including opportunities for further learning.

CONCLUSIONS

Several considerations were generated to inform the development of future multimedia for donor education/recruitment and are relevant to donor recruitment organizations worldwide.

« Faire le deuil » en temps d’innovations thérapeutiques

Nous traitons la problématique du deuil dans le cadre de l’allogreffe de cellules souches hématopoïétiques à partir d’un donneur haplo-identique. L’analyse d’un cas clinique permet d’interroger l’application systématique des catégories du normal et du pathologique au deuil, la surmédicalisation des sujets endeuillés ainsi que l’injonction sociale à « faire son deuil », selon les modalités décrites par la nosographie psychiatrique. Les modalités d’accompagnement des donneurs endeuillés seront questionnées en réaffirmant la pertinence d’une clinique nourrie par une réflexion psychanalytique.

The Hitchhiker's Guide to Neurophenomenology - The Case of Studying Self Boundaries With Meditators

This paper is a practical guide to neurophenomenology. Varela's neurophenomenological research program (NRP) aspires to bridge the gap between, and integrate, first-person (1P) and third-person (3P) approaches to understanding the mind. It does so by suggesting a methodological framework allowing these two irreducible phenomenal domains to relate and reciprocally support the investigation of one another. While highly appealing theoretically, neurophenomenology invites researchers to a challenging methodological endeavor. Based on our experience with empirical neurophenomenological implementation, we offer practical clarifications and insights learnt along the way. In the first part of the paper, we outline the theoretical principles of the NRP and briefly present the field of 1P research. We speak to the importance of phenomenological training and outline the utility of cooperating with meditators as skilled participants. We suggest that 1P accounts of subjective experience can be placed on a complexity continuum ranging between thick and thin phenomenology, highlighting the tension and trade-off inherent to the neurophenomenological attempt to naturalize phenomenology. We then outline a typology of bridges, which create mutual constraints between 1P and 3P approaches, and argue for the utility of alternating between the bridges depending on the available experimental resources, domain of interest and level of sought articulation. In the second part of the paper, we demonstrate how the theory can be put into practice by describing a decade of neurophenomenological studies investigating the sense of self with increasing focus on its embodied, and minimal, aspects. These aspects are accessed via the dissolution of the sense-of-boundaries, shedding new light on the multi-dimensionality and flexibility of embodied selfhood. We emphasize the evolving neurophenomenological dialogue, showing how consecutive studies, placed differently on the thin-to-thick 1P continuum, advance the research project by using the bridging principles appropriate for each stage.

Thewithdrawal of consent to haematopoietic stem cells (HSC) donation: The complicated balance between donor's rights and patient's protection

Hematopoietic stem cells donation is an essential prerequisite of allogeneic transplantation. Both family donors and matched unrelated donors should have a conscious involvement in every phase of the overall path, from selection to HSC collection. Donors also should be informed about the right to withdraw at any time as well as the extreme risk for recipient's life coming from the decision of interrupting, if the donation is not carried out once the patient's preparative regimen has commenced. We report our challenging experience about a donor who withdraws her consent to HSC donation after 3 days of mobilization with G-CSF. The possibility of withdrawal protects the donor but it also puts at risk both a chance for a transplant and the patient's life if preparative regimen has started. Can the donor really be free to withdraw the consent to HSC donation at any time even when this endangers the life of a recipient? Is this ethical? However, if the donor decides to withdraw, would we really be ready to manage promptly all the consequences coming from the consent revocation? At the moment there is not a well-defined "plan B" in case of impossibility to proceed with the transplant when conditioning has already started or has even been completed. In our opinion, because of this hard balance and such a high risk, it would be necessary to plan every time an alternative strategy which may be different according to different circumstances.

Physical and Psychological Discomfort Experienced by Hematopoietic Stem-Cell Donors

This study investigates the types and degrees of physical and psychological discomfort experienced by hematopoietic stem cell donors before, during, and after the donation process in order to provide helpful information for developing education programs that can help donors to cope with their discomforts. One hundred and thirty-one individuals who donated hematopoietic stem cells from 2017 to 2019 were asked to self-report the types and degrees of physical and psychological discomfort they felt in the process, and the results were analyzed using SPSS. All participants donated peripheral blood stem cells; the most commonly reported physical discomfort was myalgia (72.5%), followed by bone pain (62.6%), fatigue (60.3%), and headache (55.0%). Of the donors, 88.5% responded that they experienced psychological discomforts, including fear (44.3%), anxiety (44.3%), stress (39.7%), depression (31.3%), loneliness (31.3%), regret (29.8%), and ambivalence (23.7%). In particular, female donors experienced more discomfort than males in rash (Z = -2.123, p = 0.034), fear (Z = -2.851, p = 0.004), and anxiety (Z = -1.861, p = 0.044). Therefore, it is necessary for healthcare providers and experts to make efforts to educate and help donors to prepare and mitigate their discomfort throughout the donation process, and to strategically manage donors' well-being by monitoring and evaluating their discomfort levels and providing interventions if necessary.

Does Being A Cancer Patient or Family Caregiver of A Cancer Patient Affect Stem Cell Donation Awareness?

Objective:

One of the most difficult challenges regarding hematopoietic stem cell transplantation in Turkey is finding donors for allogeneic transplantation candidates who do not have related donors. This study aims to determine whether there is any difference in the awareness of stem cell donation and transplantation between cancer and noncancer patients and their family caregivers. In addition, this study aims to determine the awareness of stem cell donation and transplantation in the entire study population.

Methods:

This descriptive study was conducted in Turkey using a data collection form comprising questions about demographics, stem cell transplantations, donations, and medical history. On analyzing the research data, variables were expressed as mean ± standard deviation and as numbers (n) and percentages (%). The Chi-square and Fisher's exact tests were performed to evaluate differences among cancer and noncancer diagnosed patients and their family members.

Results:

A total of 192 patients and 169 family caregivers participated in the study. In comparison with noncancer patients, cancer patients showed more awareness on what stem cell transplantation is, how lifesaving it is, and how to donate stem cells. Similarly, the family caregivers of cancer patients were more aware of what stem cell transplantation is and how to donate stem cells.

Conclusions:

The results of this study showed that cancer patients and their families were more aware of stem cell donation and transplantation; however, most of the patients and families did not know enough about the national registry program and how to donate stem cells.

Hematopoietic cell transplant nurse coordinators' perceptions of related donor care: a European survey from the EBMT Nurses Group

Allogeneic haematopoietic cell transplantation (HCT) is a curative procedure for patients with haematological malignancies and immune deficiencies. A human leukocyte antigen (HLA) identical sibling is only available for 25-35% of patients in need. The improvement in haplo-identical transplantation has led to a marked increase in cell donation from relatives. Despite international recommendations, discrepancies in related-donors (RD) care exist between centres, particularly regarding medical suitability criteria, consenting procedures and donor follow-up. This European survey aimed to explore hematopoietic cell transplantation coordinators nurses' (HCT-CNs) perceptions of RD care, in particular the association with the presence or not of an independent unit (IU). Ninety-three HCT-CNs from seventy-six EBMT centres responded, representing 19 countries (response rate: 27%). Our results did not show a significant association between IU and HCT-CNs perceptions of related-donors care. The practices for RD care vary among centres regarding presence or not of an IU (48%), person caring for RD (haematologist in 54%, HCT physician in 17%, HCT-CNs in 20%), person to whom the results of HLA typing are communicated, use of a booklet for RD, follow-up or not and periodicity of follow-up. Qualitative data highlight the related-donation ethical issues and the need for improvement in RD care. HCT-CNs' main concerns were: the necessary confidentiality to insure the voluntary status of RD, the perceived conflict of interest felt by professionals when managing both patients and RD, plus the psychosocial aspects of related-donation. Even if there is a variety of a practice among centres, the presence of an IU is not significantly associated with an improvement in RD care.

Adult related haematopoietic stem cell donor care: Views of Transplant Nurses

PURPOSE

The objective of this mixed-methods study was to explore the experiences and perspectives of Transplant Nurses (TNs) in caring for related donors (RDs).

METHOD

In this mixed-methods study, both quantitative and qualitative data were collected from semi-structured interviews with seven TNs from two clinical hospitals. Closed and multiple-choice questions regarding the organisation of RD care were administered in addition to an in-depth exploration of TN experiences and perspectives of RD care. Interviews were audio-recorded, transcribed, and qualitative data was subjected to thematic analyses.

RESULTS

The analysis identified 5 themes relating to RD care: managing complex family dynamics and ambivalence; concerns about RD psychological adjustment; identifying and correcting RD misperceptions; limited guidelines and structured processes; limited training for the role and access to supervision. Five themes were identified describing the barriers to delivering RD care: RDs unwilling to express their concerns; language; time constraints; medical priority of clinicians; biomedical focus of TNs. All TNs agreed they would like additional training in the psychosocial management of RDs. TNs identified key areas for improvement, including psychosocial support and educational material.

CONCLUSIONS

Our results highlight the significant role of TNs in RD care, and underline issues specific to the current RD care environment. Lack of training for the role and limited guidelines addressing RD care management are key issues which may detrimentally affect RD care. The pivotal role of TNs must be acknowledged and supported by improving TN training and implementing clear guidelines for the management of RDs. The trial has been registered on the publicly accessible register: www.clinicaltrials.gov site with the identifier ACTRN12617000407392.

The experience of adults with sickle cell disease and their HLA-matched adult sibling donors after allogeneic hematopoietic stem cell transplantation

AIM

To provide a rich description and in-depth understanding of the recipient-donor allogeneic hematopoietic stem cell transplantation experience.

BACKGROUND

A stem cell transplant has a high likelihood of improving symptoms of sickle cell disease in adults. While studies have reported the transplant experiences of recipients and donors with haematological malignancies, no published reports have examined the experience of both adult recipients with sickle cell disease and their donors.

DESIGN

Exploratory qualitative descriptive analysis.

METHODS

We conducted individual interviews with 13 recipients and donors (eight males, five females) representing five recipient-donor dyads and one recipient-donor triad from one Midwest transplant centre between August 2017-February 2018. Interviews were digitally audio-recorded, transcribed verbatim and analysed using conventional content analysis.

FINDINGS

Five themes were identified: the downward spiral and a second chance; getting the monster off my back; difficult and manageable; it was worth it; and relating to the healthcare team.

CONCLUSIONS

The results provide a description and insights into the complex nature of the stem cell transplant experience in sickle cell disease from the perspectives of both recipients and donors.

IMPACT

Health provider awareness of recipient-donor experiences can contribute to family-centred care that supports the health and quality of life for both recipients and donors. This understanding promotes high quality clinical care and improved communications by taking into account the knowledge, values and informed preferences of recipients and donors and contributes to improved decision-making and clinical care. Future research can assess family experiences that support informed choice for potential transplant candidates.

[Related donors follow-up: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]

Since 2010 there has been an exponential increase of the number of transplants performed from related donors. The development of haploidentical transplants increases the resort to related-donation, which presents two main advantages: a less important financial cost and a faster availability of the graft. Standards for mandatory accreditation exist, but the adherence to these recommendations is not optimal: currently, different practices regarding the organizational modalities of care, recruitment criteria, qualification and follow-up of related donors have been observed among French transplant centers. The Francophone Society of Marrow Transplant and Cellular Therapy (SFGM-TC) has developed guidelines for the consent and the non-eligibility criteria for hematopoietic stem cell donors. A multidisciplinary group has devised a booklet as a medium to inform donors about hematopoietic cell donation and transplantation in a clear and accessible language. This paper provides recommendations on post-donation follow-up, taking into account both medical standards and organizational constraints of French centers. Some tools are proposed.

The Meaning of Being a Living Kidney, Liver, or Stem Cell Donor-A Meta-Ethnography

BACKGROUND

Studies on living donors from the donors' perspective show that the donation process involves both positive and negative feelings involving vulnerability. Qualitative studies of living kidney, liver, and allogeneic hematopoietic stem cell donors have not previously been merged in the same analysis. Therefore, our aim was to synthesize current knowledge of these donors' experiences to deepen understanding of the meaning of being a living donor for the purpose of saving or extending someone's life.

METHODS

The meta-ethnography steps presented by Noblit and Hare in 1988 were used.

RESULTS

Forty-one qualitative studies from 1968 to 2016 that fulfilled the inclusion criteria were analyzed. The studies comprised experiences of over 670 donors. The time since donation varied from 2 days to 29 years. A majority of the studies, 25 of 41, were on living kidney donors. The synthesis revealed that the essential meaning of being a donor is doing what one feels one has to do, involving 6 themes; A sense of responsibility, loneliness and abandonment, suffering, pride and gratitude, a sense of togetherness, and a life changing event.

CONCLUSIONS

The main issue is that one donates irrespective of what one donates. The relationship to the recipient determines the motives for donation. The deeper insight into the donors' experiences provides implications for their psychological care.

Collection of hematopoietic stem cells and immune effector cells in small children

Apheresis procedures are standard of care for a wide range of indications in children, collection of hematopoietic stem cells being the most frequent one. With increasing numbers of hematopoietic stem cell transplants, advances in graft manipulation techniques and the development of innovative therapies using immune effector cells and gene therapy, apheresis within the pediatric population is growing in demand. While young children have higher circulating white blood cell counts and robustly mobilize hematopoietic stem cells, apheresis machines were designed for use within the adult population and apheresis procedures in children, particularly small children, can be more challenging as vascular access, collection techniques and impact of extracorporeal volumes increase the rate of adverse events. In this article we review topics of particular relevance to hematopoietic stem cell and immune effector cell collections in small children.

Adult-related haematopoietic stem cell donor experiences and the provision of information and psychosocial support: A systematic literature review

For blood cancer patients, haematopoietic stem cells (HSC) donated by a relative can be lifesaving. However, related donors can face significant physical and psychosocial challenges. As the demand for adult-related HSC donors is increasing, it is important to review our understanding of adult-related HSC donors' need for and availability of information and psychosocial support with a view to identifying gaps in the literature. A systematic review of relevant studies (2000-2017) was conducted using five databases with supplementary hand searching. Sixteen studies involving 1,024 related HSC donors met the following criteria: English or Dutch language, peer-reviewed, sampled first-time-related HSC donors, ≥18 years, haematological malignancies, assessed psychosocial aspects, retrospective or prospective and with or without comparison group. Data were abstracted, and study quality was assessed using the PRISMA criteria. Studies contained limited information on the provision of information and psychosocial support. Most studies addressed pre-donation information, and none reported providing information or support to donors post-donation. Additionally, few studies formally assessed unmet needs. Recommendations include improved transparency of reporting for the availability, sources and timing of information and psychosocial support, and the identification of unmet needs to enable the development of educational and psychosocial interventions for this invaluable donor population.

Donation of peripheral blood stem cells to unrelated strangers: A thematic analysis

BACKGROUND

Donation of haematopoietic stem cells, either through bone marrow (BM) or peripheral blood stem cell (PBSC) collection, is a generally safe procedure for healthy donors, although side effects are a known risk. Previous research, including our recent quantitative study, has shown that the psychosocial response to donating is usually a positive one and most donors would be willing to donate again in the future. This is often despite experiencing significant side effects during the donation process. Due to the relative recent introduction of PBSC, a comprehensive understanding of the range of physical and emotional issues donors may experience is lacking, as well as an understanding of specific donor characteristics Qualitative research can provide rich narrative data into these areas. This study was set up in order to identify specific donor characteristics and to further explore the relationship between pre-donation physical health and the donation experience, as previously identified in our quantitative study.

METHODS

It involved in-depth telephone interviews with 14 PBSC donors who participated in our original quantitative study. Thematic analysis was used to analyse the findings and the results provide a summary of participants' characteristics using themes and constituent codes.

RESULTS

We identified several donor characteristics, including strong intrinsic motivation, altruism, sense of duty, determination, low levels of ambivalence and the ability to develop a strong emotional relationship with an (unknown/anonymous) recipient whilst being able to manage strong feelings and emotions.

CONCLUSIONS

These personality traits may explain the resilience that has been observed previously in haematopoietic stem cells donors. Significant feelings of grief were reported after a recipient's death. Possibilities to alleviate these symptoms may include raising awareness of potential poor outcomes in the recipient and offering improved counselling services if the recipient dies. We acknowledge several limitations including the sampling frame.

Short-term side effects and attitudes towards second donation: A comparison of related and unrelated haematopoietic stem cell donors

The Nordic Register of Haematopoietic Stem Cell Donors (NRHSD) has registered related and unrelated donors from 10 transplant centres in Sweden, Norway, Finland and Denmark since 1998. We present a prospective, observational study of 1,957 donors, focusing mainly on the differences between related and unrelated donors. Related donors are reported to have more comorbidities, but similar side effects compared with unrelated donors. Side effects after BM or PBSC donation are generally of short duration and in this study no deaths, myocardial infarctions, splenic ruptures, or thromboembolic events are reported. Interestingly, related donors express more hesitancy towards donating again when asked 1 month after donation.

'Doing good by proxy': human-animal kinship and the 'donation' of canine blood

This article demonstrates the relevance of animals to medical sociology by arguing that pet owners' accounts of veterinary decision-making can highlight key sociological themes which are important to both human and animal health. Based on semi-structured interviews, the article argues that interspecies 'kinship' allows for the extension of sociological claims regarding altruism, self-interest and mutuality from human blood donation to companion animal blood 'donation'. Furthermore, this study extends sociological understanding of the human-animal bond by showing how the dog's status as kin meant they were expected to donate blood, and that the act of donation itself represents an important opportunity for family 'display'. However, owners who do not or cannot donate blood themselves describe pet blood donation as an opportunity to lessen associated feelings of guilt or obligation through 'doing good by proxy'. These findings raise critical sociological and ethical questions concerning the risks and benefits of donation, and for how we understand third-party decision making. Finally, the article argues for the close entanglement of human and animal health, and concludes that sociologists of health and medicine should explore the radical possibility that decision-making in healthcare more generally might be influenced by experiences at the veterinary clinic, and vice versa. (A Virtual Abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA).

HIV Testing Preferences Among MSM Members of an LGBT Community Organization in Los Angeles

Lack of regular HIV testing puts African American, Asian, and Latino men who have sex with men (MSM) at high risk for HIV infection. Rapid self-testing may be an effective option for these men. We explored acceptability, preferences, and usability of HIV self-test kits with MSM of color using semi-structured focus groups to discuss HIV testing history, reasons for testing, and self-testing preferences. Participants (n = 21) lived in Los Angeles, identified as MSM of color, and were 18-35 years of age. Discussions were audio-recorded, transcribed, and analyzed using grounded theory. Participants expressed needs for (a) accessibility, (b) privacy, (c) local support, and (d) access to testing professionals. Self-testing for HIV infection may be an effective method for high-risk MSM. Effective self-testing programs need to consider accessibility, confidentiality, and support to increase routine testing. Community-based organizations have an opportunity to increase HIV testing for MSM of color.

Being a haematopoietic stem cell donor for a sick sibling: Adult donors' experiences prior to donation

BACKGROUND

There is a lack of knowledge about sibling stem cell donors' experiences pre-donation and the waiting period before the donation might have been long. The donors and their corresponding sibling recipients were simultaneously included in two different interview studies. The results from the recipient study have been presented in a separate paper.

PURPOSE

The aim was to explore the experiences of being a stem cell donor for a sibling, prior to donation.

METHOD

Ten adult sibling donors were interviewed prior to stem cell donation. The interviews were digitally recorded, transcribed verbatim and subjected to qualitative content analysis.

RESULTS

The main theme Being a cog in a big wheel describes the complex process of being a sibling donor prior to donation, covering a mixture of emotions and thoughts. The four subthemes Being available, Being anxious, Being concerned and Being obliged cover the various experiences. The sibling donors' experiences are influenced by the quality of the relationship with the sick sibling.

CONCLUSIONS

Sibling stem cell donors go through a complex process once they have accidentally got involved in. They have been asked to become a donor; it was not a voluntary choice. In caring for sibling stem cell donors the nurses should be aware of the complexity of the process they experience and take into consideration their personal situation and needs. Providing optimal care for both sibling donors and their corresponding recipients is a challenge, and further improvement and exploration are needed.

Volunteer unrelated donor experience after administration of filgrastim and apheresis for the collection of haemopoietic stem cells: the Australian perspective

BACKGROUND

Voluntary donations of peripheral blood stem cells after administration of filgrastim (granulocyte-colony stimulating factor, G-CSF) are undertaken throughout the world by healthy individuals, but the short-, medium- and long-term adverse events during and after donation are not fully understood.

AIMS

We document the experience of donors of peripheral blood stem cells mobilised by G-CSF at Australian Bone Marrow Donor Registry collection centres.

METHODS

When the Australian Bone Marrow Donor Registry commenced collecting mobilised peripheral blood stem cells, based on data used for registration of G-CSF, all adverse reactions in donors were documented prospectively to determine the rate and severity of events. A total of 512 consecutive first-time donors assessed between July 2001 and March 2010 were included in this study.

RESULTS

The median age at work-up was 40 years and 71% of donors were male. A large proportion of donors (91%) experienced bone pain during administration of G-CSF, and in fewer numbers headache (61%) and fatigue (61%). Bone pain was associated with a body mass index of overweight/obese (P = 0.03). Headache (P = 0.03), muscle pain (P = 0.03) and fatigue (P = 0.001) were all significantly associated with female sex. More than a quarter (28%) of donations involved a range of complications at collection.

CONCLUSION

The incidence of short- and medium-term symptoms and events observed provide support for the information provided to unrelated donors at counselling. Follow up of the consequences of unrelated voluntary donation remains important to provide accurate and relevant information to prospective donors.