Assessment of optimal size and composition of the U.S. National Registry of hematopoietic stem cell donors.
BACKGROUND
The National Marrow Donor Program (NMDP) receives federal funding to operate a registry of over 4 million volunteer donors for patients in need of a hematopoietic stem cell transplant. Because minority patients are less likely to find a suitably matched donor than whites, special efforts have been aimed toward recruitment of minorities. Significant financial resources are required to recruit and tissue type additional volunteer donors.


METHODS
Population genetics models have been constructed to project likelihoods of finding a human leukocyte antigen (HLA)-matched donor for patients of various racial/ethnic groups. These projections have been made under a variety of strategies for expansion of the NMDP Registry. Cost-effectiveness calculations incorporated donor unavailability and other barriers to transplantation.


RESULTS
At current recruitment rates, the probability of an available HLA-A,B,DRB1 matched donor is projected to increase from 27% to 34%; 45% to 54%; 75% to 79%; and 48% to 55%, for blacks, Asians/Pacific Islanders, whites and Hispanics, respectively, by the year 2007. Substantial increases in minority recruitment would have only modest impacts on these projections. These projections are heavily affected by donor availability rates, which are less than 50% for minority volunteers.


CONCLUSIONS
Continued recruitment of additional volunteers can improve the likelihood of finding an HLA-matched donor, but will still leave significant numbers of patients of all racial/ethnic groups without a match. Efforts to improve donor availability (especially among minorities) and to increase the number of patients with access to the NMDP Registry may prove to be more cost-effective means of increasing transplants.
Kollman
Craig
C
National Marrow Donor Program, Minneapolis, MN, USA. ckollman@jaeb.org
Abella
Esteban
E
Baitty
Robert L
RL
Beatty
Patrick G
PG
Chakraborty
Ranajit
R
Christiansen
Cindy L
CL
Hartzman
Robert J
RJ
Hurley
Carolyn Katovich
CK
Milford
Edgar
E
Nyman
John A
JA
Smith
Thomas J
TJ
Switzer
Galen E
GE
Wada
Randal K
RK
Setterholm
Michelle
M
D005828:Genetics, Population; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D011640:Public Policy; D012042:Registries / Q000706:statistics & numerical data*; D014019:Tissue Donors / Q000706:statistics & numerical data*; D014481:United States