title: Significant Improvements in the Practice Patterns of Adult Related Donor Care in US Transplantation Centers.
abstract: Recent investigations have found a higher incidence of adverse events associated with hematopoietic cell donation in related donors (RDs) who have morbidities that if present in an unrelated donor (UD) would preclude donation. In the UD setting, regulatory standards ensure independent assessment of donors, one of several crucial measures to safeguard donor health and safety. A survey conducted by the Center for International Blood and Marrow Transplant Research (CIBMTR) Donor Health and Safety Working Committee in 2007 reported a potential conflict of interest in >70% of US centers, where physicians had simultaneous responsibility for RDs and their recipients. Consequently, several international organizations have endeavored to improve practice through regulations and consensus recommendations. We hypothesized that the changes in the 2012 Foundation for the Accreditation of Cellular Therapy and the Joint Accreditation Committee-International Society for Cellular Therapy and European Society for Blood and Marrow Transplantation standards resulting from the CIBMTR study would have significantly impacted practice. Accordingly, we conducted a follow-up survey of US transplantation centers to assess practice changes since 2007, and to investigate additional areas where RD care was predicted to differ from UD care. A total of 73 centers (53%), performing 79% of RD transplantations in the United States, responded. Significant improvements were observed since the earlier survey; 62% centers now ensure separation of RD and recipient care (P < .0001). This study identifies several areas where RD management does not meet international donor care standards, however. Particular concerns include counseling and assessment of donors before HLA typing, with 61% centers first disclosing donor HLA results to an individual other than the donor, the use of unlicensed mobilization agents, and the absence of long-term donor follow-up. Recommendations for improvement are made.
authors.affiliation: Anthony Nolan Research Institute, London, UK. Electronic address: chloe.anthias@anthonynolan.org.
authors.forename: Chloe
authors.initials: C
authors.lastname: Anthias
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Bronwen E
authors.initials: BE
authors.lastname: Shaw
authors.affiliation: Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN, USA.
authors.forename: Deidre M
authors.initials: DM
authors.lastname: Kiefer
authors.affiliation: Department of Medicine, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Liesveld
authors.affiliation: Department of Medicine, Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Yared
authors.affiliation: Division of Hematology and Oncology, Baylor College of Medicine Center for Cell and Gene Therapy, Houston, TX, USA.
authors.forename: Rammurti T
authors.initials: RT
authors.lastname: Kamble
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: D'Souza
authors.affiliation: Division of Hematology/Oncology/Bone Marrow Transplantation, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
authors.forename: Peiman
authors.initials: P
authors.lastname: Hematti
authors.affiliation: Department of Medical Oncology and Haematology, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Seftel
authors.affiliation: Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL, USA.
authors.forename: Maxim
authors.initials: M
authors.lastname: Norkin
authors.affiliation: Winship Cancer Institute of Emory University, Atlanta, GA, USA.
authors.forename: Zachariah
authors.initials: Z
authors.lastname: DeFilipp
authors.affiliation: Division of Hematology-Oncology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Kasow
authors.affiliation: Department of Oncology, Spectrum Health, Michigan State University, Grand Rapids, MI, USA.
authors.forename: Muneer H
authors.initials: MH
authors.lastname: Abidi
authors.affiliation: Division of Hematology/Oncology, Vanderbilt Medical Center, Nashville, TN, USA.
authors.forename: Bipin N
authors.initials: BN
authors.lastname: Savani
authors.affiliation: Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
authors.forename: Nirali N
authors.initials: NN
authors.lastname: Shah
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Paolo
authors.initials: P
authors.lastname: Anderlini
authors.affiliation: Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Diaz
authors.affiliation: Tisch Cancer Institute, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Adriana K
authors.initials: AK
authors.lastname: Malone
authors.affiliation: Department of Hematology, University Hospital Basel, Switzerland.
authors.forename: Joerg P
authors.initials: JP
authors.lastname: Halter
authors.affiliation: Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Brent R
authors.initials: BR
authors.lastname: Logan
authors.affiliation: University of Pittsburgh, VA Medical Healthcare System, Pittsburgh, PA, USA.
authors.forename: Galen E
authors.initials: GE
authors.lastname: Switzer
authors.affiliation: Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital of Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pulsipher
authors.affiliation: National Marrow Donor Program/Be The Match, Minneapolis, MN, USA.
authors.forename: Dennis L
authors.initials: DL
authors.lastname: Confer
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Paul V
authors.initials: PV
authors.lastname: O'Donnell
mesh_terms: D000328:Adult; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006782:Hospitals, Special / Q000592:standards*; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012189:Retrospective Studies; D014019:Tissue Donors; D014481:United States
keywords: Accreditation; Hematopoietic cell donation; Related donor