Active Donor Search

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Based on the results of the Preliminary Search, the patient’s physician will decide whether to

activate the search.

An active search has the following phases:

Activation of The Search


In consultation with the physician in charge of the patient, a donor testing strategy will be agreed upon. At this stage donors will actively be contacted to be tested. The patient will be levied a once-off, non-refundable fee to activate the search by the SABMR. Should a donor in an international registry be selected for testing, any search activation fee levied by the international registry will also be passed on to the patient.

If the search is urgent, and many are, it is customary to test more than one donor at a time.

DONOR SELECTION

The first choice, whenever possible, is a donor from the SABMR (local) database. However, this is not always possible because of the extreme variability of the HLA system. Many patients do not find a potential donor in their “home” registry and it will then be necessary to turn to the international database immediately. Currently, 45% of stem cell donations worldwide cross international borders.

Donor testing strategy


The donor/s selected may require EXTENDED TYPING or may be sufficiently well-typed to proceed
immediately to CONFIRMATORY TYPING.

EXTENDED TYPING OF SELECTED DONOR/S

Ideally, a donor should have information at all of the HLA loci (points of matching). Some donors are listed who have incomplete information. Such a donor might still be the best potential match for a patient and the transplant centre will then request that extended typing of the donor takes place. The results will be reported to the transplant centre. The patient / funder will be required to pre-pay / provide authorisation for the costs involved.

If the donor is not a match after further testing, another donor – if more are available – is selected and the process begins again.

If the search is urgent, and many are, it is customary to test more than one donor at a time.

CONFIRMATORY TYPING OF POTENTIAL DONOR/S

When the donor’s HLA typing indicates that there is a potential match with the patient, the next step is to obtain a fresh sample from the donor for mandatory confirmatory typing. This HLA typing must ideally take place in the same laboratory that performed the HLA typing of the patient. The SABMR further requires that this testing takes place in an internationally accredited laboratory. At present, the only such laboratory in South Africa is the NHLS Laboratory for Tissue Immunology, Cape Town, which is accredited by the European Federation for Immunogenetics.

If the search is urgent, and many are, it is customary to test more than one donor at a time.

Procurement of stem cells


Each donor registry, including SABMR, charges a global fee for the procurement of stem cells. For international donors, the exact cost depends on the registry of the donor and fluctuation in the foreign exchange rate. In addition to the procurement costs, for international donors, there is a levy to cover the stringent requirements involved in transporting the stem cells. These must be hand-carried from the donor centre to the transplant centre by experienced couriers.

POSTPONEMENT / CANCELLATION FEES

If the procurement of stem cells is postponed or cancelled prior to collection (or shipment in the case of a cord blood unit), a postponement or cancellation fee will be charged to recover the costs for tests and other activities already performed.