| content | ||||||||||||||||||||||||||||||||||||||
| National Marrow Donor Program | |
|---|---|
 |
|
| Type | Non-profit |
| Founded | St. Paul, Minnesota, USA (1986) |
| Headquarters | Minneapolis, Minnesota, USA |
| Key people | Jeff Chell, M.D., CEO Dennis L. Confer, M.D., Chief Medical Officer |
| Industry | Health care |
| Employees | 612 (July 2008) |
| Website | www.marrow.org |
The National Marrow Donor Program (NMDP) is a nonprofit organization founded in 1986 and based in Minneapolis, Minnesota that operates the federally funded registry of volunteer hematopoietic cell donors and umbilical cord blood units in the United States.
The NMDP Registry is the world's largest hematopoietic cell registry, with more than 7 million individuals. The NMDP Registry also contains more than 83,000 cord blood units, and in October 2006 the NMDP was awarded a federal contract to operate the nation's cord blood registry. Hematopoietic cells from NMDP donors or cord blood units are used to transplant patients with a variety of blood, bone marrow or immune system disorders. As of July 2008, the NMDP had facilitated more than 32,000 transplants worldwide.
Contents |
What the NMDP does
The NMDP coordinates the collection of hematopoietic ("blood-forming") cells that are used to perform what used to be called bone marrow transplants, but are now more properly called hematopoietic cell transplants. Patients needing a hematopoietic cell transplant but who lack a suitably matched donor in their family can search the NMDP Registry for a matched unrelated donor or cord blood unit.
The NMDP provides hematopoietic cells to patients being transplanted to treat life-threatening disorders such as leukemia, lymphoma, aplastic anemia, as well as certain immune system and metabolic disorders. Hematopoietic cells can come from bone marrow, umbilical cord blood, or the circulating blood (peripheral blood stem cells, or PBSCs). Hematopoietic cells are a type of adult (i.e., non-embryonic) stem cell that can multiply and differentiate into the three types of blood cells: red blood cells, white blood cells, and platelets.
Collecting hematopoietic cells
Bone marrow and PBSCs come from living adult donors. Bone marrow is extracted from the donor's pelvic bones while the donor is under general or local anesthesia. PBSCs are collected from the donor's blood after five or six days of taking a drug that causes hematopoietic cells in the bone marrow to move into the circulating blood. In both cases, recovery is usually swift and donors typically have fully restored marrow and blood cell counts in under two weeks.
Cord blood cells are obtained from the umbilcal cord and placenta of a newborn baby after the cord is clamped and cut as in a normal delivery. The cord blood is then stored frozen in a bank until needed for a transplant. The baby is not harmed in any way by this collection, as the cord blood is collected from tissues that in the past had been discarded as medical waste.
The need for large registries
The NMDP Registry is one of many registries of unrelated donors and cord blood units in the world. Most large, developed nations have such registries. Large registries of unrelated donors are needed because only about 30% of patients with diseases treatable with hematopoietic cell transplantation can find a suitably HLA matched donor among their family members.
For the remaining 70%, an unrelated hematopoietic cell donor is required in order to receive a transplant. Because the odds that two random individuals will be HLA matched exceeds 1 in 20,000, a registry will not be successful unless it contains a very large number of volunteer donors.
How the NMDP operates
The NMDP coordinates hematopoietic cell transplants by managing a worldwide network of affiliated organizations. These organizations (mostly hospitals and blood banks) have established relationships with the NMDP and work together to arrange the collection and transfer of donated bone marrow or PBSCs, or the transfer of previously collected cord blood.
When an adult volunteer donor (marrow or PBSC) registers with the NMDP, his or her HLA information is transmitted to the NMDP where it is entered into the NMDP’s computers. Contact information on the volunteer donor is also obtained so that he or she can be contacted by the NMDP if ever matched with a searching patient. The NMDP also has more than 83,000 cord blood units listed by HLA type on its registry. These cord blood units are stored at 26 cord blood banks around the world that are affiliated with the NMDP.
Physicians can search the NMDP registry on behalf of a patient who needs a transplant by submitting the patient’s HLA tissue type to the NMDP, which then searches its computerized database for an HLA-matched adult donor (marrow or PBSC) or cord blood unit.
If a match is made with an adult donor, the NMDP notifies him or her that a match has been made with a patient. After this potential donor has been educated about the donation process, he or she is asked to donate. If the potential donor wishes to proceed, he or she is given a medical exam, which includes testing the blood for infectious diseases. If the potential donor meets all donation requirements, his or her bone marrow or peripheral blood stem cells are collected and transferred by courier to the awaiting patient.
If a match is made with a cord blood unit, the NMDP notifies the cord blood bank where the unit is stored and makes arrangements to transport it to the awaiting patient. Cord blood units are shipped frozen, in specially designed coolers, and are thawed after arrival at the patient's hospital.
Whether an adult donor (marrow or PBSC) or cord bloood is used for a transplant depends on several clinical factors that are evaluated by the transplant physician treating a patient.
International connections
The NMDP participates with Bone Marrow Donors Worldwide (BMDW), the organization that coordinates communications among the world’s registries. BMDW is based in Leiden, The Netherlands. Throughout the world, there are an estimated ten million volunteer hematopoietic cell donors. Most national registries, including the NMDP, have access to these worldwide volunteer donors, either through the BMDW or through individually arranged agreements.
Although based in the United States, the NMDP has worldwide connections. More than 40 percent of the transplants arranged by the NMDP involve either a foreign patient or a foreign donor. The NMDP contracts with seven donor centers (where donors are recruited) outside of the United States. These are located in The Netherlands, Israel, Sweden, Norway, and Germany (three centers).
In addition, the NMDP is affiliated with seventeen transplant centers (where patients can receive transplants using cells from NMDP donors) outside of the United States.
Other U.S. registries
Although the NMDP is the sole federally funded and Congressionally authorized stem cell registry in the United States, three other smaller registries exist.[1]
- The Caitlin Raymond International Registry, based at the UMass Memorial Medical Center in Massachusetts, has approximately 64,000 adult volunteer donors and access to approximately 10,000 cord blood units.
- The American Bone Marrow Donor Registry (ABMDR), based in Mandeville, Louisiana, has approximately 32,000 adult volunteer donors. The Caitlin Raymond International Registry serves as the search center for the ABMDR.
- The Gift of Life Bone Marrow Foundation, based in Boca Raton, Florida, was established in 1991 as a recruitment organization for donors of Jewish ethnic ancestry. It has registered approximately 120,000 volunteer donors and has access to approximately 1,000 cord blood units.
In May 2004, the Gift of Life Bone Marrow Foundation and the NMDP formed a partnership, with the Gift of Life Bone Marrow Foundation becoming an Associate Donor Registry of the NMDP.
In July 2007, the Caitlin Raymond International Registry became an affiliated registry with the NMDP.
Finances
The NMDP receives annually about US$ 23 million from the US government through the Health Resources and Services Administration. The US Navy also provides some funding.[2]
The program also receives income from donations, from fees charged to donors for tissue typing (about $50 as of 2008, waived for some minority groups), from fees charged for in-depth database searches (initial searches are free, full searches can cost several thousand dollars), and from the fees charged to the transplanting hospital once a match is found and the stem cells have been transferred. The latter charge amounts to about $21,000, which is somewhat more than other registries in the US and abroad charge.[3] (The final cost to the patient or his/her insurance company for the completed transplant can range from $100,000 to $250,000.[4])
The NMDP pays affiliated donor centers and recruitment groups for every new donor they sign up.[3]
References
- ^ [1] All registry and cord blood figures obtained from the Bone Marrow Donors Worldwide Web site, accessed 25 January, 2007.
- ^ Information on the National Bone Marrow Donor Registry Assessment, 2004, from ExpectMore.gov. Accessed 21 November 2006.
- ^ a b Bone Marrow Transplants--Despite Recruitment Successes, National Program May Be Underutilized, report by the GAO, October 2002
- ^ Bone Marrow/Stem Cell Transplants (BMT), from Ped-Onc Resource Center. Accessed 21 November 2006
See also
External links
- www.marrow.org, official site of the National Marrow Donor Program
|
|||||||||||||||||
