Donor policies for hematopoietic stem cell transplantation

With the advent of more sophisticated transplantation techniques and rapid advancements in supportive care, allogeneic hematopoietic stem cell transplantation has become part of standard therapy for a variety of hematologic diseases. Improvements in allogeneic transplant outcomes are due largely to our enhanced capability of identifying better-matched donors. Donor-recipient HLA-matching remains of paramount importance in minimizing transplant-associated risks. Policies that safeguard donor welfare should focus on the establishment of adequate screening procedures and optimal stem cell harvesting strategies to minimize risks to the donor. The development of a protocol for the mobilization and collection of peripheral blood stem cells streamlined the donorship process and provided a less traumatic alternative to bone marrow harvesting. For patients without an adequately matched donor, umbilical cord blood is increasingly being utilized as an alternative source of hematopoietic stem cells despite the unique challenges associated with its maintenance, storage, and transport. As hematopoietic transplantation forges forward, issues pertaining to international donorship and donor compensation will need to be addressed.