Inclusive practices for safe and equitable donor assessment
Blood, vol. 146, pp. 2648
Abstract
Abstract Background: Guidance is needed to optimize the recruitment, verification typing (VT) and workup of donors from vulnerable populations and to overcome structural barriers to donation. Purpose: In 2022, the World Marrow Donor Association (WMDA) Donor Medical Suitability Committee set out to advance health equity in donor suitability guidance (published to https://share.wmda.info/display/LP/Donor+Suitability+Pages+index ). Our goals were to harmonize global practices for donor assessments, and concurrently advance health equity and donation safety for patients and donors. Expanding on this work, here, we report the development of recommendations on inclusive practices for safe and equitable donor assessments. Methods: A project group was assembled including representation from donor registries worldwide, specialists in stem cell transplantation, donor care and follow-up, and cellular therapy, and healthcare providers with lived experience with and/or expertise caring for vulnerable populations, across the intersectionality of race, ethnicity, sex, gender identity, sexual orientation, socioeconomic status, and disability. The group met regularly to develop consensus recommendations, as well as tools to guide implementation. Guidance developed focused on potential unrelated peripheral blood stem cell, bone marrow, and maternal cord blood donors, with most recommendations also being applicable to related allograft, autologous stem cell, and cell therapy product donors. Results: We developed a series of recommendations for inclusive practices for safe and equitable assessment of donors from vulnerable populations. Recommendations emphasized that health equity should be prioritized alongside donation safety, and provided guidance on donor/ transplant center communication with donors, donor health history questionnaire design, deferral criteria at registration, VT, or workup, reporting requirements for donor centers to transplant centers and to recipients (balancing clinical decision making/patient safety with donor privacy/confidentiality), and equity in laboratory testing and evaluation. Specific recommendations focused on donors who are racialized, transgender or non-binary, facing social (e.g. language), cultural, or financial barriers, living with disabilities or mental health challenges, or those who are living with HIV, taking HIV pre- or post-exposure prophylaxis, or have a history of high-risk sexual behavior, non-prescription injection drug use, incarceration, or sex work. Tools developed to guide implementation included inclusive donor screening questionnaires, scripts, workflows, and training to guide collection, reporting, and use of sensitive donor data, and algorithms to guide clinical decision making for vulnerable populations. Conclusions: These guidelines and tools will support stakeholders across transplantation and cellular therapy, including donor and transplant centers and all medical teams involved in donor assessments, to advocate for donation policies and practices which uplift, include, support, and empower donors from marginalized groups. Implementing these recommendations will help dismantle structural barriers to donation, improve donor well-being and enhance donation experience, and advance a more inclusive healthcare system for donors from vulnerable populations.
Authors 17
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The University of Texas MD Anderson Cancer Center · World Marrow Donor Association
Affiliation as printed
1The University of Texas MD Anderson Cancer Center, Stem Cell Transplantation and Cellular Therapy, Houston, United States
2Saving Lives with Pride, Houston, United States
3Stem Cell Club, Toronto, Canada
4Donor Medical Suitability Committee, World Marrow Donor Association, Leiden, Netherlands
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World Marrow Donor Association
Affiliation as printed
4Donor Medical Suitability Committee, World Marrow Donor Association, Leiden, Netherlands
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Affiliation as printed
5Canadian Blood Services, Ottawa, Canada
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Albert Einstein College of Medicine · Montefiore Medical Center
Affiliation as printed
6Montefiore Medical Center/Albert Einstein College of Medicine, Department of Medicine, Bronx, United States
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World Marrow Donor Association · Fundación Josep Carreras Contra la Leucemia
Affiliation as printed
4Donor Medical Suitability Committee, World Marrow Donor Association, Leiden, Netherlands
7REDMO, Fundación Josep Carreras contra la Leucemia, Barcelona, Spain
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World Marrow Donor Association · Deutsche Knochenmarkspenderdatei
Affiliation as printed
4Donor Medical Suitability Committee, World Marrow Donor Association, Leiden, Netherlands
8DKMS, Tübingen, Germany
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National Marrow Donor Program · World Marrow Donor Association
Affiliation as printed
4Donor Medical Suitability Committee, World Marrow Donor Association, Leiden, Netherlands
9NMDP, Minneapolis, United States
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World Marrow Donor Association · Deutsche Knochenmarkspenderdatei
Affiliation as printed
4Donor Medical Suitability Committee, World Marrow Donor Association, Leiden, Netherlands
8DKMS, Tübingen, Germany
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World Marrow Donor Association
Affiliation as printed
10South African Bone Marrow Registry, Cape Town, South Africa
4Donor Medical Suitability Committee, World Marrow Donor Association, Leiden, Netherlands
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Affiliation as printed
11Bone Marrow Donor Programme, Singapore, Singapore
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World Marrow Donor Association
Affiliation as printed
12Registro Brasileiro de Doadores Voluntários de Medula Óssea (REDOME), Rio de Janeiro, Brazil
4Donor Medical Suitability Committee, World Marrow Donor Association, Leiden, Netherlands
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World Marrow Donor Association · Deutsche Knochenmarkspenderdatei
Affiliation as printed
4Donor Medical Suitability Committee, World Marrow Donor Association, Leiden, Netherlands
8DKMS, Tübingen, Germany
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World Marrow Donor Association
Affiliation as printed
13Australian Bone Marrow Donor Registry, Sydney, Australia
4Donor Medical Suitability Committee, World Marrow Donor Association, Leiden, Netherlands
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World Marrow Donor Association
Affiliation as printed
10South African Bone Marrow Registry, Cape Town, South Africa
4Donor Medical Suitability Committee, World Marrow Donor Association, Leiden, Netherlands
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World Marrow Donor Association · Deutsche Knochenmarkspenderdatei
Affiliation as printed
4Donor Medical Suitability Committee, World Marrow Donor Association, Leiden, Netherlands
8DKMS, Tübingen, Germany
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National Marrow Donor Program · World Marrow Donor Association
Affiliation as printed
4Donor Medical Suitability Committee, World Marrow Donor Association, Leiden, Netherlands
9NMDP, Minneapolis, United States
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Anthony Nolan · World Marrow Donor Association
Affiliation as printed
14Anthony Nolan, London, United Kingdom
4Donor Medical Suitability Committee, World Marrow Donor Association, Leiden, Netherlands
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