What is the status of the donor-recipient gap for bone marrow transplants in the country?
Only 20 to 25 per cent bone marrow transplant patients have a match. Sometimes we have to find a match inside the family. If we have a 100 per cent match in the family, that is great. But such patients are just 25 per cent. Sometimes we don’t have a full match and hence, prefer a match with less percentage. There are dedicated registries where an interested donor can enrol.
We send our requirement to them. In India, there are two lakh registered donors but our requirement is at least 20 lakh. Hence, there is a huge gap which has to be addressed.
What is the state of bone marrow transplant in Maharashtra?
Bone marrow transplants are mostly done in Pune and Mumbai and new private centres coming up in other cities. They need to be as per guidelines of Indian Stem Cell Transplant Registry (ISCTR). The private body has guidelines about how centres should function and infrastructure needed.
How can a person get bone marrow done or register for donation?
A Bone Marrow Stem Cell Transplant involves relocation of blood-forming stem cells collected from donor’s bone marrow and later transfused in the patient’s system, while Peripheral Blood Stem Cell Transplant involves harvesting blood-forming stem cells from the peripheral blood from a donor.
About 95 per cent of stem cell transplants are done using peripheral blood stem cells. Young and healthy people can volunteer to donate by registering at one of the registries in India. The registries are well networked and equitable allocation of stem cells is assured.
For the bone marrow donation, the donor has to go through a surgical procedure involving anaesthesia and drawing of the bone marrow from the back of the pelvis. The donor experiences a slight discomfort that goes in two weeks. The lost stem cells and bone marrow are replenished in 2 to 3 weeks.
In another process, the volunteer is given an injection called ‘Granulocyte Colony Stimulating Factor (GCSF)’ to increase number of stem cells in the blood. The stem cells are collected after the injection is administered for five days. This is the preferred method. This does not require admission or anaesthesia and the donor can go home the same day.
The process is like blood donation.
What challenges do patients face in getting the bone marrow? Is there any intervention from the government to facilitate more transplants?
A major challenge for patients is the high cost of the transplant. About 60 per cent patients cannot afford the life-saving procedure. Apart from All India Institute of Medical Sciences (AIIMS), there are no government-funded institutes that perform the transplants. Private trusts are there but the cost is high.
The government has many initiatives to facilitate stem cell donations and bone marrow transplants. There are 70 to 80 transplant centres in India and per year about 200 transplants are performed. However, in the US, 30,000 transplants are done every year.
The government can come up with a generic drug and other modalities. It can reduce drug cost and increase number of government-approved centres and help in cost reduction for the treatment.
