India staggers with a significantly lesser number of bone marrow donors and stooping bone marrow donation rates, despite increasing demand for bone marrow transplants in the country. A recent report revealed that cancer has outrun cardiovascular diseases and emerged to be the topmost killer globally.
While about only 2,000 stem cell transplants take place in India every year, around 80,000 to 1,00,000 annual transplants are required to tackle the large burden of blood cancers and fatal blood disorders.
However, it is very hard to find a matching donor. India has only about 4 lakh donors registered on the bone marrow registry. Chances of finding a donor match are as low as 10% to 15% compared to the West where the chances of matching are as high as 60% to 70%.
Bone marrow donation is a procedure where liquid marrow wherein the body’s blood-forming cells are generated, is drawn from both sides of the back of one’s pelvic bone with the help of a needle.
The donor hardly feels any pain as the procedure is conducted under anesthesia. Following the donation, the liquid marrow is transplanted on the patient’s body.
Peripheral stem cell donation is a procedure where instead of collecting the marrow directly, the stem cells from the marrow are mobilised in the blood by giving growth factor injections to the donor for roughly five days and then collected. The donor just needs to lie down and be connected to the machine for a few hours. No anesthesia is needed.
Bone marrow transplant serves as a complete cure for those suffering from several kinds of blood cancer like acute leukemia, genetic blood disorder or bone marrow failures which otherwise can be fatal.
Challenges in India
Lack of donation centers, funds for registry: Not many hospitals in the country have the infrastructure to support bone marrow donation in large numbers. Also, the medical fraternity does not have enough doctors with expertise in the area.
The other concern is inadequate funding for appropriate functioning of bone marrow registry that includes organising donor camps, testing of donors for human leukocyte antigen (HLA) typing, maintenance of the laboratory and maintaining the staff required for the procedure. The state and central governments do not support the registry financially. The funding for the few existing registries comes from private organisations, and there is not much help otherwise.
Lack of awareness: People are mostly unaware of the terms bone marrow or stem cell donation, how it helps or why it is essential. This makes people reluctant to come forward and register for donating bone marrow. Creating awareness can bust several myths related to bone marrow transplants and help people make informed decisions about becoming donors.
Lack of funds for treatment: Bone marrow transplant is an expensive treatment. Most patients in India come from poor and middle-class backgrounds, thereby making it difficult for them to afford a bone marrow transplant.
Lack of matching donors: Despite having a unique gene pool due to a variety of ethnicity, culture, language, marriages within communities and migration waves, it is difficult to find a matched unrelated donor. That is mostly because of a very less number of willing donors register for donating stem cells in comparison to the western countries.
Increased donor dropout rates: It is important to check the rising donor dropout rates at various stages of the procedure. Donor dropout has always remained a serious challenge in the country.
Bone marrow or stem cell donation is the only organ donation where the donor saves lives without any loss for themselves as the stem cells almost immediately regenerate. Interestingly, in India, there are more people from the southern parts on the donor list, because of the increased awareness and multiple donation drives conducted in the south. Same can happen in the north too. Joint efforts by the government, hospitals, medical fraternity, research institutes and nonprofits can help India overcome the problems in bone marrow donation.
(The writer is consultant, Paediatric Haematology, Oncology and BMT, Aster CMI Hospital)