Impact of a Related Donor Pre-Screening Questionnaire on Donor Deferrals

Abstract

Background Match related donors (MRDs) have long been a critical source of stem cells for patients needing an allogeneic transplant. In both our center and across the country, approximately 30% of patients needing an allogeneic transplant will have a matched family member who can serve as their donor. In our center these donors are, on average, over a decade older (median age = 40) than unrelated donors (median age = 27) at the time of donation. Additionally, 21% of our potential donors live outside the northeastern (New England and New York) region, and thus make significant travel time investments to come to our center. This makes it critical that any disqualifying medical issues be caught as early in the process as possible, preferably prior to the donor coming on site. Methods A donor pre-screen questionnaire was designed to be administered to potential donors by phone prior to typing. A pilot program was implemented with a subset of patients in December 2016 and expanded to all patients in June of 2017. If any potentially disqualifying conditions or other concerning information was noted on the donor pre-screen, it was given to a member of the Donor Services clinical team for review and follow-up. Donors not meeting medical suitability criteria were deferred either prior to typing or after a physical exam (PE). Results In the first two years after full implementation, 1073 potential related donors were referred to the Donor Services group. All but 40 (3.7%) of these were able to be pre-screened. Those who were not pre-screened were primarily international potential donors or non-responsive to phone contact. Of the remaining 1033 donors, 441 (42.6%) had prescreens requiring clinical review. After this review, 112 donors (11%) were deferred prior to typing. An additional 30 (3%) were preemptively disqualified from donating one product type (either PBSC or marrow) at time of pre-screen, and 15 (1.5%) were noted to have issues that may defer them if they were selected. The most common reasons for deferral were multiple complex medical issues (25%), severe cardiac issues and/or treatment with blood thinners (23%), and recent cancer history (13%). The rate of deferral after PE dropped from 11% to 5% (p Conclusion The donor pre-screening process has been beneficial for our center. Fewer HLA kits were sent out to donors not meeting medical criteria for clearance, and more donors were deferred prior to coming on site. Additionally, donor PE visits were streamlined as medical record requests and additional testing could be ordered prior to the visit allowing us to see greater donor volume (18% increase) without expanding resources. Finally, important information about the donor was able to be communicated to the recipient team prior to donor selection, helping them optimize donor selection.