The Network - Issue 1, Spring 2011
Doctor, Donor, Lifesaver
A Day in a Life of Princess Margaret's Collection Centre
By: Jennifer Jones, RN, OneMatch Case Manager
The Network is pleased to profile Canada's largest stem cell Transplant and Collection Centre, Princess Margaret Hospital (PMH) of Toronto, Ontario. This account follows stem cell donor Dr. Jeannie Callum as she made her way through PMH's donor procedure for a bone marrow harvest one day in early 2009, and is told by her Case Manager, Jennifer Jones, RN of OneMatch. It profiles the unique bond between the donor and the collection staff.
As the OneMatch Case Manager for Dr. Jeannie Callum, I had the honour of being part of her incredible journey to become a marrow donor. Dr. Callum wanted to be part of this article, which provides a play-by-play account of her donation process, because she wanted to dispel the rumours and misconceptions about the process, in particular the pain involved when offering a bone marrow harvest.
Confirmatory Typing: 'Getting the Call'
On October 24, 2008, I contacted Dr. Callum to happily report that after only 17 months on the OneMatch volunteer donor stem cell registry, her profile (which contains her preliminary HLA typing) had been identified as a possible match for a patient in need of a stem cell transplant. Dr. Callum understood that her potential donation could go to either a Canadian or international patient. She was eager to get the process going toward confirmatory typing to determine if she was a perfect match for the patient.
Confirmatory typing involves the potential donor completing a health assessment questionnaire and having blood samples taken. Canadian Blood Services' laboratories test some of the donor's samples for infectious disease markers. The remaining samples are sent to the appropriate transplant centre for completion of HLA typing. This typing step is important as only six out of the 10 DNA markers are tested when the donor initially joins the Network and provides their buccal swab sample. This is one of the most confidential parts of the process as no personal information is available to either donor or patient at this point.
Work-up: 'You are the One Match to Save a Life'
On December 24, I contacted Dr. Callum to report that the transplant centre had provided their final decision-she would be the 'one match to save a life!'
Prior to agreeing to participate, she had a family meeting. "My kids had many questions and, along with my husband, seemed a little worried about the whole process," she said. "But in the end they agreed: 'You need to do it because you are the only one.'"
Dr. Callum was excited and anxious to move the process along.
Thus began the work-up phase, representing one of the most personal connections between OneMatch and the donor. I began guiding Dr. Callum through the series of appointments and assessments necessary prior to her bone marrow donation at Princess Margaret Hospital (PMH) in Toronto, all designed to ensure she was medically fit to donate. The health assessment questionnaire was repeated to ensure her overall medical eligibility.
On January 20, Dr. Callum attended an interview at PMH's collection centre that involved a medical physical assessment by the collecting physicians. She signed the necessary consents and was provided with an overview of the donation procedure by the physicians. Dr. Callum was then asked to provide an additional blood test profiling complete blood count (CBC ) with differential (a biochemical profile that includes live function tests, kidney function tests, electrolytes, and blood sugar analysis). For female donors of childbearing age, a pregnancy test is required, as is electrocardiogram for all over the age of 40. In addition, donors undergo ABO blood testing and other tests deemed necessary by the collecting physicians.
Dr. Callum had a second set of blood samples drawn at Canadian Blood Services for repeat testing for infectious disease markers-a step for all donors that must be repeated within 30 days of their donation.
When all the tests were completed and the infectious disease markers reviewed, PMH provided me with Dr. Callum's official donor clearance; she was medically eligible to proceed with the donation. I notified the patient's transplant centre that the donor (both the donor and patient remain anonymous to each other) was ready for a stem cell donation. If any recipient risk had been identified, such as infectious diseases, the transplant centre would immediately be notified under Health Canada policy for Cells Tissues and Organs (CTO) CSA Standards.
Dr. Callum knew the big day was coming and she was ready!
Providing a Bone Marrow Donation: 'Game Day'
At 7:30 a.m. on February 4, 2009, Dr. Callum was admitted into Princess Margaret Hospital's collection centre on the 18th floor. She was weighed to confirm her marrow donation of one litre, and her temperature taken. Following this she answered an oral questionnaire to confirm her health, and provided an oral release of her bone marrow harvest to the patient. Next she underwent an MRSA (methicillin-resistant Staphylococcus aureus) swab test to identify the antibiotic to use in case of infection.
At 8 a.m., as she waited to enter the surgical suite, Dr. Callum underwent a further health assessment. After meeting with one of the attending staff and bone marrow transplant specialist, Dr. David Loach she was ready to get the job done. "I still can't believe I can be the one to help someone continue to live," she stated. "What an amazing privilege to offer my bone marrow."And with this selfless and resolving comment, she was off to donate.
To the surprise of most, by 10:30 a.m., Dr. Callum's stem cell harvest was done and she was already up and walking around-almost four hours sooner than what would normally be the time after such a procedure. Our amazingly fit donor had awoken at 10:00 a.m. and was raring to go!
At 2:30 p.m., OneMatch Patient Transplant Liaison Specialist, Mary Lynn Pride, visited Dr. Callum to ask her a few questions about her health and get her final understanding concerning the release of her donation to the patient. Dr. Callum was then presented with a beautiful glass sculpture with a helix inside to commemorate her donation.
As Dr. Callum prepared to leave the hospital, a hoard of empty Gatorade bottles littered the night stand next to her. She had been drinking them in order to replenish her body of lost nutrients and vitamins. She was ever so ready to go home to her family. "I feel some minor discomfort, but all around I feel great!" she exclaimed. "In reality, I have had more aches from the ski hill than this."
By 5 p.m., she was on her way home.
Case Manager Follow-up: After the Donation
As the day drew to a close for Dr. Callum, I as Case Manager continued with the job of getting these precious cells to the patient. A trained courier was waiting for the product to be handed over so they could personally transport it directly to the patient, where it would be infused liked a blood transfusion.
In all procedures, the Case Manager continues to follow-up with the donor every week until he or she has completely recovered. The donor is reserved for the patient for one year, in case a second donation is required. Dr. Callum fully recovered within a short period and generously offered to help out again if the patient required more treatment. Her generosity was fortuitous as the patient did end up needing an additional transplant.
A OneMatch donor must wait three months following their donation to request an update on the health of their recipient. However, the patient is able to refuse the release of such information. After one year, the donor and/or patient may request the release of personal information, such as their name. Some countries require a waiting period of two years, while other countries never allow the release of personal information. Where it is allowed, both parties must consent to have their information released, and then the donor and patient may communicate with each other after consents have been signed. OneMatch does not get involved with this personal exchange, but does support them when the need to tell their story to others through media is requested.
When asked if she would always remember her donation day, Dr. Callum reflected and then replied: "I will never forget this day. It feels like I've won a lottery by being able to donate my bone marrow. I am so lucky."
And a patient somewhere was having the same revelation of fortuity, but with one big difference. They would be able start their life again thanks to a woman in Toronto who sees donating stem cells as a privilege and tribute.
Dr. Jeannie Callum, MD, FRCPC, is Director of Transfusion Medicine and Tissue Bank at Sunnybrook Health Sciences Centre in Toronto. As both a member of Canadian Blood Services' Regional Liaison Committee and a prominent hematologist, she is acutely aware of the need for blood and stem cell donation in Canada.