The Politics of Bone Marrow

Following on from our post on the DWIB Leukaemia Trust, its attempts to establish a bone marrow register in an African malarial zone, and its attempts to register with the International Bone Marrow Register, I have been doing some research into why First World bone marrow donor registers refuse potential donors from a malarial zone, whatever their ethnicity (which, in this post for the sake of brevity I will refer to as Black, Asian and Caucasian. Equally, for the sake of simplicity, I will use the expressions 1^st, 2^nd and 3^rd worlds).

Results of my research:

1. There are two types of bone marrow transplant (BMT) – one through direct extracts of stem cells from bone marrow, one through stem cells present in the donor’s blood.
2. Malaria, whether symptomatic or asymptomatic (i.e. no symptoms but it is in your body) can produce alterations of stem cells necessary for bone marrow transplants) in that it produces immuno-depression and anaemia.
3. First World Registers appear to think that both of the two methods of stem cell transplant can result in malaria infection.

• First, they understand that a complete blood transfusion could transmit malaria. True.
• Second, I understand that a bone marrow transplant will not, in itself, transmit malaria as modern methods of stem cell extraction from blood separate the red blood cells attacked by malaria from the stem cells in the blood when it is donated and before transplant.
• Third, it would seem likely that asymptomatic malaria would lead to lower levels of stem cells in both bone and blood as the donor would likely be anaemic. However, anaemia can be tested for. It is also unclear (to me at least) what effect the stem cell growth factors, given to donors-by-blood before donation, would have on an anaemic donor.

The Canadian Blood Service even claims it cannot test for malaria! Bullshit - when everyday thousands of people across the world are tested for malaria with a simple technique that takes but an hour.

The results of First World bone marrow policies are prejudicial, and probably racist to say the least ...

Black and Asian people in the First World are prejudiced against in that they do not have access to donations from the Third World – an enormous potential, but as yet unrealized, resource. The DWIB Leukaemia Trust is setting up an example in Ghana. The health service in India and several other Third World countries (but not in Africa) are performing BMTs.

If the International Bone Marrow Register guidelines are not to use donors from malarial zones, then Third World countries are prejudiced against in that they cannot use donors from other malarial zones.

Certainly, I think international and national guidelines need to be revised along the following lines:

• First World donor searches should not reject searches in malaria zone registers but, if more than one equal match is found, then donor origin should be taken into account. If the matches are slightly unequal, a risk assessment protocol should be followed.
• First World donors recently resident in the Third World and Third World donors recently resident in the First World, both groups having recently been in malarial countries, should be allowed to register and have their blood tested for malaria/anaemia. This can be annotated to their records.
• Malarial zone to malarial zone matches should basically be totally permitted.
• If First World non-malarial countries do not want donors from malarial countries, they should at least allow access Third World countries to First World donors through the international register.

There we have it.

Medical/scientific/political knowledge greater than mine will be appreciated – please post in the comments or email me.

As one medical author I read put it, better a match with a donor from a malarial zone than no donor at all.

Let us hope Kezia never goes there.

Update: I note the South African register, a full member of the Global Register, stipulates donors must not have had malaria in the last 12 months rather than the stricter criteria of, for example, the UK register of not having been in a malarial area.