Statement: Recruiting Donors to the BBMR - changes effective 1st April 2016

Tuesday, 22 Mar 2016

What is changing?

Over the past year, Blood Donation teams have done a remarkable job recruiting donors to the BBMR, especially young donors and those of  black, Asian and minority ethnic (BAME) backgrounds.  These donors are preferentially selected to donate by transplant physicians. Building on  the success of this strategy, from next year we intend to go further to maximise the number of patients who may benefit from a life-saving  transplant.

From April 1st 2016, donors can only join the BBMR if they fit in to one of two groups:

  • Caucasian male donors aged 17 to 40;
  • Black, Asian or minority ethnicity donors of either gender, aged 17 to 40.

Why is this change being made?

  • The majority of bone marrow transplants in the UK (from a UK donor) are from male donors.  This is despite the fact that over  60% of donors on the BBMR  are female.
  • Nearly half of all bone marrow transplants in the UK (from a UK donor) were from donors aged under 30, yet less than 15% of BBMR  donors are under 30.
  • BAME patients are less likely to be able to find a suitably matched donor than Caucasian patients, which is why we are recruiting  BAME donors from both genders as we urgently need to address this.

In recent years NHS Blood and Transplant has accepted all blood donors under the age of 49 who would like to join the BBMR, whilst  specifically focussing on young Caucasian males and young Black, Asian, mixed race and minority ethnic donors of either gender.  We know that  young Caucasian male donors are the most likely to be selected to donate for a patient and that we have a real lack of non-Caucasian donors on  the registry.

Whilst we are meeting our targets for these groups we have also recruited an equal number of donors who fall outside these targeted groups.  We are limited on the number of donors that we can recruit annually due to both financial constraints and our capacity to type the donors and we  need to make sure we recruit only those donors who are most likely to be selected to donate for a patient. Therefore we have made the decision to  change our donor recruitment criteria so that we only accept those donors that are most needed on the BBMR.

Despite the fact that over 60% of those currently registered on the BBMR are female, there is strong evidence to suggest that young male  donors are eight times more likely to be selected as matches for patients compared to the rest of the current donor panel.   So far in 2015/16,  48% of blood stem cell donations have been from Caucasian male donors aged under 40, yet only 11% of donors registered to BBMR fit in to this  category.  While we are very grateful for the many tens of thousands of Caucasian women who have joined BBMR over the years - and we continue to  expect to ask such donors to donate for patients in need each month - we must focus on changing the demographic mix of the BBMR to better meet  patient demand.  We believe this approach will best enable us to help as many patients in need as possible.

Patients from Black, Asian, mixed race and minority ethnic backgrounds are significantly less likely to find a suitably matched donor than  Caucasian patients, which is why we are recruiting BAME donors from both genders as we urgently need to address this. This approach will complement  our cord blood banking strategy, which also seeks to address the need to provide suitable stem cell donations for these patient groups.  We have  set ourselves challenging targets to increase recruitment of BAME donors by 50% in 2016/17 compared with the previous year and believe that this  narrower age focus, the commitment of our blood donation teams across the country and the generous support of our donor base will enable us to  achieve this and help many more patients in the years to come.

Why is the minimum recruitment age dropping to 17?

We are hoping that many 17 year olds will consider joining the BBMR when they start to give blood - we hope that this double sign up to  altruistic donation will reinforce their commitment to both.  When a 17 year old joins they will be tissue typed and added to the BBMR's database,  but they will not be searched as potential matches for a patient until they turn 18.  Our database will do this automatically on their 18th  birthday.

Why is the maximum recruitment age dropping to 40?

Owing to the strong preference for younger donors, we have decided to reduce the maximum age to join BBMR to 40.  Even if a donor joins  the day before they turn 40, they will still potentially be active on the BBMR for up to 20 years.  Under the old recruitment policy, when the  maximum age was 49, some donors would only be active on the BBMR for ten years - while a decade is of course a long time, it makes sense to  marshal finite NHS funds on recruiting donors who will be available to potentially donate for longer.

Why are we no longer recruiting Caucasian women?

This has been a difficult decision.  However, our over-riding priority is to ensure that as many patients as possible have access to a  life-saving transplant, and the best way to do this is to focus recruitment on the donors most-likely to be requested to donate.

We are certainly not saying that Caucasian women no longer make good bone marrow donors - indeed, as 60% of the donors on the BBMR are women  we certainly expect many donations each month to come from this group.  If you fall into this demographic we hope you will continue to help  patients by giving blood. You may also be eligible for platelet donation, and might consider joining the Organ Donation Register if you have  not already done so.

Why do other UK bone marrow donor registries recruit Caucasian women, when BBMR does not?

The BBMR relies on limited funding from the Department of Health for donor recruitment and typing. The BBMR has sufficient resource to  recruit and tissue type 11,000 new donors in 2016/17, and we need to deploy this limited funding to save as many lives as possible. Other registries set their own donor recruitment policies. The changes we are making are based on patient need.

I want to join BBMR although I don't meet the recruitment criteria?

If you don't meet our criteria, you may well meet the recruitment criteria for Anthony Nolan or Delete Blood Cancer UK.   Full details of  their recruitment criteria are available on their websites.

If a donor is aged 16 - 30, they may be eligible to join the Anthony Nolan.  Delete Blood Cancer UK recruits all donors, regardless of  gender, aged 18 - 55.  Donors from BBMR, Anthony Nolan and Delete blood Cancer UK are all listed on the Anthony Nolan and NHS Stem Cell Registry  so it does not matter which panel you join.

Rationale

Stem Cell Donation and Transplantation launched a new five year strategy, approved by the Executive Team and Board, in March 2015. One  pillar of the strategy is to target donor recruitment to better match the clinical demand for young male and BAME donors.

Following on from the success of our DH funded programme to establish a panel of young donors, HLA typed to a high resolution, we now have  very clear evidence of which donors are most likely to be selected for stem cell donation. Our young male donors, typed to high resolution, are  eight times more likely to be selected as matches for patients compared to the rest of the current donor panel.