Blood Journal
Leading the way in experimental and clinical research in hematology

Race and ethnicity in decisions about unrelated hematopoietic stem cell donation

  1. Galen E. Switzer1,*,
  2. Jessica G. Bruce2,
  3. Larissa Myaskovsky3,
  4. Andrea DiMartini2,
  5. Diana Shellmer4,
  6. Dennis L. Confer5,
  7. Linda K. Abress5,
  8. Roberta J. King5,
  9. Allyson G. Harnaha2,
  10. Sibylle Ohngemach2, and
  11. Mary Amanda Dew6
  1. 1 Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, United States;
  2. 2 Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States;
  3. 3 Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States;
  4. 4 Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States;
  5. 5 National Marrow Donor Program, Minneapolis, MN, United States;
  6. 6 Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States
  1. * Corresponding author; email: switzerge{at}

Key points

  • Across racial/ethnic groups, ambivalence is strongly associated with HSC donation decisions


Large international registries of potential unrelated hematopoietic stem cell (HSC) donors including the National Marrow Donor program (NMDP) continue to face difficulties finding matched donors for racial/ethnic minorities. One reason - in addition to the generally less common HLA types among minority patients - is the much higher registry attrition rate of racial/ethnic minorities as compared to Whites. Reasons for the higher attrition among minority potential donors remain unexplained. The goal of our cross-sectional telephone interview study was to generate a diverse sample of potential HSC donors who have preliminarily matched a patient and to identify factors associated with race/ethnicity and with the decision to continue toward potential donation or to opt-out of the registry. Multiple culturally-related, psychosocial, and donation-related factors were associated both with race/ethnic group membership and attrition from the registry. The most consistent factor associated with opting-out of the registry across all race/ethnic groups was ambivalence about donation - doubts and worries, feeling unsure about donation, wishing someone else would donate in one's place. Findings suggest that universal donor recruitment and management approaches based on reducing donation-related ambivalence as well as tailored messages and strategies for each of the individual race/ethnic groups are important.

  • Submitted June 15, 2012.
  • Accepted October 27, 2012.