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Race and ethnicity in decisions about unrelated hematopoietic stem cell donation

Galen E. Switzer, Jessica G. Bruce, Larissa Myaskovsky, Andrea DiMartini, Diana Shellmer, Dennis L. Confer, Linda K. Abress, Roberta J. King, Allyson G. Harnaha, Sibylle Ohngemach, Mary Amanda Dew

Key points

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

Abstract

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.