Understanding donors' motivations: a study of unrelated bone marrow donors

Medical advances in bone marrow transplantation techniques and immunosuppressive medications have dramatically increased the number of such transplants performed each year, and consequently, the demand for bone marrow from unrelated donors. Although physiological aspects of bone marrow donation have been thoroughly investigated, very few studies have examined psychosocial factors that may impact individuals' donation decisions and outcomes. To examine one particular set of donor psychosocial issues, this study investigated motives for bone marrow donation among 343 unrelated bone marrow donors who donated through the National Marrow Donor Program. Six distinct types of donor motives were identified from open-ended questionnaire responses. Donors most frequently reported motives reflecting some awareness of both the costs (to themselves) and potential benefits (to themselves and the recipient) of donation. A desire to act in accordance with social or religious precepts, expected positive feelings about donating, empathy for the recipient, and the simple desire to help another person were also commonly cited reasons for donating. Among a series of donor background characteristics, donors' gender was the variable most strongly associated with motive type; women were most likely to cite expected positive feelings, empathy, and the desire to help someone. Central study findings indicated that donor motives predicted donors reactions to donation even after the effects of donor background characteristics (including gender) were controlled. Donors who reported exchange motives (weighing costs and benefits) and donors who reported simple (or idealized) helping motives experienced the donation as less positive in terms of higher predonation ambivalence and negative postdonation psychological reactions than did remaining donors. Donors who reported positive feeling and empathy motives had the most positive donation reactions in terms of lower ambivalence, and feeling like better persons postdonation. These finding add substantially to the body of work concerning medical volunteerism generally, and also have important practical implications for the recruitment and education of potential bone marrow donors.     

Analysis of donor versus nondonor demographics

A retrospective analysis of the demographic features of all potential organ donors over a 3-year period (1994-1996) at one organ procurement organization was conducted. The potential donor pool of 495 people was 42% female and 58% male, with a slight difference in consent by gender. The mean income difference between donors and nondonors was less than $3000 per year (obtained from zip code census data). Educational achievement affected donation at the lowest educational levels. Cause of death influenced donation, with motor vehicle crash victims donating more often. The strongest factor in consent for donation was ethnicity; whites were more likely to donate than were other ethnic groups. The combination of gender, ethnicity, and cause of death improved the probability of determining a positive outcome to 63%. Demographic information on donors and nondonors can increase public and professional understanding as well as influence decision making to improve donation.     

Getting blood from collective turnips: Volunteer donation in mass blood drives.

Analyzed correlates of volunteer blood donation in 2 separate mass blood drives, based on data from 1,722 university students, 1,080 donors and 642 nondonors. Previous research on blood donor motivation has suggested that altruistic, humanitarian reasons are the chief motives for donation. Present results indicate virtually no association between donorship and altruism (measured by a modified version of Wrightman's Philosophies of Human Nature Scale). Donors were more responsive to social pressure and incentives and less impeded by a free-rider tendency and the costs of giving than were nondonors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

10 years Swiss bone marrow donor registry

The Swiss Bone Marrow Donor Registry was established 1988 as a project of Swiss Transplant. Up to the end of 1997, 13,500 unrelated volunteer donors have been added to the central registry in Bern in cooperation with the regional transfusion centers of Switzerland. During this period, the registry responded to over 15,000 international search requests. 67 matching Swiss donors were found for patients all over the world. On the other hand, 77 Swiss patients received unrelated bone marrow transplantation from international donors. In 1997, 24 donors were selected from the Swiss registry and 21 bone marrow transplantations were performed, which is more than in any year before. The most recent developments are peripheral blood stem cell donation and the creation of cord blood banks.     

Preoperative predictors for organ-confined disease in Japanese patients with stage T1c prostate cancer

BACKGROUND: Little is known about the effects of long-term plateletpheresis on the donors' health. The aim of this study was to examine the effect of plateletpheresis on the time course of reticulated platelet counts as an estimate for thrombopoiesis. STUDY DESIGN AND METHODS: The effect of moderate platelet depletion on the thrombopoietic capacity was evaluated prospectively by the measurement of reticulated platelets before and after plateletpheresis and on the following 4 days. Donors undergoing plateletpheresis for the first time were compared to those donating platelets every other week for more than 18 months. RESULTS: The median levels of reticulated platelets were significantly lower in frequent donors than in new donors. In new donors, there was a transient increase in the median levels of reticulated platelets on Day 3 after apheresis, and baseline values were reached again on Day 4. On the contrary, in repeat donors, there was a sustained rise in the percentage of reticulated platelets from Days 1 through 4. However, this increase in reticulated platelet counts was still less than that seen in new donors. There was no difference in the peripheral blood platelet counts in the two groups at any time point. CONCLUSION: These findings suggest that repeat platelet donation might lead to a relative exhaustion of thrombopoiesis, as evidenced by the low levels of reticulated platelets exhibited by repeat donors. The reticulated platelet count can be used to monitor the thrombopoietic capacity of long-term platelet donors.     

The effects of applied tension on symptoms in french-speaking blood donors: A randomized trial.

Blood-donation-related symptoms such as dizziness and weakness discourage people from participating in this important health-related activity. Four hundred sixty-seven young adult, French-speaking blood donors were randomly assigned to (a) a condition in which they learned a possible preventive technique called applied tension and were asked to practice it from the time they got on the donation chair until they were just about to get up, (b) a placebo condition in which they learned applied tension and were asked to practice it from the time they got on the chair until the insertion of the donation needle, or (c) a no-treatment control condition. Donors assigned to the treatment condition reported significantly fewer blood-donation-related symptoms than did donors assigned to the other conditions and rated their likelihood of returning to give blood again as greater than did those in the no treatment condition. Among donors whose chairs were not reclined, participants in the treatment condition had significantly smaller heart rate reactions to blood donation than did those in the other conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Weight-related attitudes and behaviors of black women

Weight-related attitudes and practices of women who attended health department clinics or who worked for a health and human services agency were assessed by means of an anonymous, self-administered questionnaire. Black women who were 25 to 64 years old and were not pregnant or had not given birth within the past year were included in this analysis (n = 500). The overweight women perceived themselves as being overweight. They were less likely to be satisfied with their weight and more likely to have dieted and to be currently dieting than nonoverweight women. Awareness of obesity-related health risks was high, but the perceived psychosocial consequences of being overweight were somewhat limited. Approximately 40% of moderately and severely overweight women considered their figures to be attractive or very attractive, which indicates a relatively positive body image. The overweight women were less likely to exercise, less likely to skip meals, and more likely to eat between meals than the nonoverweight women. Among the subset who had ever attempted to lose weight (n = 368), the overweight women were significantly more likely to have regained all or more of the weight lost during their most recent attempt. The findings of this exploratory survey suggest that although overweight black women are weight conscious, the absence of strong negative social pressure combined with a relatively positive body image may limit the extent to which weight loss efforts are sustained. Findings about eating and exercise patterns suggest some specific factors that may interfere with the effectiveness of weight control among black women.     

Addiction to altruism? Opponent-process theory and habitual blood donation.

Explores the possibility that one of undoubtedly several interacting motives behind commitment to regular blood donation is the development of an affective "addiction" to the behavior, based on initial anxiety, through the mechanisms postulated by opponent-process theory. Pre- and post-donation responses to 1,846 blood donation experiences were subjected to correlational and regression analyses. Support was found for the relevance of opponent-process theory to the development of positive affective responses to donation. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Donor attitudes about exporting and importing blood

BACKGROUND: The movement of blood among different areas of the United States and the collection of more blood than is needed locally in some areas are increasing. Little is known of donors' attitudes about this blood resource sharing. STUDY DESIGN AND METHODS: One thousand donors from five regions of the American Red Cross Blood Services were surveyed by telephone. Demographic information about the donors and the regions was obtained, and the donors were asked to describe their attitudes about blood resource sharing as well as other blood donation-related issues. RESULTS: Donors are not very knowledgeable about whether their community is self-sufficient in its blood supply. In regions that import blood, 29 to 43 percent of donors believed that enough blood was collected to meet all local needs, and, in regions that export blood, only 22 to 24 percent of donors believed that more than enough blood was collected. About three-fourths of the donors believed it acceptable to send their blood to other communities if it is needed there. However, this attitude was based on the premise that all local needs would be met first. Only 4 percent of donors would be less willing to donate if their blood was being sent to another community. CONCLUSION: Donors are not very aware of blood resource sharing but are willing, under certain circumstances, to donate blood for use outside their local communities.     

Norplant selection and satisfaction among low-income women

OBJECTIVES: This study examined correlates of Norplant selection and satisfaction among low-income women. METHODS: Interviews were completed in family planning clinics in 4 Florida counties with 1152 Norplant users and 1268 nonusers, with follow-up interviews with a subsample up to 1 year later. Logistic regression models estimated the associations of socio-demographic and medical characteristics with Norplant selection and method satisfaction. RESULTS: Odds ratios for Norplant selection were significantly greater among women who planned to have children in 5 or more years, those who were "offered" Norplant, those who lived in Palm Beach County, those who were using drugs, and those who were Medicaid clients. Women younger than 17 and those who learned about Norplant from a friend were twice as likely as others to select Norplant. Ninety-two percent of Norplant users were satisfied with the method; women with side effects and those who felt pressure to select a method were significantly less likely than others to be satisfied. CONCLUSIONS: Norplant provides an acceptable and satisfying method of birth control for many low-income women. Proper counseling about all methods of birth control and about Norplant's side effects remains critical to the appropriate delivery of this method.     

Porphyrobacter tepidarius sp. nov., a moderately thermophilic aerobic photosynthetic bacterium isolated from a hot spring

BACKGROUND: The epidemic of Human Immunodeficiency Virus (HIV) infection led blood banks to initiate donation deferral criteria based on self-reported risk factors. However little information is available on the differences in reporting risk factors before and after HIV status is known. METHODS: Between April and July 1994, blood donors in a provincial hospital in northern. Thailand were interviewed at the time of donation, about their demographic characteristics and risk factors. All donors had agreed to learn their test results and were called back for post-test counselling and reinterview. RESULTS: HIV-positive blood donors were more likely to change from 'denying' to 'acknowledging' risk factors while HIV-negatives were more likely to change from 'acknowledging' to 'denying'. The differences between risk factors obtained before and after test results were known resulted in stronger, weaker or even opposite risk measures. CONCLUSION: The study results raise questions about the impact of the differences in reporting HIV-related risk factors by the donors on how effective donation deferral criteria can be developed.     

Caffeine attenuates vasovagal reactions in female first-time blood donors.

The experience of vasovagal reactions during blood donation (e.g., faintness, dizziness, lightheadedness) can be a deterrent to repeat donation. Because these reactions are associated with decreases in blood pressure, caffeine was examined as a potential modulator of vasovagal reactions by virtue of its pressor effects. Using a randomized, double-blind design, 62 female undergraduate 1st-time blood donors received either 0, 125, or 250 mg of caffeine prior to blood donation. Participants who received 250 mg of caffeine had lower scores on the Blood Donation Reactions Inventory, required fewer interventions by phlebotomists for negative reactions, and reported a greater likelihood of repeat donation than participants who received placebo. These findings suggest that a moderate dose of caffeine attenuates negative reactions in novice female blood donors and may increase the likelihood of repeat donations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do attitudes toward disclosure in donor oocyte recipients predict the use of anonymous versus directed donation?

OBJECTIVE: To compare the demographic and psychological characteristics of oocyte recipients and to determine whether the issue of disclosure about the use of a donor is a correlate of the decision to use an anonymous or directed donor. DESIGN: Cross-sectional study. SETTING: University teaching hospital. PATIENT(S): Ninety consecutive recipients of donated oocytes (64 of whom used anonymous donors and 26 of whom used directed donors). INTERVENTION(S): Pretreatment psychosocial evaluation. MAIN OUTCOME MEASURE(S): Recipient opinions and attitudes regarding the choice of donor type and disclosure to others as determined through a semistructured interview. RESULT(S): There were no statistically significant differences with regard to demographic characteristics between recipients who used anonymous and directed donors. There were statistically significant differences between the groups with regard to the issue of disclosure. Recipients who used directed donors were more likely to have told others about using an oocyte donor and were more likely to indicate that they intended to inform the child about the nature of his or her conception. CONCLUSION(S): Oocyte recipients who use known donors differ significantly from those who use anonymous donors with regard to the issue of disclosure to others. Further studies are needed to determine the causal direction of this relation.     

How to reduce the prevalence of HIV-positive blood donors

Despite abolishing the policy of giving the results of the serological test as a way to promote blood donation, and also after improving the predonation questionnaire, we still have a high prevalence of HIV positive blood donors. In this paper we try to analyze, interviewing the HIV positive blood donors in our Counselling Clinic from January 1995 to December 1996, why they were accepted. We asked the HIV positive blood donors to fill a form with the following questions: identification, kind and frequency of blood donation, HIV high risk behaviour, awareness of predonation serological status, willingness toward blood donation, awareness of how dangerous the transfusion of HIV contaminated blood is. For the screening we used Abbott HIV1/HIV 3rd generation plus EIA, test and HIV-1 Western Blot Cambridge, Biotest, Worcester MA, for confirmatory assays. During the evaluation period, 53,338 blood donors were attended, 130 (0.24%) were confirmed HIV positive. Only 18/130 (13.84%) assisted to the Counselling Clinic. The mean age was 33.27 +/- 5.35 years old, all males, 15 singles and 3 with stable couples. 6/18 (33.33%) could have been discarded because of physical appearance or because of theirs jobs. "Voluntary Donation" was higher than in the control group (p = 0.0001). Homo/bisexual and promiscuous behaviour (p = 0.0003) were the predominant high risk factors, in this group 55.55% had more than one risk factor. The association with HBV and syphilis was high (p = 0.0001 and p = 0.0005). 5/18 (27.77%) knew they were HIV positive; 3/18 (16.66%) had the suspicion they were HIV positive and 10/18 (55.55%) did not know it; however the risk factors were the same in those groups. In the knew/suspicion group the main reasons for blood donation were: Performing the test once more, 6; failure in the predonation questionnaire, 1; family pressure, 1. In the group that ignored their HIV positivity: ignorance of belonging to a high-risk group, 6; lack of confidence in the interviewer, 3 and failure in the predonation questionnaire, 1. 61.11% knew that the HIV tests were performed on all blood donations and the the positive ones were discarded. No one had knowledge of the window period. CONCLUSIONS: 1. It is necessary to spread more information to the general population about the ways of HIV transmission, the risk factors and its prevention. 2. To make aware all HIV positive or those that suspect they are the HIV positive how dangerous their blood donation could be. 3. Offering the general population a free HIV test and giving the appropriate counselling and support. 4. Improving the questionnaire, assuring that the blood donor could understand the real meaning of the questions and how important his/her truthfulness is. 5. To consider the implementation of the p24 antigen test as mandatory to all blood donations and all the new techniques to avoid HIV transmission. 6. To change the "related" blood donors to the true voluntary, altruistic, blood donor.     

1997 results of medical assisted procreation with third party donations and autopreservation. CECOS French Federation

During the year 1997, the French Federation of CECOS recorded the results of the 23 CECOS centers and IFRAERES in Toulouse. 1620 first demands of procreation with sperm donors were registed (versus 1,690 in 1996) but only 3,235 patients received at least one donation in the year, 22% less than 1996. From 10,935 cycles (AID or IVFD), 1,333 pregnancies were obtained, scoring the identical amount in terms of pregnancies as in 1996 but with less 30% in terms of cycles. The analysis of the 1,298 deliveries of the 1996 pregnancies show a malformation rate of 1.9%. 419 male volunteers came forward as sperm donors (5% more than 1996). In gamete autocryopreservation, the number of semen preservation is globally increasing (11.2% more than 1996), mainly because the capacity of a better reutilization with ICSI.     

Results of allogeneic bone marrow transplants for leukemia using donors other than HLA-identical siblings

PURPOSE: To compare outcomes of bone marrow transplants for leukemia from HLA-identical siblings, haploidentical HLA-mismatched relatives, and HLA-matched and mismatched unrelated donors. PATIENTS: A total of 2,055 recipients of allogeneic bone marrow transplants for chronic myelogenous leukemia (CML), acute myelogenous leukemia (AML), and acute lymphoblastic leukemia (ALL) were entered onto the study. Transplants were performed between 1985 and 1991 and reported to the International Bone Marrow Transplant Registry (IBMTR). Donors were HLA-identical siblings (n = 1,224); haploidentical relatives mismatched for one (n = 238) or two (n = 102) HLA-A, -B, or -DR antigens; or unrelated persons who were HLA-matched (n = 383) or mismatched for one HLA-A, -B, or -DR antigen (n = 108). HLA typing was performed using serologic techniques. RESULTS: Transplant-related mortality was significantly higher after alternative donor transplants than after HLA-identical sibling transplants. Among patients with early leukemia (CML in chronic phase or acute leukemia in first remission), 3-year transplant-related mortality (+/-SE) was 21% +/- 2% after HLA-identical sibling transplants and greater than 50% after all types of alternative donor transplants studied. Among patients with early leukemia, relative risks of treatment failure (inverse of leukemia-free survival), using HLA-identical sibling transplants as the reference group, were 2.43 (P < .0001) with 1-HLA-antigen-mismatched related donors, 3.79 (P < .0001) with 2-HLA-antigen-mismatched related donors, 2.11 (P < .0001) with HLA-matched unrelated donors, and 3.33 (P < .0001) with 1-HLA-antigen-mismatched unrelated donors. For patients with more advanced leukemia, differences in treatment failure were less striking: 1-HLA-antigen-mismatched relatives, 1.22 (P = not significant [NS]); 2-HLA-antigen-mismatched relatives, 1.81 (P < .0001); HLA-matched unrelated donors, 1.39 (P = .002); and 1-HLA-antigen-mismatched unrelated donors, 1.63 (P = .002). CONCLUSION: Although transplants from alternative donors are effective in some patients with leukemia, treatment failure is higher than after HLA-identical sibling transplants. Outcome depends on leukemia state, donor-recipient relationship, and degree of HLA matching. In early leukemia, alternative donor transplants have a more than twofold increased risk of treatment failure compared with HLA-identical sibling transplants. This difference is less in advanced leukemia.     

Giving and taking--to whom and from whom? People's attitudes toward transplantation of organs and tissue from different sources

The aims of the study were: 1) to describe the willingness of the public to receive material of different origins in one's own body; 2) to compare the willingness to donate and receive body material; 3) to compare the willingness to donate while alive and after death; 4) to compare the willingness to donate to a next-of-kin and unknown recipients. A random sample of 1500 inhabitants, 18 to 70 yr old, in the county of Uppsala, Sweden, were sent a questionnaire asking about their opinion on transplantation and transfusion issues. The response rate was 71%. Ninety-five percent accepted to receive blood transfusion, 89% bone-marrow transplantation, and 85% transplantation of a solid organ. Organs from living donors were preferred (77%), then organs from decreased donors (69%), then artificial organs (63%), and last animal organs (40%). More than half of those accepting transplants made exceptions for some types of organs. The youngest and those with higher education were more positive toward receiving all types of organs than the older ones and those with lower education. Women were less prepared than men to accept animal organs. Those who accepted organs from animals usually also accepted all other types of organs, and were willing to donate organs and tissue more often than those who did not accept to receive animal organs. The readiness to support a sick family member by giving bone-marrow and even a kidney was considerable, 89 and 81%, respectively. The attitudes were less positive with regard to giving blood and bone-marrow to unknown recipients, 54 and 41%, respectively. Sixty-one percent of the respondents were positive toward donating their own organs after death. Of those who were positive, 10% made exceptions for special organs that they did not want to donate, mostly heart, eyes, and brain. Individuals with higher education and young people were more often positive than those with lower education and old people regarding donation of blood and organs, and bone-marrow donation to a relative. Women were somewhat more accepting to donate while alive than males. Thirty-one percent, more often women than men, had signed a donor card and/or registered with the Swedish Organ Donation Registry. The results with regard to receiving organs and tissue are discussed in terms of two different sets of explanations, which can be seen as different sides of the same coin, and mutually strengthening the reactions. The great readiness to donate to a family member as well as the discrepancy between giving in life and after death is commented upon.     

The feasibility of organ salvage from non-heart-beating trauma donors

BACKGROUND: Blunt trauma patients without vital signs on admission are potential non-heart-beating donors. OBJECTIVE: To review the feasibility of postmortem visceral perfusion and organ donation in blunt trauma patients without vital signs. DESIGN: A retrospective case series of blunt trauma victims who were declared dead in the emergency department. SETTING: A level I trauma center. MAIN OUTCOME MEASURES: Factors potentially precluding donation and potential donor yield. RESULTS: The mean trauma-to-death interval was 71 minutes (< 60 minutes in 57% of the cases). Injuries likely to interfere with in situ perfusion were present in 41% of the cases. The tissue donation consent rate was 45%. Assuming a similar organ donation consent rate, the potential donor yield was 9% after excluding victims who were younger than 60 years of age, warm ischemia times that were less than 60 minutes, and patients who had injuries precluding perfusion. CONCLUSIONS: The potential organ yield from non-heart-beating, blunt trauma victims is low, which highlights the ethical and legal problems of this approach.     

Bone marrow transplantation in adult thalassemic patients

One hundred seven adult patients with thalassemia aged from 17 through 35 years and transplanted from HLA-identical siblings between November 1988 and September 1996 were evaluated on December 31, 1997. The outcome experience of 20 consecutive patients transplanted between November 13, 1988 and January 10, 1991 and reported in September 1992 is updated after 5 additional years. The experience on 87 patients transplanted between May 1991 and September 1996 is described and evaluated as of the end of December 1997. Of 107 patients, 69 survive between 1.5 and 9 years after transplantation. Sixty-six of these patients do not have thalassemia and are identified as ex-thalassemic after bone marrow transplantation. The youngest survivor is 20 years old, 6 are older than 30 years, and the oldest is 37 years of age. Patients with chronic active hepatitis at the time of transplant were significantly more likely to die than patients without (P =.05; relative risk, 2.05). Marrow transplantation is a valid treatment option for older patients with thalassemia who have suitable donors and show deterioration with conventional therapy.     

Marrow transplantation from unrelated donors

The use of an HLA-compatible unrelated donor is an option for patients who require an allogeneic transplant but lack a family member match. Grafts from unrelated volunteer donors have provided long-term disease-free survival for a variable proportion of patients, depending on degree of HLA matching with the donor, patient's disease, disease stage, and age. The number of volunteers in marrow donor registries worldwide has increased to more than 2.5 million. The number of unrelated donor transplants facilitated by the US National Marrow Donor Program alone will exceed 900 this year. Progress in HLA-typing technology results in a more precise definition of donor and recipient matching and new assays have been developed with initial success to measure alloreactive T-cell precursors for selection of donors with less antihost reactivity. Prevention and treatment of graft failure, graft-versus-host disease, opportunistic infections, and Epstein-Barr virus-associated lymphoproliferative disease remain a challenge.