The SA Bone Marrow Registry (SABMR) cautions other registries operating in South Africa against outsourcing donor searchers to international centralised hubs outside of the country, as it could lead to local expertise being lost.
Jane Ward, Deputy Director of the SABMR explains that bone marrow registries recruit, register and search for haemopoietic progenitor cell (HPC) transplants, more commonly known as stem cell transplants, which are an important life-saving treatment for many South African patients suffering from certain haematological malignancies, such as leukaemia, lymphoma, myeloma, bone marrow failure syndromes and genetic abnormalities.
She says contracting out donor searches to overseas countries is bound to erode essential skills in a highly specialised medical field, which need to be retained locally.
“Conducting donor searches within our own country is important for the following reasons:
- Database security: Allows for retention and safe custody of the South African patient/donor database.
- Proximity: Searching for potential donors within the same country increases the chances of finding a suitable match quickly. It reduces the time and logistical challenges associated with international searches, such as transportation and coordination.
- Compatibility: Genetic diversity exists among different populations and finding a match within the same country may increase the likelihood of compatibility between the donor and recipient. This is particularly important for matching certain tissue types and human leukocyte antigens (HLA), which play a crucial role in determining transplant success.
- Availability: By focusing on donors within their own country, bone marrow registries can prioritise individuals who are readily accessible for further testing and potential donation. This can help streamline the process and increase the chances of finding a willing and available donor. However, it is important to note that in cases where a suitable match cannot be found within the country, registries may expand their search internationally to increase the chances of finding a compatible donor. While SA’s donor pool is growing, it is not sufficient to service our population needs. Thousands more donors are needed to increase the likelihood of SA patients finding a local unrelated donor match.
- Capacity building: Keeping the skills within the country helps to build capacity and key competencies among the next generation of SA’s workforce. Biennially, the SABMR offers local graduates the opportunity to train in this highly specialised field as part of the DSI-HSRC Internship Programme, which is funded by the Department of Science and Innovation (DSI) and manged by the Human Sciences Research Council (HSRC). Its broader purpose is to attract and retain skilled human capital within the National System of Innovation (NSI) where graduates and postgraduates gain practical work experience and mentorship in the fields of science, technology, engineering, maths, social sciences and humanities.
“SA-based search coordinators also understand the language, geography, customs, and traditions of the country, which provide a much better patient service experience. Local search coordinators also have a firm grasp on the specific genes that are predominant among SA’s 60+ million population. These include at least 14 distinct ethnic groups and an estimated 870 distinct haplotypes, which is likely to increase as more research is done into South African population genetics.Top of Form
“Haplotypes play a crucial role in the process of matching potential bone marrow or stem cell donors with recipients. They provide information about the genetic diversity within populations. Donor search coordinators aim to find donors who have haplotypes similar to the patient’s, particularly within their ethnic or racial group. This is because individuals from the same population are more likely to have similar haplotypes, increasing the chances of finding a suitable match. Haplotypes are sets of genetic markers or variations that are inherited together from a single parent. These markers are found in specific regions of the genome (complete set of DNA or genetic material in a person or group of persons) and are used to distinguish one individual’s genetic profile from another. By comparing the haplotypes of a patient and potential donors, coordinators can determine the compatibility and likelihood of a successful transplant.
“Given that African populations are characterised by greater levels of genetic diversity compared to non-African populations, and the fact that they also possess a number of genetic adaptations that have evolved in response to diverse climates and diets, as well as exposure to pathogens and infectious disease, make it critical for South Africa to preserve its expertise in this field.
“The SABMR is the only World Marrow Donor Association (WMDA) accredited registry in Africa and has been in operation for more than 30 years. All of our search coordinators are required to have a degree or diploma in genetics or medical technology and must complete the WMDA Search Coordinator Certificate Programme.
“When patients and/or transplant centres choose the SABMR as their registry of choice, they help to keep the expertise within South Africa, which not only benefits patients, but creates a more skilled and diverse workforce that promotes the economic development and social well-being of our country,” concludes Ward.