Bone Marrow Transplants

Each year, thousands of people diagnosed with leukemia and other fatal blood diseases discover that a bone marrow transplant may be their only hope for long-term survival. About two-thirds of all patients who might benefit from this procedure, however, have no related donor with compatible tissues and are compelled to seek out marrow donations from unrelated volunteers. The National Marrow Donor Program, established by Congress in the mid-1980s, has expanded its bone marrow registry from nearly 73,000 donors at the end of 1989 to about 561,000 donors in April 1992. The proportion of minorities more than doubled during this period, from about 5.8 percent to about 14.2 percent. This larger and more diverse pool of donors has improved the odds of finding matching donors for patients with rarer tissue types. Yet the proportion of blacks and Hispanics on the registry remains considerably less than their proportion of the U.S. population as indicated by the 1990 census. Although the number of transplants increased, the proportion of searches that culminated in a bone marrow transplant did not change markedly from 1987 to mid-1991. As of July 1991, only 13 percent of the patients searching for a donor actually obtained a marrow transplant. This paucity of results occurred for many reasons--financial, genetic, medical, and personal. Research on the matching of blood cell proteins, known as human leukocyte antigens, and other factors affecting the patients' search, such as difficulties in finding a suitable donor, may help improve the outcomes of donor searches and of marrow transplants using unrelated donors.

GAO found that: (1) from December 1989 to April 1992, registered donors increased from 72,900 to 560,871; (2) minority donors more than doubled to 14.2 percent, but their proportions remained considerably less than in the general population; (3) community drives recruited more than 50 percent of the new donors, and also raised funds for typing that were matched by the program; (4) because of test costs and the commonality of certain antigen combinations among nonminorities, new donors were only partially typed, but this caused delays in finding donors for patients with rarer combinations; (5) with increased federal funding, NMDP began to type fully donors with rarer antigen combinations, and to store blood of other new donors for full typing if they became potential donors for a patient; (6) although transplants increased, most search requests between September 1, 1987, and July 18, 1991, did not result in a transplant, and almost one third were cancelled; (7) the median charge for a search that resulted in a transplant was $20,000; (8) for the first 6 months of 1991, private insurers paid for 50 percent of searches, while hospitals, charitable funds and state government funds paid for 20 percent, Medicaid and Medicare paid for 15 percent, uninsured patients paid for 10 percent, and 5 percent were unreimbursed; (9) NMDP approved researchers' access to its database, member organizations, and donors, when the research supported its research priorities and had potential benefits for the program; and (10) NMDP is participating in bone marrow research and is beginning to incorporate preliminary research findings into its program.