You may have heard such opinions:

...." bone marrow is harvested form the spine",
"it is very painful",
"bone marrow harvesting is dangerous and may cause leg paresis",
"if someone has donated his bone marrow once, he has to give his bone marrow systematically for the rest of his life",
"there are big and ugly scars on the donor's body",
"the donor has to stay at the hospital for a long time"

STOP This is not true!!!

If you, your friends, family or neighbours have any doubts, read the below text. And show it to your friends. Help us break the ignorance of the society on the bone marrow harvesting, destroy myths and untrue stories that do no good to the sick and to the donors! You need to know that in total around 10,000 unrelated donors and a few dozen thousands related donors have donated their bone marrow all over the world, including small children (data source: National Marrow Donor Program, USA). Some have donated their marrow many times and this fact had no negative impact on their lives, health and future. Many bone marrow donors are also blood donors. They are healthy and live their everyday lives. They have experienced something unusual. They have saved many people suffering form leukemia and other types of blood cancers. The bone marrow harvesting is a simple and safe procedure. Below we describe step after step what's to be expected by the donor that will be asked to give his bone marrow.

Please, donate your bone marrow!

You decided to donate your bone marrow. Your personal data are on the Bone Marrow Registry for many months now. Maybe you have even forgotten about that. Then, suddenly you are informed: "Someone needs your help. Please, donate your bone marrow". After the surprise and joy that you will be able to help someone is over, questions and doubts come to your mind:
When and where will the bone marrow be harvested?
What examinations will I have to undergo?
Who will take care of me in that time?
How long will I have to stay at the hospital?
Who will cover the costs of examinations and travel?
Should I prepare for the procedure?
What's exactly the bone marrow harvesting?

You need to be aware that there are two ways to get your hematopoietic cells (i.e. the cells that decide on the health of the donee). One of them is separation of hematopoietic cells from the peripheral blood, the other is bone marrow harvesting form the pelvic bone. You decide on the method which will be applied in your case; you are advised on this issue by the Bone Marrow Registry. There are, of course, certain circumstances as to what would be more favourable for the donee, certain suggestions form the transplantation center, however, the final decision is yours. Please, keep in mind, that it is worth consulting the Bone Marrow Registry on what would be more favourable for the donee.
Separation of hematopoietic cells from the peripheral blood is a non-invading procedure. Neither general anesthesia nor the longer stay at the hospital is necessary when applying that method. The hematopoietic cells are harvested form the donor with the use of a so called cell separator. The blood is harvested form one vein (elbow vein), then it is mixed with anticoagulant solution outside the donor's body. Next, the hematopoietic cells are separated from the blood. The remaining blood returns to the donor's body through another vein. In order to apply the separation method, the donor receives (in the form of hypodermic injection in the arm) the medicine that increases the number of hematopoietic cells in the peripheral blood. The injections are taken for 5-6 days. Morphological examinations are done every day to determine the number of the hematopoietic cells circulating in the blood. As soon as the number is high enough, the separation may begin. Usually two separations are necessary (each separation takes up to 4 hours, they are done 2 days in a row). *bone marrow harvesting form the pelvic bone, done in the operating room under general anesthesia. You chose the other method, i.e. surgical bone marrow harvesting. The transplantation centre asked you to harvest your bone marrow and you wish to everything possible to make sure the donee's chances of surviving are as high as possible.

The preparations have begun!!

The bone marrow will be harvested at the specialized hospital or clinic, experienced in the field of hematology and transplantation. Similar procedures have been performed there many times. Such centre may be situated far from the place you live. The Bone Marrow Registry will let you know where the centre is located. You will be asked to come to such hospital. The Bone Marrow Registry covers the costs of donor's travel, security policy and accommodation.

A few weeks earlier.......

First you meet the Bone Marrow Registry representative and the doctor that will collect the bone marrow from you. The doctor will explain you the whole procedure, tell you about the preparation for the procedure and explain how you may feel after the harvesting, what are the side effects of the general anesthesia and will answer all you questions in detail. The sample of you blood will be taken again for checking that it is free form viruses eg. HIV, hepatits B, cytomegalia and others. This meeting is also a small "psychological test" for the donor. This is the last moment for the person to consult herself/himself, the family and relatives and make sure the decision to donate bone marrow is right.
At this moment the withdrawal of the donor implies no serious consequences, besides the fact, that the donee loses his chance for recovery (maybe even for survival). Searching for the next donor may be difficult or even impossible. If you decided to donate your bone marrow, the donee is prepared for a graft. His/her bone marrow is destroyed by the process of radiation of the whole body and as a result of administering cytotoxical medicines. This process is important as it is necessary to destroy all the cancer cells in the donee's body. From that moment on, the donee is defenceless and the withdrawal of the donor means death for the patient.

Two weeks before......

You are asked to come to the nearby blood-collecting station where a sample of your blood will be taken for the so called autotransfusion. About 450 ml of your blood is taken to be transferred to your body immediately after the procedure of bone marrow donation. It is done to avoid the transfusion of someone else's blood to the donor. Remember, before coming to the blood-collection station, eat a decent breakfast so that you do not suffer from vertigos or debility.

A day before......

The day before the bone marrow harvesting (or at the day of harvesting - depending on the recommendations of the transplantation centre) you will be admitted to the hospital. A bit strange feeling. A healthy person admitted at the hospital. The strange feeling disappears as soon as you get used to your room, especially if you are supported by your close ones. It is recommended that you take your personal toilet necessities, books, newspapers, jogging suit, bottled water, something to eat (e.g. wafers or biscuits) to the hospital with you. Probably the blood test will be repeated, the doctor will examine your general condition and check the activity of a cardiac muscle by doing electrocardiographical examination. In the evening you will receive a pill or an injection that will make you sleep soundly. You should eat light meals the day before the bone marrow donation. Eat your supper around 18.00 and abstain from food until after the procedure.

filtering bone marrow

Zero hour...

Get up! It's morning! Time for the ride! The nurses bring you to the operating room. Don't be afraid. There are many people inside, all dressed up in green or white aprons. Everything is done to make sure you are safe. The nurse puts a needle in your arm vein, through which the medicine will be transferred to your body. The anesthesiologist will be with you until the end of the procedure. It is the anesthesiologist who orders the nurses to administer anesthesia. You do not notice when you fall asleep. You feel that your eyelids are heavy, you want to say something but you are unable to say a word.

What happens when you sleep...

After you fall asleep the anesthesiologist inserts a tube into your trachea to administer oxygen and anesthetic during the harvesting. You are connected to the apparatus that control the work of a heart muscle, the oxygenation of blood, the blood pressure. When the anesthesiologist confirms that your life parameters are stable, you are turned back up and the bone marrow harvesting begins. The bone marrow is harvested from the back upper crest of a pelvic bone (located a bit over the buttock) by repetitive sucking and aspiration of the bone marrow. The bone marrow is harvested by two doctors and two others pour it into the special bag. Each time the syringe needle is pulled out of your body, the "harvesting" doctors give the exact quantity of the bone marrow collected from you for the nurse to register. No milliliter of bone marrow may be overlooked. The harvesting takes up to 60-90 minutes and 1000 to 1500 ml of bone marrow is collected form the donor. The quantity of bone marrow harvested depends on the weight of the donor and donee. No more than 20-25 ml of bone marrow per each kilogram of the donor's weight may be harvested. After the harvesting, the doctor puts a dressing on the injected spots, then the donor is lain on his/her back. The only marks left on your body are the spots where the needle entered into the body, these will disappear within the next couple of days. The anesthesiologist begins to wake you up.

bone marrow harvesting

Coming back...

You are not able to open your eyes. You hear strange sounds, you don't remember what to associate them with. You are swimming... Someone is talking to you. "It's over!". But what's over? - you think. You open your eyes, you see glaring light and many people. Your first thought: "I see, I'm awake". You come back to reality. The anesthesiologist administers oxygen. You get the drip of your own blood taken form you two weeks ago. You may feel a bit cold and dizzy. The anesthesiologist makes sure everything is back to normal. The ride through the hospital halls again. You go to postoperating room. You stay there for around 2-3 hours and then are moved back to your room. You may meet your friends and family. After you have enough of lying in your bed, you go to the toilet (be careful with vertigos - it's better to be accompanied by a relative or a nurse) and in general, come back to the real world. From time to time a doctor or a nurse drops in to ask how you feel. In the afternoon you get really hungry: don't get embarrassed. Eat as much of you wafers of biscuits as you need! Resign form the heavy meals that may be brought to the hospital by your family. If you are well and there are no contraindications, you are released home the same day in the evening (or the next morning at the latest)

What next???

During the next couple of days after the harvesting the injection spots may feel a bit painful. Take some painkiller and rest. The majority of donors do not complain about any disorders. For 2-3 days you should take showers instead of hot baths. Do not take aspirin (as it stops the functions of platelets), aspirin-containing products or ibuprofen unless recommended so by your doctor (this recommendation is to be obeyed in the period of a few days before the harvesting as well). Avoid swimming in a pool, heavy physical effort and sports. Drink 6-8 glasses of liquids a day, take iron and folic acid as recommended by your doctor. After 3 days you may come back to work and your hematological parameters will stabilize within the next couple of weeks.

What happened to the bone marrow?

The harvested bone marrow is filtered for separation of small bone elements and other unnecessary material, it is put through the filter to separate the clods of cells and placed in the transplantation bag. If the donee has different blood type than yours, the bone marrow has to undergo one more phase - the red blood cells or the plasma have to be eliminated. The bone marrow must be administered to the donee as soon as possible, within 24 hours would be optimal. Otherwise the bone marrow has to be frozen.

The end

This is the end. It wasn't that terrible, was it? You have slept over the main part of what's happened, anyway. Nevertheless, many of your friends and those you know think, you are a hero. And they are right. You are a hero. You have given away the part of yourself selflessly and anonymously to someone else. This is one of the most beautiful things that may happen in your life. We admire you, we admire your courage, the way you feel, your humanity. If your donee will undergo the bone marrow transplantation successfully, after one year you may meet him//her. But this is not compulsive. Such meeting is arranged only if both parties wish to meet.

Epilogue

They have experienced bone marrow harvesting.

Iwona - the bone marrow donor form Urszula Jaworska's Foundation
"Bone marrow harvesting is associated with one memory in mind. Fact and regret that I actually can't remember anything. I came to the hospital on the harvesting day and was put to bed at once. I can't even remember the moment I fell asleep. I don't know when the needle was put in my arm. I have a vague memory of doctors and nurses bustling about around me and then just sleeping. The only unpleasant moment was waking up from anesthesia and taking off the tube form my trachea. The rest was a pleasure. Four hours after the bone marrow harvesting I was walking around the hospital hall (I couldn't bear the children making noise in my room - I was located at the Children Surgery Ward) and in the evening I was back home. I could sleep peacefully in my own bed. And the next morning the usual life began...like every other day."

Marek - the bone marrow donor from the Urszula Jaworska's Foundation
"Everything went on so quickly. The doctor's examinations, giving away in two parts 800 ml of my blood to be infused during the bone marrow harvesting and the great kindness of the doctors from the Bone Marrow Hematology and Transplantation Clinic of the Silesian Medical School in Katowice, where, at my request, the harvesting was performed. I stayed at the hospital for 7 days - 3 days before and 3 days after the harvesting (at present the donor stays at the hospital for 1-2 days). It is difficult to describe the harvesting itself, as it is done under general anesthesia and the period from 8 am till 11 am of the day is cut out of my memory. When I woke up around 13 I saw my wife, doctor Krawczyk and professor Hołowiecki, both of who did the harvesting, at my bed. It may sound strange but one of the fist sentences I said was: "...it's over? Impossible, I have just been taken to the operating room." But it's true. The recovery period, in the course of which I have taken the vitamine preparations took up 14 days in my case. Then I returned to my usual professional activities. I suppose it would be shorter but the doctors had to harvest about 600 ml of my bone marrow more, as my donee Paweł has unexpectedly put on his weight a dozen or so kilograms and the quantity of bone marrow harvested must be proportional to the donee's weight. I admit I have felt real joy after two weeks when I found out that my bone marrow was accepted by Paweł's body and, form the medical perspective, Paweł should recover. I wish that everyone could experience such moment that I once compared to a feeling of a woman that gives birth to her child."

Created by: Iwona Świerczek-Bażańska
Medicial consultation: doctor Jacek Toporski

Translation: Maria Kukawska