RECRUITING OVER 45: THE REASONING BEHIND OUR 45-YEAR-OLD AGE CUTOFF FOR NEW DONORS
We get asked a lot why we won’t register donors over the age of 45. And that’s great! We’re so excited that people of all ages are interested in joining the SABMR. Unfortunately, in our current capacities, we can’t recruit donors over the age of 45. Here’s why:
Younger stem cells are better for patients
When a patient gets a bone marrow transplant, they’re actually receiving healthy stem cells so that they can start producing normal, healthy blood. The first key point is that stem cells have finite lifespans. Fun fact: that’s actually why we get wrinkles when we age; our stem cells are really helpful in nourishing our skin, and as they age, they don’t produce as many of those important nutrients our skin needs.
In regard to bone marrow transplants, a stem cell’s single lifespan continues on even when that cell is transplanted to another body. Therefore, we want to give our patients the youngest stem cells possible, so that those stem cells still have a long lifespan ahead of them when the patient receives them. This is especially true when we’re dealing with our youngest child patients. If you were giving food to child who was hungry, you wouldn’t want to give them something that has been in the cupboard for a long time and is starting to go a bit stale. You’d want to give them something fresh and nourishing.
The second point is that older donors, even if they are generally in good health, have a higher chance of hitting one or more of our exclusionary criteria, or certain conditions that disqualify someone from being a donor. That’s because a lot of the things on that list are conditions we become more at risk for as we age. Even manageable health conditions like diabetes and rheumatoid arthritis are on the list. We want to be recruiting donors with the highest chance of passing the extensive medical authorization a donor must clear to donate to a patient in need. If you’re interested in checking out our exclusionary criteria, click here.
The third point is the most important one: there’s a lot of medical research out there demonstrating that using younger donors is directly related to higher patient survival, more so than any other donor factor like gender or race. One 2018 study on donor selection factors cited that “the only donor factor consistently associated with patient survival in the testing sets was donor age” (Shaw et. al., Development of an Unrelated Donor Selection Score Predictive of Survival after HCT: Donor Age Matters Most). That’s why we love younger donors, and why, if you are young, you shouldn’t wait to register! To sign up, click here, call (021) 447-8638, or email donors@sabmr.co.za.
But don’t let this discourage you if you are over the age of 45 and still on our registry. There’s still a possibility that you will be contacted to be a donor if a younger match isn’t available. Until you turn sixty and are removed from the registry, you still have the chance to save a life!
It’s more financially sensible
The health of our patients is our biggest priority, and that’s why we prefer to register younger donors. But finance also plays a role. It makes more “money sense” for us to pursue younger donors, and we’ll explain why:
Adding a donor to the registry costs money. How much? Well, about R 2,000 to R 2,500 per donor. It’s expensive because adding a donor includes a lot of steps, even before the tissue-typing test can be done. (Not sure what tissue-typing is? Click here). The costs of donor registration include:
- the raw cost of the sampling kit, including the swab materials, box and packaging, and written content;
- the shipping costs to the United States, where each sample is tested (because it is much cheaper to test in the United States than in South Africa);
- the actual cost of the tissue-typing test;
- staff salaries and other operational costs.
For health reasons, people over the age of sixty cannot be donors. Like we mentioned above, if you are a registered donor, you are removed from the registry when you turn sixty. That means that the younger you are when you sign up, the longer you get to remain on the registry. And more years on the registry means that you will be exposed to more patients over time and have more chances to save a life.
Take this example: a twenty-year-old and a 45-year-old join the registry at the same time. Because they are both healthy, qualified donors, they have pretty much the same chance of being identified as a potential match. But fifteen years later, the 45-year-old turns sixty and is removed from the registry, while our other donor is now only 35, and has 25 more years to be considered in a search. That’s why it makes more sense for us to spend that R 2,000 to R 2,500 on registering the twenty-year-old over the 45-year-old.
To help overcome this financial limitation, we’re looking into an alternative recruitment program for people over the age of 45 that would allow them to provide a financial contribution towards their own registration with the SABMR. The level of contribution would be dependent on the person’s age. For example, although both would be contributing, a donor between the age of 45 and 50 would pay less than a donor between 55 and 60. This self-funding, or copayment, model is still in the works, so we’ll have to stick with our 45-year-old cutoff for now.
We also have a lot of other costs to pay for to ensure that bone marrow donation can remain free for the donor. And we have our Patient Assistance Program, in which we help take on some of the financial burden for patients unable to pay for their donor search. All of that takes money, and we need to make sure we can fulfill our existing obligations to both patients and donors.
Donate to SABMR
We wish money didn’t have to play a role in donor recruitment, but unfortunately, we need to be sustainable. We run independently from the government, which means we rely completely on the funds that we can raise ourselves. More donations mean more capacity to save lives, and donating is a great way to be involved in our organization if you’ve already aged out of donor eligibility. If you’re interested in donating, click here.
