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PURPOSE: To characterize donor search and selection practices, the National Marrow Donor Program (NMDP) Histocompatibility Advisory Group developed a survey of allogeneic hematopoietic cell transplant (HCT) physicians and search coordinators. Objectives were to describe search practices, understand practices surrounding urgent time to HCT, and characterize strategies used when identifying a matched unrelated donor (MUD) is unlikely. METHODS: Participants included United States physician members of the American Society for Transplantation and Cellular Therapy (ASTCT) and donor search coordinators within the NMDP network. The web-based survey was conducted February to May 2018. RESULTS: A total of 317/858 physicians (37%) and 225/327 coordinators (69%) responded, of which 263 and 194 respectively were eligible and were included in the analysis. Most centers, 142 (95%) were represented; 108 (72%) had at least one physician and 128 (85%) had at least one coordinator respondent. Most (68% physicians, 61% coordinators) indicated donor selection decisions were made by individual physicians. Urgent time to HCT was most commonly (90 and 87%, of physicians and coordinators, respectively) defined as HCT within 4–6 weeks of search nitiation. Higher HCT urgency was associated with a higher disease risk index. For urgent cases with low probability of an 8/8 MUD, 75 and 80% of physicians and coordinators endorsed short (1–2 weeks) unrelated donor search before proceeding to an alternative donor source. NMDP-provided solutions to expedite donor identification were strongly endorsed. CONCLUSIONS: This survey clarified current donor selection practices in the United States and defined urgent time to HCT. These data provide insight to NMDP on potential solutions to support the path to transplant, such as highlighting futile searches and providing alternative donor options at the time of search initiation.

Hematopoietic cell transplantation (HCT) is a complex procedure that requires availability of adequate infrastructure, personnel, and resources at transplantation centers. We conducted a national survey of transplantation centers in the United States to obtain data on their personnel, infrastructure, and care delivery models. A 42-item web-based survey was administered to medical directors of transplantation centers in the United States that reported any allogeneic HCT to the Center for International Blood and Marrow Transplant Research in 2011. The response rate for the survey was 79% for adult programs (85 of 108 centers) and 82% for pediatric programs (54 of 66 centers). For describing results, we categorized centers into groups with similar volumes based on 2010 total HCT activity (adult centers, 9 categories; pediatric centers, 6 categories). We observed considerable variation in available resources, infrastructure, personnel, and care delivery models among adult and pediatric transplantation centers. Characteristics varied substantially among centers with comparable transplantation volumes. Transplantation centers may find these data helpful in assessing their present capacity and use them to evaluate potential resource needs for personnel, infrastructure, and care delivery and in planning for growth.

Introduction Unrelated donor search and selection practices by hematopoietic cell transplant (HCT) physicians and search coordinators are not standardized across centers, and what defines urgent TtT is not well understood. Objective To evaluate donor search practices, HCT urgency definition based on disease risk, and strategies utilized in the event of a low likelihood of identifying an HLA 8/8 matched unrelated donor (MUD). Methods From February-May 2018, NMDP's Histocompatibility Advisory Group conducted a web-based survey of ASBMT-member physicians and search coordinators in the United States (US). Results A total of 317/904 physicians (37%) and 225/333 coordinators (68%) responded. Most centers (95%) were represented; 72% had at least one physician and 85% at least one coordinator respondent. There were no statistically significant differences between physician and coordinator responses. Most (77%) indicated that donor selection decisions were made by individual physicians. Uniform use of a selection algorithm (11%) or a single decision maker (7%) for the program was uncommon. Urgent TtT was most commonly (89%) defined by respondents as HCT occurring within 4-6 weeks of search initiation (Figure 1), although 65% indicated that physicians also have individual systems to determine urgency. Higher physician-perceived HCT urgency was associated with higher disease risk index; for example, for acute myeloid leukemia (AML), 27%, 60% and 86% of physicians indicated TtT of 90% agree/strongly agree) of respondents reported good communication among physicians and search coordinators regarding desired TtT, preferred donor type, and alternatives when the preferred source was unavailable. Conclusions This national survey clarified current donor selection decision making practices in the US and defined urgent TtT. These data provide insight to NMDP on potential solutions to support the path to transplant, such as highlighting futile searches and providing alternative donor options at the time of search initiation.