Matched unrelated donor attrition in a stem cell registry: What makes people break their commitment?

Background and Objective: Increment in voluntary stem cell donor registrations has led to an increase in the chances of a patient finding a perfect match for matched unrelated donor (MUD) hematopoietic stem cell (HSC) transplant. However, it has been seen multiple times that the donor's passion to donate HSCs is short lived. They register with a strong commitment, however, when they are approached to donate, they back out. This write-up is an attempt to quantify and analyze the rate and reasons of MUD deferral in a stem cell registry from North India. Methods: Registered volunteer stem cell donors who backed out after getting matched were interviewed to understand the reasons behind their deferral. Key steps taken for sustaining the passion of registered donors included amendments in the donor recruitment process and maintaining constant communication with the recruited donors. Results: The attrition rate of the registry for final donation during the studied period was 22.91%. A total of 22 cases of donor deferral were observed. Among these, 15 donors (68.19%) who backed out were female and 7 (31.81%) were male. There were three main reasons observed behind this attrition, namely personal reasons, medical reasons from the donor side, and medical reasons from the patient side. Conclusion: To minimize donor deferral, various new strategies could be implemented such as requesting the participation of experienced donors in counseling sessions, requesting guardian's involvement in case the donor is a teen or is in their early twenties (between 18 and 25 years), and requesting the name of the person they consulted before signing up for donation.