Matches made in bone marrow banks
Both Jews and Arabs whose names are listed in their respective bone marrow registries are willing to donate to save the life of a perfect stranger.
By Avigayil Kadesh
Only about 1.2 million of the world's roughly 400 million ethnic Arabs live in Israel, yet the sole registry for Arab bone marrow donors is located in Jerusalem's Hadassah-Hebrew University Medical Center. Bone marrow transplanted from a genetically matching donor may be effective against blood cancers and a variety of genetic diseases.
Arab registry director Amal Bishara, an Arab woman with a Ph.D. in microbiology and immunology from Hadassah, has traveled to 60 Arab communities since the registry was created in 2008 as an offshoot of the hospital's 22-year-old Jewish registry. Through lectures, publicity campaigns, newspaper articles and social media, Bishara has brought in 9,000 registrants resulting in six donations.
But before she can collect samples - often with the help of her family or a cadre of retired Arab nurses - she must sell the concept of unrelated, anonymous donors. Since Arabs frequently marry relatives, at least 60 percent of patients find matches within their own extended families (on the flip side, about 90 percent of Arab requests for bone marrow transplants are for children with genetic diseases resulting from consanguineous marriages). Hadassah previously had little success in recruiting Arab registrants. Thanks to Bishara, attitudes are changing.
"A small [Arab] girl needed a transplant recently and our phone did not stop ringing," Bishara relates with obvious pride. "People want to participate. Now my emphasis is on getting university students to join because they are committed, young and healthy." Her overall goal is 50,000 registrants.
Get aware, get tested
About 15 million people are registered globally, says Dr. Shoshana Israel, head of Hadassah's bone marrow registry and tissue typing laboratory. "However, each ethnic population presents different tissue types, and you have to try to find a population most suitable for each patient," for example Druze and Bedouin Arabs or Georgian and Yemenite Jews. "Otherwise," continues Israel, "the chance of finding donors is very low. So we have to get people aware and tested."
Part of that awareness is accepting that the identity of the recipient is not revealed, and that an Arab might be a match for a Jew and vice versa. Anyone who balks at these conditions is not tested. As a result, few potential donors fail to follow through if they turn out to be a match.
"The donors are really angels," says Israel. "Even though it's not a huge operation, donating is not a trivial thing. Arabs and Jews alike are willing to go through the process just to save the life of someone they don't know."
Usually, the marrow stem cells are extracted from blood, rather than from bone marrow. After receiving injections to raise their stem cell count, donors are hooked up to an apheresis machine that harvests stem cells as the blood flows from one arm to the other. In cases where actual marrow is needed, it is extracted from a hipbone with a surgical syringe.
"We are very excited whenever we find a match," says Bishara, who was herself a backup donor for a 24-year-old female patient. "I often accompany donors through the whole process, and it actually changes their lives. One 19-year-old girl said it was the first time she felt she did something good in her life."
Cord blood bank in the works
Hadassah's was the first Israeli marrow registry, established by Prof. Chaim Brautbar and now including more than 75,000 potential donors. The non-profit Ezer Mizion registry, the largest Jewish bone marrow registry in the world, has about 500,000. Another small one is based at Sheba Medical Center near Tel Aviv.
"We are also working on the cord blood bank in parallel," says Israel. “If we don't find a donor from the marrow registry we might do better with cord blood, because it does not require a perfect match. That's a big advantage for minority populations like the Bedouins, where we don't have enough donors because we haven't had the budget to test them."
Hadassah and Sheba maintain public cord blood registries of samples banked by the organizations Magen David Adom and Dor Yeshorim.
In the past two years, Hadassah started using the simpler and less-invasive cheek swab method of acquiring tissue samples, rather than drawing blood. The fastest and most cost-effective way of processing the swabs is to send them to specialized labs in the United States. Even accounting for travel time, this procedure adds names to the registry as quickly as possible.
Funding is a chronic concern, and Brautbar spends much time soliciting overseas contributions - which can be earmarked for the Arab project if that is the desire of the funder. Israel and Bishara rarely have the budget for large testing drives. Instead, they reach out to specific patients' ethnic communities. But mass recruitment would allow for more and faster matching in Israel and other countries where transplants are done.
"When I explain that because of our unique genetics we only find matches for 10 percent of the Arab population without a family donor, that convinces people that we need them," Bishara relates. "It's a good experience and once people know it doesn't harm them they will be encouraged to join the registry and give a donation if they're matched."