Pretransplant counseling

Both patient and donor arecompletely evaluated before stem cell transplantation. The evaluation shouldcomply within guidelines established by the Food and Drug Administration(FDA), Foundation for the Accreditation of Cellular Therapy (FACT), andother regulations and should be available in written form specific to yourinstitution. Both patient and donor evaluations include a thorough historyand physical examination and a series of studies to confirm medicaleligibility.

Treatment recommendationsshould be discussed thoroughly with the patient, donor, and family. Themarrow graft procedure as well as alternative forms of therapy, as far asthey exist, should be presented as objectively as possible. The risks andhazards of stem cell mobilization and the donation procedure and any otherprocedures associated with the donation must be explained to the donor aswell as to the patient or, in the case of minors, to the donor or patient’sresponsible family member. Plans for protection of fertility are alsodiscussed at this time. Reading material, videos, and other educational aidsare helpful and should be available. In addition, a discussion of patientwishes regarding aggressive supportive measures (i.e., cardiopulmonaryresuscitation, mechanical ventilation, other artificial means of lifesupport) and establishment of a living will or other advanced directivesshould be included in these discussions. It is important to point outspecifically that some aspects of hematopoietic stem cell transplantation(HSCT) are still considered experimental. We strongly recommend thatpatients undergo a psychosocial evaluation and that financial aspects of thetransplant are discussed with the patient and his/her family beforetransplantation.