West African Bone Marrow Donor Ban, Arising From HIV Concerns, Under Reconsideration
The United States' two largest bone marrow registries are reconsidering a five-year-old ban -- implemented due to concerns about possible HIV transmission -- that precludes certain people who have lived in eight West African countries from donating their marrow. The shift comes after lobbying by a relative of a Nigerian born-man with leukemia living in Maryland who was unable to find a suitable donor because of the restriction, the Washington Post reports. Samuel Nwagbo, a 50-year old taxi driver who immigrated to Lanham, Md., outside of Washington, D.C., from Nigeria, had gone through five unsuccessful series of chemotherapy treatments and was in need of a bone marrow transplant. After a search for a suitable donor "among his relatives and the donor volunteer registries" failed, friends of his "tried to mount a donor drive" among the large Nigerian population that has settled in the region. But they "ran into" the registry ban, which prevents all people who have lived in the Western African countries of Nigeria, Cameroon, the Central African Republic, Chad, Congo, Equatorial Guinea, Gabon or Niger after 1977 from serving as donors. The ban, which followed a similar 1996 FDA recommendation for the nation's blood banks, was implemented because a strain of HIV known as HIV-1 Group O, which is different from the prevalent U.S. strain, is found in these countries, and the "only way to determine" whether donors who lived in these nations are "free of [this] strain ... is to use a test, called Western blot, that is too time-consuming and labor-intensive to be used in mass blood screenings," the Post reports.
Dialing Through Bureaucracy
Believing the ban unnecessary, Nwagbo's distant cousin, Joseph Nnadike, who is also a physician, set out to convince donor officials to lift the restriction, "reason[ing]" that the Western blot test was an effective and practical tool for screening bone marrow donors. The Post reports that while the West African ban may make sense for blood donors, bone marrow donors "must undergo much more detailed screening before their tissue can be transferred to another person," thereby making the Western blot test "appropriate" in these circumstances. Nnadike "dialed his way through the donor system bureaucracy" and got Dennis Confer, chief medical officer for the National Marrow Donor Program, the nation's largest registry, to listen. Confer, who noted that Nnadike was the first person to "complain" about the rule, "agreed to waive the ban in Nwagbo's case," and is now considering whether to end it, a policy change also being weighed by the Caitlin Raymond International Registry, the nation's second-largest donor registry. Discussing the 1996 decision, Confer said, "We frequently follow the same rules that are set for blood donors. And we adopted the (West African ban) without realizing that it really had an impact on a particular ethnic group." The Post reports that the removal of the ban "could be a major boon to immigrants" from the West African countries because "patients have a dramatically higher chance of finding a matching donor within the same ethnic group" -- "at least" a 50% success rate for those who go through the National Marrow Donor Program. Even though Confer agreed to waive the ban for Nwagbo, the decision came too late for him to "wait for the results of the donor drive," and he was forced to undergo a "risky transplant" from one of his sons, giving him only a 5% chance of success as opposed to a 20% to 30% chance from a "better match." Nnadike said, "There's no words to describe the necessity" of lifting the ban. "It will save many, many lives" (Aizenman, Washington Post, 7/26).