Practice patterns for evaluation, consent, and care of related donors and recipients at hematopoietic cell transplantation centers in the United States

Abstract

Conflict of interest may arise when 1 physician serves 2 persons whose medical care is interdependent. In hematopoietic cell transplantation (HCT) from unrelated donors and in the setting of solid organ transplantation from living donors, the standard of care is for donors and recipients to be managed by separate physicians to provide unbiased care. However, the practice patterns of evaluation and care of related donors and recipients are not well described. A survey of HCT centers in the United States was conducted by the Donor Health and Safety Working Committee of the Center for International Blood and Marrow Transplant Research to determine the type of provider involved in medical clearance, informed consent, and medical management of hematopoietic cell collection and the relationship of that provider to the HC transplant recipient. The response rate was 40%. In greater than 70% of centers, transplantation physicians were involved or potentially involved in overlapping care of the HC transplant donor and the recipient. These patterns were similar between transplantation teams caring for adult or pediatric donors and recipients. Among responding centers, medical management of recipients and their related donors by the same provider is common, a practice that has the potential for conflict of interest.

Figure 1

Characteristics of responding and nonresponding centers. (A) Distribution of transplantation volumes at responding and nonresponding centers. (B) Geographic distribution of responding and nonresponding centers. US regions: NEng indicates, New England; Mid-Atl, Mid-Atlantic; So-Atl, South Atlantic; ENC, East North Central; ESC, East South Central; WNC, West North Central; WSC, West South Central; Mt, Mountain; and Pac, Pacific.

Figure 2

Provider responsible for donor care. (A) Providers associated with the transplantation team (transplantation physician, midlevel practitioner, or nurse); providers not associated with the transplantation team (internal/family medicine physician, hematology/oncology physician, or pediatrician). (B) Involvement of donor's provider in care of the recipient.

Figure 3

Effect of center volume on donor care patterns. (A) Role of provider responsible for donor medical clearance in care of recipient. (B) Role of provider managing donor medical care in care of recipient.