The National Marrow Donor Program (NMDP) projects the need for allogeneic unrelated blood and marrow transplants (BMT) in the United States is 10,000 per year. While the NMDP is preparing to facilitate that number by 2015, there are a number of barriers to meeting this need including recruiting additional health care personnel including BMT providers. To learn how best to recruit BMT physicians, we sought to understand why practicing BMT physicians chose to enter BMT, and why others did not. We conducted a web-based survey amongst Pediatric Hematology/Oncology (PHO) and BMT physician providers and trainees to determine the factors influencing their decision to choose or not choose a career in BMT. There were 259 respondents (48% male, 74% of Caucasian origin); 94 identified as BMT physicians, 112 as PHO physicians and 53 as PHO trainees. PHO and BMT providers spent an average of 53% in clinical activities. More than 2/3 of PHO providers stated that they provide BMT services at their institutions, most commonly inpatient coverage (73%). The proportion of providers exposed to BMT early in their training was significantly higher amongst BMT providers than PHO providers (51% vs. 18% during medical school [p<0.0001] and 70% vs. 50% during residency [p < 0.005]). Exposure during fellowship (94%) did not differ amongst groups. The decision to pursue a career in BMT was made before fellowship (medical school or residency) in 50% of the respondents. A lower proportion of BMT providers reported currently being involved in education of medical students and residents compared to PHO providers (98% vs. 76%, p<0.0001). Of 53 trainees, 64% reported that they were not contemplating a career in BMT. Of these, 68% stated that inadequate exposure to BMT prior to PHO fellowship was the reason. Only 26% reported BMT exposure in medical school and 43% during residency. The two most common reasons for the choice of a BMT career were the degree of intellectual and scientific challenge (89%) and role models/mentors in the field (67%). This survey suggests that early exposure to BMT during medical school and residency results in increased interest in pursuing a career in BMT. BMT physicians and training program directors can foster interest in the BMT field by promoting BMT focused education and clinical inpatient and outpatient rotations during medical school and residency. This early exposure to BMT may aid in a higher recruitment of future transplant providers.

The National Marrow Donor Program established a cord blood banking program in 1999. Currently, 14 U.S. banks have joined the network. A steering committee comprised of bank directors, laboratory supervisors, ethicists, obstetricians, scientists, transplanters and experts in information technology and regulatory affairs and ad hoc representation from HRSA and the Navy was established and meets on a quarterly basis. The purpose of the committee is to advance cord blood transplantation, improve clinical practice and improve patient outcomes. Over the past 18 months, the committee established common standards for donor recruitment and screening, cord blood collection, testing, processing, cryopreservation and storage. Eligible cord blood units are listed on the NMDP donor registry which provides search management, patient advocacy, confirmatory typing and donor reservations. The Registry also facilitates distribution of the cord blood units to the transplant centers, acquires post transplant follow-up data and provides this data back to the banks for their internal quality assurance and regulatory reporting requirements. The NMDP also holds contracts with over 150 transplant centers performing unrelated donor transplants, oversees quality and manages billing for donor procurement. The initial goals of the NMDP banking program were to standardize banking practices among member banks. Five subcommittees were established to address Collections, Quality Standards, Research, IS/IT, Research and Economies. These committees established uniform standards for donor selection, collection, processing, testing and banking; criteria for assessing congenital anomalies and infant health; an inter-bank proficiency program; an eye-friendly search report through TRANS Link and cord blood unit report through CORD Link; improved data outcomes reporting system and incorporated FDA requirements for eligibility determination and cGTPs into screening documentation and labeling. A preliminary research agenda was also developed. A commitment to apply for mandatory accreditation by 12/05 was adopted by all member banks. Criteria were established for a cord blood unit to qualify for listing in the NMDP registry and included a minimum total nucleated cell count of 9 × 108 cells with minimal post processing viability of 90%, enumeration of NRBC and CD34 content, negative bacterial cultures, CFU growth, high resolution HLA typing for DRB1, testing for hemoglobinopathies and a minimum of 2 attached segments on the bag in which the unit was cryopreserved. Collection criteria were standardized to exclude multiple births; gestational age <34 weeks; a history of cancer, immune or blood disorders in a first degree relative; and the presence of congenital anomalies associated with congenital blood disorders on the newborn physical examination. The NMDP inventory now contains approximately 40,000 cord blood units. Thirty-six percent of the donors represent ethnic minority backgrounds. Approximately 500 units have been shipped for transplant to date. Current barriers to collection and banking were reviewed with their potential solutions. In conclusion, the NMDP banking network functions as a program within the NMDP employing common standards for cord blood donors, collection, processing and storage listing on a single registry in combination with volunteer adult donors. Oversight is provided by HRSA. The recent affiliation with the CIBMTR will enable the research agenda. Efforts over the next years will focus on increasing collections, establishing protocols for clinical research and obtaining accreditation for all participating banks.

The majority of patients in need of a bone marrow or stem cell transplant do not have a matched related family member to serve as their donor. Over 17 years ago, the National Marrow Donor Program was established to provide a registry of volunteer adult unrelated donors for patients in need of a hematopoietic stem cell transplant. The NMDP lists >5,000,000 adult donors and has facilitated >20,000 transplants to date. Despite this success, approximately 30% of Caucasian and 80% of African American and Asian patients are unable to find a suitably matched adult volunteer donor. Over the past 11 years, studies have demonstrated that banked unrelated donor, partially HLA mismatched umbilical cord blood (UCB) could serve as an alternative source of hematopoietic stem and progenitor cells for allogeneic transplantation. UCB may increase access to transplantation therapy for patients lacking a matched donor, particularly those of ethnic or racial minority backgrounds. To date, approximately 14 public cord blood banks have been established in the U.S. creating a heterogeneous inventory of approximately 50,000 cord blood units (CBUs). Uniform standards were not followed by the different banks and all lack sufficient inventory of HLA diverse, large CBUs. Over the past year, 13 U.S. banks have voluntarily joined together to create a network of public cord blood banks as part of the NMDP. A steering committee was established comprised of cord blood bank directors, transplanters, experts in HLA, an ethicist, representation from FDA and HRSA with experts in information technology (IT) and administrative support from the NMDP. The committee adopted uniform standards for cord blood donor recruitment and screening, donor education and consent, medical histories, infectious disease and hemoglobinopathy testing, cord blood collection, processing, testing, cryopreservation and storage. Subcommittees for quality standards, collection, education, research, IT, economies, bank/transplant center interface and proficiency testing were developed with active ongoing agendas. Management systems for UCB donor searches, collection, analysis and distribution of clinical outcomes data back to the banks are being established. This NMDP Cord Blood Banking Network represents the first cooperative effort unifying the majority of public cord blood banks in the U.S. Importantly, all CBUs will be listed on a single web-based search registry providing easy access to all NMDP Transplant Centers. The majority of patients in need of a bone marrow or stem cell transplant do not have a matched related family member to serve as their donor. Over 17 years ago, the National Marrow Donor Program was established to provide a registry of volunteer adult unrelated donors for patients in need of a hematopoietic stem cell transplant. The NMDP lists >5,000,000 adult donors and has facilitated >20,000 transplants to date. Despite this success, approximately 30% of Caucasian and 80% of African American and Asian patients are unable to find a suitably matched adult volunteer donor. Over the past 11 years, studies have demonstrated that banked unrelated donor, partially HLA mismatched umbilical cord blood (UCB) could serve as an alternative source of hematopoietic stem and progenitor cells for allogeneic transplantation. UCB may increase access to transplantation therapy for patients lacking a matched donor, particularly those of ethnic or racial minority backgrounds. To date, approximately 14 public cord blood banks have been established in the U.S. creating a heterogeneous inventory of approximately 50,000 cord blood units (CBUs). Uniform standards were not followed by the different banks and all lack sufficient inventory of HLA diverse, large CBUs. Over the past year, 13 U.S. banks have voluntarily joined together to create a network of public cord blood banks as part of the NMDP. A steering committee was established comprised of cord blood bank directors, transplanters, experts in HLA, an ethicist, representation from FDA and HRSA with experts in information technology (IT) and administrative support from the NMDP. The committee adopted uniform standards for cord blood donor recruitment and screening, donor education and consent, medical histories, infectious disease and hemoglobinopathy testing, cord blood collection, processing, testing, cryopreservation and storage. Subcommittees for quality standards, collection, education, research, IT, economies, bank/transplant center interface and proficiency testing were developed with active ongoing agendas. Management systems for UCB donor searches, collection, analysis and distribution of clinical outcomes data back to the banks are being established. This NMDP Cord Blood Banking Network represents the first cooperative effort unifying the majority of public cord blood banks in the U.S. Importantly, all CBUs will be listed on a single web-based search registry providing easy access to all NMDP Transplant Centers.

Bone marrow transplantation can successfully treat patients with advanced malignancies, bone marrow failure syndromes, congenital immunodeficiency syndromes, hemoglobinopathies and inborn errors of metabolism. However the majority of patients in need of this therapy lack a matched related family member to serve as the donor. The National Marrow Donor Program was established 17 years ago to provide a registry of volunteer adult unrelated donors for patients in need of a hematopoietic stem cell transplant. The NMDP lists >5,000,000 donors and has facilitated >20,000 unrelated transplants to date. Despite this success, approximately 30% of Caucasian and 80% of African American patients are unable to find a suitably matched living volunteer adult donor.