DULUTH — Swab your cheek, save a life.
That was Miranda Sweely’s dream when she attended a bone marrow drive three years ago. But she never expected to get an email that she was a match.
“I swabbed it and I remembered a friend of my dad had leukemia,” Sweely said. “Well, god if I can help someone like that, then I would totally go for it.”
Then on Aug. 24, Sweely, now a staff nurse at St. Luke’s hospital in Duluth, got the notice: She was a match for someone with leukemia. After a series of blood tests, a physical exam and look into her medical history, Sweely flew out to a hospital in Washington, D.C., where she donated her bone marrow mid-October.
Under anesthesia, she had two doctors insert needles into her pelvis, at two sites in the small of her back. With each doctor alternating between their respective sites, they extracted fluid that would be transplanted into another woman later that day.
Sweely won’t know the success of the transplant for awhile. That’s the protocol for bone marrow donations. Despite that ambiguity, Sweely’s donation is special because finding a match for bone marrow is rare.
“Historically, it’s been hard to find (a match),” said Linda Burns, a medical director at the Center for International Blood and Marrow Transplant Research.
That’s because donated bone marrow has to be very similar to the patient in need of it. In a screening process called HLA typing, doctors try to match a potential donor’s bone marrow with that of the patient. While it’s preferred that donors be siblings of the patient, there is only a 25 percent chance that a brother or sister’s marrow will match. If that option is not available, then doctors will screen for unrelated donors. A study on donor selection said that even with a registry of 25 million donors worldwide that’s been increasing since 1986, finding a match can take months.
If a donor is identified, there is a lengthy process like the one Sweely went through when she was notified of her status. At the same time, patients seeking a transplant must undergo chemotherapy because the cancer has to be in remission before the body can accept new bone marrow.
“Once it’s in remission, we don’t want to wait to do HLA typing because time is of the essence,” said Anne Skwira-Brown, a nurse practitioner at Essentia Health. “It’s important once they are in remission so they don’t relapse early or have something else come up.”
It was at this stage when Sweely had committed to donating bone marrow she learned of the risks to the person who was sick if she were to get cold feet.
“At that point, you can back out but they (physicians) explicitly state if you back out at anytime after you do the blood work and say you’ll do it, the recipient of your bone marrow is going to die,” sad Sweely.
Skwira-Brown said success comes in many forms. Even if all the pieces fall into place and bone marrow is successfully moved from donor to patient, what happens next presents a new wave of struggles.
“There are some people whose cancer is gone and we can’t detect it and have no side effects,” she said. “Some people have side effects that survived a disease that would have taken their life. Some people may die in the process while some people die waiting for a match.”
Patients will remain in the hospital for several weeks after a transplant due to the higher chance of getting an infection. After that several side effects can occur, including mouth sores, diarrhea, nausea, vomiting or hair loss, as well as lung, liver and bone problems.
The recovery for Sweely wasn’t easy either, with side effects after her surgery including bruising, back pain, increased fatigue and dropping blood pressure. Despite the process “afterwards kind of sucking,” she said she’d do it again in a heartbeat.
“It’s so weird because there’s like this huge level of trust between you and someone you’ve never met,” she said. “It’s just crazy what our bodies can do when you’re healthy versus when you’re sick. It’s crazy I can help someone who wouldn’t be able to overcome their disease and most likely die.”
Stories like Sweely’s are told every day. However, they aren’t equal for everyone. Race and ethnicity can be a key indicator for the chances someone finds a suitable match that meets the necessary requirements:
White European - 75-97 percent
Middle Eastern - 46-90 percent
African American - 19-76 percent
African - 18-71 percent
Those disparities are why the Be the Match National Donor Program continues to expand its outreach campaigns. Marketing to college campuses with a large population of diverse backgrounds and creating ad campaigns to seek out younger donors, the program can build awareness about the necessity for broadening its register.
“We’ve worked hard to increase the registry. There’s been significant growth since it started,” said Burns. “Every patient has a donor in this day and age.”