The Donor Demographic Information section is to be completed for all non-NMDP allogeneic donors / CBUs. If the stem cell product was from an NMDP donor or an autologous donor, submit the form.
Question 134: Was the donor ever pregnant?
Report if the donor was ever pregnant. If there is no documentation regarding whether the donor has ever been pregnant, select Unknown.
Questions 135 – 136: Number of pregnancies
Indicate if the number of pregnancies is Known. If Known, specify the total number of pregnancies.
If the total number of pregnancies is not documented or cannot be determined, report Unknown.
Questions 137 – 138: Geographic ancestry (select one or more options that closets identifies the donor’s background.)
Indicate the geographic ancestry and geographic ancestry detail of the donor, select all that apply.
Report the geographic ancestry as Not otherwise specified in the following scenarios:
- The race, ethnicity or ancestry is unknown.
- The race, ethnicity or ancestry is not documented or lack of documentation.
- The race, ethnicity or ancestry is known but does not fit one of the options available on the form (i.e., source documentation notes the race, ethnicity, or ancestry as ‘other,’ ‘two or more races’ (the specific races are not noted) etc.).
Report the geographic ancestry as Prefer not to answer in the following scenarios:
- If the patient declines to provide their geographic ancestry.
- If the patient is not a US resident and the country’s rules / regulations prohibit the collection or reporting of race, ethnicity or ancestry.
For more information regarding race, see Appendix I: Race, Ethnicity and Ancestry.
Question 139: Was the donor a carrier for potentially transferable genetic diseases?
Specify if the donor was a carrier for a potentially transferable genetic disease. If the donor was not tested, or if there is no documentation of genetic testing, select No.
Questions 140 – 141: Specify potentially transferable genetic disease (check all that apply)
Indicate the potentially transferable genetic disease for which the donor is a carrier. If the donor was a carrier for a potentially transferable disease, but the disease was not listed, select Other disease and specify. Only genetic diseases that are transferable (from donor to recipient) should be reported. Chagas and WNV (West Nile Virus) should not be reported as a potentially transferable genetic disease as they are examples of infections and not a genetic disease.
Submit a ticket through CIBMTR Center support regarding questions about transferable genetic diseases.
Question 142: Was the donor / product tested for other transferable genetic or clonal abnormalities?
Specify if the donor / product was tested for other transferable genetic or clonal abnormalities.
If this is a related donor and / or the donor / product were not tested, or if there is no documentation of genetic testing, select No or Unknown, respectively and submit the form.
It should be noted for cord blood unit transplants that almost all units are screened, or the infant is screened, for potentially transferable genetic diseases. This may be documented as a ‘hemoglobin screen,’ which evaluates for sickle cell disease and / or thalassemia, both of which are considered hemoglobinopathies.
Questions 143 – 146: Specify transferable genetic and / or clonal abnormalities tested
For each of the genetic or clonal abnormalities listed, indicate whether testing was done and specify the method of. Do not leave any responses blank. If the donor was tested for a potentially transferable genetic or clonal abnormality, but it was not listed, select Yes for Other transferable genetic or clonal abnormality and specify.
Question 148: Did this donor have a central line placed?
This question only applies to non-NMDP PBSC donors. Indicate if the donor had a central line placed during the donation process.
Question 149: Was the donor hospitalized (inpatient) during or after the collection?
Indicate if the donor was hospitalized for complications during or after the collection. If the donor was not hospitalized as an inpatient or if the donor was admitted to an observation unit and discharged in less than 24 hours, report No.
Questions 150 – 151: Did the donor experience any life-threatening complications during or after the collection?
Examples of life-threatening complications include, but are not limited to the following:
- Allergic reaction to filgrastim
- Reaction to anesthesia
- PBSC donors: Low platelet counts (<30,000)
- Marrow donors: Injury to bone, nerve, or muscle during collection
Many of these criteria are outlined by the Common Terminology Criteria for Adverse Events (CTCAE) and would be reported as a Grade 4 or higher adverse event. For more information on CTCAE complications that can be reported, see the published criteria at: https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm.
If the donor experienced life-threatening complications during or after the collection, select Yes and specify the complication(s).
If the donor did not experience life-threatening complications during or after the collection, select No.
Questions 152 – 154: Did the allogeneic donor give one or more autologous transfusion units?
If the allogeneic donor gave one or more autologous transfusion units, select Yes, and specify the date of collection of the first unit and total number of units collected. If the donor did not give autologous blood transfusion units, select No.
Questions 155 – 157: Did the donor receive blood transfusions as a result of the collection? (check all that apply)
Indicate if the donor received blood transfusions as a result of the collection. If the donor received transfusions of their own blood that had been previously collected and stored, even once, indicate Autologous transfusions and specify the number of units received.
If the donor received blood transfusions (excluding autologous blood product), indicate Allogeneic transfusions and specify the number of units received.
If the recipient did not receive blood transfusions as a result of the collection, select No.
Questions 158 – 159: Did the donor die as a result of the collection?
Indicate if the donor died as a result of the collection. If Yes, specify the cause of death.
Section Updates:
| Question Number | Date of Change | Add/Remove/Modify | Description | Reasoning (If applicable) |
|---|---|---|---|---|
| . | . | . | . | . |
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