Before her brother got cancer, Theresa To Siu-lai had never thought of or got in touch with bone marrow donation. “I had no concept [of bone marrow donation] and it is not common in Hong Kong,” she said.

 

But when Calvin To Wai-ho was diagnosed with leukaemia, Ms To was eager to be his match and donate bone marrow.

 

Ms To is only one of many public members who are unaware of or unwilling to participate in bone marrow donation due to various reasons, including lack of knowledge, unnecessary worries and misconceptions about the process of donation. They only realise its importance when someone nearby is diagnosed with blood cancer.

 

“Sometimes people are under pressure from family not supportive of the donation,” said Dr Joycelyn Sim Pui-yin. “Misconception about the risks of permanent damage after donation, worries about the adverse effect on work in terms of having to take days off and a long period to recover are also their main hesitations.”

 

Mr To, who is in recovery after gaining his sister’s bone marrow, said, “Many people are not conscious towards bone marrow donation and may be afraid of pain, but the current method of bone marrow donation has no risk.”

 

Nowadays, there are three methods of bone marrow donation. First is the traditional and surgical bone marrow donation, in which bone marrow of the anesthetised donor is extracted from his/her pelvic bones by needles and a syringe. Second is Peripheral Blood Stem Cell (PBSC) donation, a nonsurgical method used since 21st century, which collects bone marrow stem cells in donor’s circulating peripheral blood through a blood cell separator machine. Third is cord blood donation, which collects stem cells in a newborn baby's umbilical cord, but this is usually categorised separately from “bone marrow”.

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“The new [PBSC] donation causes less pain, with no wound,” said Ms To. Having two children, the fifty-year-old chose to undergo PBSC donation as she did not need to stay overnight in hospital. “It is not painful, just like blood donation.”

 

During the traditional bone marrow donation, the donor generally feels no pain as the procedure is carried out under general anaesthetic. The risk of complications is as minuscule as one in ten thousand. The process takes one to two hours. The donor will feel pain at the wound for up to two weeks after donation.

 

For PBSC donation, the donor is given injections of a natural hormone called Granulocyte-Colony Stimulating Factor (G-CSF) every day for three days before donation. This mobilises his/her stem cells from the bone marrow into the blood stream. G-CSF has a rare risk of complications, while the side effects may include flu-like symptoms, nausea and tiredness lasting for a few days.

 

“After completing thorough body checks, I was injected with several injections, including nutrients, to protect myself and as a precaution for my brother,” said Ms To.

 

Being a vegetarian, she turned to eat meat because of her brother. She also ate iron pills and homemade Chinese “five elements” soup to keep her body strong.

 

“I am not worried about the process since I have to donate anyway, but I am worried about the effects and rejection by my brother's body,” said Ms To.

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PBSC donation collects a donor’s stem cells from one arm, and returns the rest of the blood through another arm. It is completed in four hours and the donor may feel numb and tingling during the process. He/she will get recovered in one to two days.

 

However, Ms To’s case is different. She felt numb and uncomfortable because of her personal anaemia and menstruation period. “So it annoys to me,” she said, about how a female donor has more concerns than the male. “I feel weak and sore in hands and legs.”

 

“But it recovers fast after taking rest for one to two days,” said Ms To, who also took some pills because of her weaker health.

 

For both donations, only 3% of the donor’s bone marrow is collected from the process. Bone marrow will naturally regenerate and replace the donated cells in short period of time.

 

But PBSC donation cannot guarantee a one-off fix. “It depends on my supply of bone marrow stem cells and the demand of my brother who would need more if he was taller and fatter,” said Ms To, who was glad that the amount of her bone marrow was enough after donation in a morning while others may need to donate twice or more.

 

“Recovery is relatively fast,” said Henry Man Ka-yue, Manager in Recruitment and Publicity of the Hong Kong Red Cross Blood Transfusion Service. “While recovery times vary depending on the individual, most PBSC donors report a full recovery within seven to ten days of donation.”

 

“We hope the public will understand that bone marrow registration and donation isn't a strange idea,” said Mr Man. “We are also disseminating the message that making a registration is just so easy and simple.”

 

According to the Hong Kong Red Cross, members of the public who are aged between 18 and 60, and are in good health, can register for bone marrow donation at any blood donor centre. The registration process includes completion of a registration form, followed by a health screening and a sample of less than 5ml blood for laboratory tests.

 

While elder donors, like Ms To, may find it harder during donation because of their health and age, Mr Man said, “So we really rely on young people to increase the number of bone marrow registration.”

 

Yet, donation may never go far beyond registration, as most donors may never be approached for follow up tests. "Even if you register, it still depends on matching. It is as difficult as winning mark-six lottery,” said Mr Man.

 

Mr Man said they can’t see any particular reasons holding Hong Kong people back. “Traditionally, Hong Kong people are very keen on steering charity events,” he said, adding the importance of selfless contributions to save lives and deliver hopes. Therefore, he said they have to keep recruiting volunteers.

 

After donation, Ms To’s bag of bone marrow was immediately transfused to Mr To through a central venous catheter into his aorta in his chest, which is the transplant process.

 

Mr To feels positive towards the trend of bone marrow donation. He said nearly all of his fellow patients’ family members are willing to donate, and the general public would not resist with the nearly zero risk of PBSC donation.

 

“It is different to organ donation, as organs are donated after death. But it will not bring any loss to yourself,” Mr To said of bone marrow donation. “And it is more open because it is not related to [the donor’s] life and death, but it depends on match or not.”

 

Mr To believes 90% of people would be willing to donate while he is rather concerned about the insufficient promotion.