The javascript used on this site for creative design effects is not supported by your browser. Please note that this will not affect access to the content on this web site.
Skip Navigation
H H S Department of Health and Human Services
Health Resources and Services Administration
Blood Cell Transplant

A-Z Index  |  Questions?  |  Order Publications

Transplant Frequently Asked Questions

Answers to questions often asked by patients who are considering a bone marrow or umbilical cord transplant are on this page.

  • Questions about whether a patient and donor can meet each other, the people in need of a transplant, and the need for more marrow donors and cord blood units are answered at General FAQs.
  • If the answers to your questions are not here or elsewhere on this website, please send your question to feedback@hrsa.gov.

Understanding bone marrow and cord blood transplants

Deciding whether to have a bone marrow or cord blood transplant

Searching for a donor or cord blood unit

Getting Help

Understanding bone marrow and cord blood transplants

What is a bone marrow transplant?

A bone marrow transplant is a potentially life-saving treatment for people with leukemia, lymphoma and many other diseases. First, patients undergo chemotherapy and sometimes radiation to destroy their diseased marrow. Then a donor's healthy blood-forming cells are given directly into the patient's bloodstream, where they can begin to multiply and function.

For a patient's body to accept these healthy cells, the donor's tissue type needs to match the patient's type as closely as possible. Patients who do not have a suitably matched donor in their family may search for an unrelated bone marrow donor or donated umbilical cord blood unit through the registry of the C.W. Bill Young Cell Transplantation Program, also called the Be The Match Registry®. The registry is a listing of potential bone marrow donors and donated cord blood units and is operated under Federal contracts by the National Marrow Donor Program®.

Related Link: Understanding Transplant as a Treatment Option

What are blood-forming cells?

Blood-forming cells are one of several types of cells in your body that can grow into other types of cells. Blood-forming cells grow into red blood cells, white blood cells, and platelets, all of which are important for your body.

  • Red blood cells carry oxygen to all parts of your body.
  • White blood cells help your body fight infection.
  • Platelets help control bleeding.

A healthy body is always making new blood-forming cells. A person cannot survive for long without healthy blood cells.

Related Link: Understanding Transplant as a Treatment Option

Where do blood-forming cells used in a transplant come from?

The blood-forming cells can come from three sources: bone marrow, peripheral (circulating) blood, and the blood in the umbilical cord and placenta after a baby's birth.

  • Bone marrow produces blood-forming cells for the body. Bone marrow is a spongy tissue found inside larger bones. In a surgical procedure, doctors make several small incisions through the skin over the back of the pelvic bone to draw out the marrow.
  • Peripheral blood stem cells (PBSC) are blood-forming cells found in the bloodstream. Normally, the bone marrow releases only a small number of blood-forming cells into the bloodstream. To donate PBSC, a donor is given injections of a medication that makes the blood-forming cells move from the bone marrow into the blood. The cells are collected from the blood during an outpatient procedure, similar to plasma or platelet donation.
  • Umbilical cord blood is collected from the umbilical cord and placenta after a baby is born. This blood contains a large number of blood-forming cells. (These are not embryonic stem cells.) If the cord blood meets standards for transplant, it is stored at a public cord blood bank for future use.

Related Links: Understanding Transplant as a Treatment Option; Donating Marrow; Donating Umbilical Cord Blood to a Public Bank

What is an umbilical cord blood unit and how is it used in transplant?

An umbilical cord blood unit is the blood collected from the umbilical cord and placenta after a baby is born. Cord blood is rich in blood-forming cells. (These cells are not embryonic stem cells.) In a cord blood transplant, these healthy cells replace the diseased cells of patients with leukemia, lymphoma, or many other life-threatening diseases.

Cord blood is one of three sources of cells used in transplant; the other two are bone marrow and peripheral blood (circulating blood), which is also called peripheral blood stem cells or PBSC.

Related Link: Cord Blood Information

When is a cord blood transplant a treatment option? 

Like bone marrow, umbilical cord blood is rich in blood-forming cells*. In a cord blood transplant, these healthy cells replace the diseased cells of patients who have leukemia, lymphoma, or many other life-threatening diseases.
*The cells in cord blood are not embryonic stem cells.

The patient’s doctor decides which source of blood-forming cells is best for the patient: cord blood, bone marrow, or PBSC.

The chances of a successful bone marrow or cord blood transplant are better when the blood-forming cells are from a donor who closely matches the patient's tissue type. However, studies suggest that cord blood may not need to match as closely as is required for a marrow donor. Umbilical cord blood may be especially promising for:

  • Patients who have difficulty finding a matched marrow donor
  • Patients from diverse heritages who often have an uncommon tissue type
  • Patients who have a life-threatening genetic disorder
  • Patients who need a transplant quickly

Related Link: The Need for More Cord Blood Donations

Does the National Cord Blood Inventory (NCBI) Program have a way of tracking donors in the event that a donor develops a disease in the future?

Each donor is told to contact the public bank where her baby's cord blood is stored if the baby develops a disease that can be passed on to others.

Are the donors contacted before the cord blood is used to ensure that the donor does not have any conditions, diseases or disorders that may affect donated blood stem cells?

Once a cord blood unit is found to be a potential match for a patient, every effort is made to contact the donor. This is to make sure that the baby's health has not changed since the cord blood donation (some changes could affect the transplant result).

If the blood stem cells have already been used and the donor develops leukemia (for example), is there a way to notify the recipient?

Every effort is made to notify the individuals affected if:

  • The donor develops health problems that could potentially affect the recipient of the donated unit.
  • The recipient develops health problems that could be due to the donated cord blood.

Additionally, a Donor and Patient Safety Monitoring Committee that is made up of experts in blood stem cell transplantation tracks these types of incidents and follows through until their resolution. This Committee is maintained by one of the Program Contractors.

Deciding whether to have a bone marrow or cord blood transplant 

Is a bone marrow or umbilical cord blood transplant the right treatment? 

A transplant can help a patient live a longer and healthier life. For many patients, a transplant offers the best or only opportunity for a cure and for survival. 

However, there are also risks from a bone marrow or cord blood transplant. Some patients suffer from life-threatening problems as a result of their transplant. These problems can include serious infections and graft-versus-host disease (GVHD), in which the transplanted cells attack the patient's body. 

The patient, doctor, and patient's family need to consider many things, including:

  • Disease
  • Disease status
  • Patient's age
  • Patient's overall health
  • Availability of a well-matched donor
  • Other treatment options

A timely referral to a transplant center for consultation can increase a patient's likelihood of a favorable outcome if a transplant is needed.

Related Links: Understanding Transplant as a Treatment Option, Physician Resources

How many unrelated bone marrow or umbilical cord blood transplants have been done and how well do they work?

More than 61,000 unrelated bone marrow and umbilical cord blood transplants have been facilitated through the National Marrow Donor Program® (NMDP) since 1987*.

How well the transplant works depends on many factors, such as:

  • The disease being treated
  • The status of the disease
  • The patient's age and general health

Related Links: Understanding Transplant as a Treatment Option, Physician Resources, Transplant Outcomes and Data.

*The NMDP is a contractor for the C.W. Bill Young Cell Transplantation Program and was also the contractor for the National Bone Marrow Donor Registry (established in 1987).

What diseases are treated most often with an unrelated bone marrow or umbilical cord blood transplant?

Leukemia and lymphoma are the diseases for which almost three-fourths of patients receive an unrelated bone marrow or umbilical cord blood transplant through the registry of the C.W. Bill Young Cell Transplantation Program (also called the Be The Match Registry®).

The specific types of these diseases include:

  • Acute lymphoblastic leukemia (ALL)
  • Acute myelogenous leukemia (AML)
  • Chronic lymphocytic leukemia (CLL)
  • Chronic myelogenous leukemia (CML)
  • Juvenile myelomonocytic leukemia
  • Lymphomas: Hodgkin and non-Hodgkin

Other diseases that may be treated with a transplant include:

  • Hemoglobinopathies such as sickle cell anemia and thalassemia
  • Inherited immune system disorders, such as severe combined immunodeficiency (SCID) and Wiskott-Aldrich syndrome
  • Inherited metabolic disorders, such as Hurler's syndrome and leukodystrophies
  • Marrow failure states such as severe aplastic anemia and fanconi anemia
  • Myelodysplastic syndromes
  • Myeloproliferative disorders
  • Plasma disorders such as multiple myeloma

Related Links: Understanding Transplant as a Treatment Option, Physician Resources.

How many bone marrow or umbilical cord blood transplants have been performed for my disease?

When considering a bone marrow or cord blood transplant as a treatment option, it may be helpful to view how many other people with your disease received a transplant. However, keep in mind that no two people are exactly alike, and responses to the same treatment can vary greatly.

To understand how statistical reports apply to your situation, talk to your doctor.

The Health Resources and Services Administration does not diagnose medical conditions, offer medical advice, or endorse specific products or services. Please do not rely on any website for medical diagnosis or treatment. Consult your health care provider about your personal health concerns.

What is the difference between an autologous and allogeneic bone marrow or umbilical cord blood transplant?

A transplant may use cells taken from the patient (autologous) or from a volunteer donor (allogeneic).

  • An autologous transplant uses the patient's own blood-forming cells that are collected and used later for transplant.
  • An allogeneic transplant uses cells from a volunteer marrow donor or cord blood unit. The donor's tissue type must closely match the patient's tissue type. The donor or cord blood unit can be either related or unrelated to the patient. Related donors are usually a brother or sister.

Patients who do not have a closely matched donor in their family may search for an unrelated marrow donor or donated cord blood unit through the registry of the C.W. Bill Young Cell Transplantation Program (also called the Be The Match Registry®).

Related Links: Understanding Transplant as a Treatment Option; Searching for a Marrow Donor or Cord Blood Unit; Physician Resources.

What are the expected outcomes if I have a bone marrow or umbilical cord blood transplant?

Survival outcomes data show an estimate of the percentage of people with a certain disease who survive for a specific amount of time. When looking at survival outcomes data, keep in mind that outcomes are affected by:

  • Patient factors, such as specific diagnosis, disease status, age, overall health, and previous treatments.
  • Donor factors, such as who donated the cells (the patient, a family member, or an unrelated donor), the source of the cells (bone marrow, peripheral blood, or umbilical cord blood) and the level of matching between the patient and the donated cells.
  • Number of patients included. Data that include larger numbers of patients can more accurately predict likely outcomes for other patients.
  • When the patients were treated. Treatments can change over time. Data for patients treated five years ago may not be representative of what patients can expect today.

Survival outcomes can help you and your doctor better understand your prognosis and can be helpful in making treatment choices.

  • Outcomes data can help you and your doctor understand the likely course of your disease (prognosis). The data show how other people with a similar disease responded to different treatments.
  • Outcomes data cannot predict the outcome of any one person. The data can only report what may happen based on the experiences of other patients.

No two people are exactly alike and responses to the same treatment can vary greatly. To understand how information applies to you, talk to your doctor.

The Health Resources and Services Administration does not diagnose medical conditions, offer medical advice, or endorse specific products or services. Please do not rely on any website for medical diagnosis or treatment. Consult your health care provider about your personal health concerns.

How does survival of patients receiving a transplant from an unrelated donor compare to those from a related donor?

Survival is improving. Outcomes of unrelated donor transplants are approaching the rates of related donor transplants. In 2010, overall survival rates at one year were 69 percent (unrelated donor) and 79 percent (related donor).

Unrelated donor transplant outcomes have improved due to a number of factors, including changes in clinical practice and a better understanding of human leukocyte antigen (HLA) typing and matching.

When a sibling donor is unavailable, unrelated donors are a very good alternative.

Figure 1.

Patient Outcomes Improving Unrelated Donors Compared to Sibling Donors.

View larger image, Detailed Description [D]

The trend of one-year survival rates is steadily improving for patients receiving a transplant from an unrelated donor compared to those receiving a transplant from a sibling donor. These patients were diagnosed with acute leukemias, chronic myelogenous leukemia (CML), or myelodysplastic syndromes (MDS). (Adapted from CIBMTR Summary Slides 2011.) exit disclaimer

Patient Information: Transplant Outcomes; HLA Matching: Finding the Best Donor or Cord Blood Unit exit disclaimer; The Search Process. exit disclaimer

Physician Information: Transplant Outcomes; CIBMTR Summary Slides exit disclaimer; Comparing Unrelated Donor to Sibling Donor Transplant exit disclaimer; Key Findings: Research and Resources exit disclaimer.

The Health Resources and Services Administration does not diagnose medical conditions, offer medical advice, or endorse specific products or services. Please do not rely on any website for medical diagnosis or treatment. Consult your health care provider about your personal health concerns.

Is the patient at risk of catching a disease from an unrelated bone marrow transplant?

Unrelated donors on the registry of the C.W. Bill Young Cell Transplantation Program (also called The Be The Match Registry®) are carefully screened and tested. These tests significantly reduce the risk—but do not completely eliminate the possibility—that a donor could pass a disease to a patient.

Before they are approved to donate, donors:

  • Are tested for infectious diseases such as acquired immunodeficiency syndrome (AIDS) and hepatitis.
  • Answer questions about their health history exit disclaimer . This helps doctors find risks that the donors may have, such as infectious or hereditary diseases.
  • Are checked by doctors for signs of disease.

The National Marrow Donor Program® (NMDP), which operates the registry under Federal contracts, keeps current with diseases and infections transmitted by blood. Sometimes new or rare diseases, such as West Nile virus or severe acute respiratory syndrome (SARS), become public concerns. When this happens, the NMDP uses available methods to watch for these diseases. If a donor shows signs of disease, in some cases he or she will not be allowed to donate. In other cases, where the risk to the patient is considered small, it may be up to the transplant doctor and patient whether or not to use that donor.

Patient and donor safety are top priority for the NMDP. The NMDP Donor and Patient Safety Monitoring Committee helps ensure that the processes and procedures are effective and safe for donors and patients. 

Is the patient at risk of catching a disease from an unrelated umbilical cord blood transplant?

Unrelated cord blood units on the registry of the C.W. Bill Young Cell Transplantation Program (also called the Be The Match Registry®) are carefully screened and tested. These tests significantly reduce the risk—but do not completely eliminate the possibility—that the cord blood unit could pass a disease to a patient.

Before a mother donates her baby's umbilical cord blood, she: 

  • Answers questions about her eligibility to donate exit disclaimer.
  • Completes health history forms about herself and her family. This information helps doctors determine if the mother is free from diseases that could be transferred to another person through blood-forming cells.

After the cord blood is donated, a sample of the mother's blood is tested for infectious diseases such as acquired immunodeficiency syndrome (AIDS) and hepatitis.

Patient and donor safety are top priority for the National Marrow Donor Program (NMDP). (The NMDP operates the registry under Federal contracts.) The NMDP Donor and Patient Safety Monitoring Committee helps ensure that the processes and procedures are effective and safe for donors and patients. 

Where are bone marrow or umbilical cord blood transplants performed? 

Hospitals that perform bone marrow or cord blood transplants are called transplant centers. Transplant centers are located in the United States and worldwide. Some topics to consider when choosing a transplant center include:

  • Does the patient's health plan have rules about which transplant centers are covered?
  • Did the patient's doctor recommend a transplant center?
  • Does the transplant center perform unrelated marrow donor or cord blood transplants? Some centers only perform autologous or related donor transplants.
  • Has the transplant center performed transplants for many patients who have the same disease as the patient?
  • Has the transplant center cared for many patients in the patient's age group? Some centers work mostly with adults or mostly with children.

Related Link: Planning for a Transplant

How much does a bone marrow or umbilical cord blood transplant cost? 

An unrelated bone marrow or cord blood transplant is expensive. Most health plans cover at least part of the cost, but they don't always cover the cost to search for a closely matched donor or cord blood unit. 

In the United States, you can also check with state and Federal programs such as Medicaid and Medicare to find out if the patient is eligible for these government health benefits. Whether or not the benefits cover the costs of a transplant often depends on the state or territory where the patient lives and the disease being treated. For help understanding the patient's health plan, call the patient's health plan, place of work, or county human services office.

Many transplant centers have financial staff who can help answer questions. Ask the transplant coordinator to contact someone who can help you with insurance and money matters.

For more information about costs, you can:

Searching for a donor or cord blood unit 

How is a bone marrow donor or umbilical cord blood unit found? 

A well-matched bone marrow donor or cord blood unit is one important factor for a successful transplant. To search for a donor or cord blood unit, the doctor has the patient's blood tested to determine his or her human leukocyte antigen (HLA) type. 

HLA are proteins—or markers—found on most cells in a body. The immune system uses these markers to recognize which cells belong in your body and which do not. Because HLA markers are inherited, a family member may be the patient's closest match. However, 70 percent of patients do not have a matching donor in their family.

If the patient does not have a closely matched donor in his or her family, the doctor will refer the patient to a transplant center. The transplant center conducts a search of the registry of the C.W. Bill Young Cell Transplantation Program (also called the Be The Match Registry®) to identify a list of potential marrow donors or donated cord blood units.

Related Links: Searching for a Marrow Donor or Cord Blood Unit, Physician Resources.

What is a preliminary search? 

A preliminary search of the registry of the C.W. Bill Young Cell Transplantation Program (also called the Be The Match Registry®) provides a snapshot of the unrelated marrow donors and umbilical cord blood units on the registry that may match the patient at a given time.

Results of a preliminary search can:

  • Indicate how challenging the search for a donor or cord blood unit may be
  • Help shape the patient's treatment plan

A preliminary search can be requested by any licensed physician as soon as the patient's tissue typing is completed and can be repeated at any time, at no cost.

If the search process continues, the patient will be referred to a transplant center. The transplant center will activate a formal search, confirm availability of potential donors, and select a closely matched marrow donor or cord blood unit.

Related Links: Searching for a Marrow Donor or Cord Blood Unit, Physician Resources.

Who do I contact to find out what is happening with the search for an unrelated marrow donor or umbilical cord blood unit through the registry of the C.W. Bill Young Cell Transplantation Program, also called the Be The Match Registry®?

Contact your transplant center coordinator or doctor. They will keep you up to date on how your search is going.

For questions about the general search process for an unrelated marrow donor or cord blood unit, you can contact Patient Services Coordinators at Be The Match Patient Services exit disclaimer. (Be The Match, operated by the National Marrow Donor Program® (NMDP) is a contractor for the C.W. Bill Young Cell Transplantation Program.) 

How long does it take to find an unrelated marrow donor or umbilical cord blood unit?

It can take a few weeks to a few months to identify a closely matched marrow donor or cord blood unit on the registry of the C.W. Bill Young Cell Transplantation Program, also called the Be The Match Registry®

Related Links: Searching for a Marrow Donor or Cord Blood Unit, Physician Resources.

What is the physician's role during the search for an unrelated marrow donor or umbilical cord blood unit and the transplant process?

After an initial transplant consultation, most patients return to the care of the physician who referred them. The referring physician continues to provide patient care during the search process until the patient proceeds to transplant. During this time, communication between the referring physician and the transplant physician is crucial to successfully coordinating treatment.

  • The referring physician updates the transplant physician on changes in the patient's clinical status.
  • Physicians discuss any treatment changes to avoid therapies likely to increase a patient's transplant complications.
  • The transplant physician updates the referring physician on the search progress.

The transplant team cares for the patient during transplant and recovery. The team also works with the referring physician to coordinate the patient's long-term post-transplant care.

Related Link: Physician Resources

Getting Help

Who can help patients with questions about bone marrow or umbilical cord blood transplants?

Be The Match has a team dedicated to supporting patients, caregivers and families before, during, and after transplant.

Be The Match Patient Services can help patients: 

  • Understand the process for a related or unrelated bone marrow or umbilical cord blood transplant
  • Answer questions about health insurance coverage and transplant costs
  • Find a transplant center that meets the patient's treatment needs

All services and resources are free. Staff are available Monday through Friday, 8 a.m. to 5 p.m., Central time.

  • Inside the United States, call 1-888-999-6743. This call is toll-free in the United States.
  • Outside the United States, call 1-612-362-3410. This call may have long-distance or international charges.
  • You can also send an e-mail message to patientinfo@nmdp.org.

Interpreters are available. If you need information in another language, you will need to tell us—in English—what language you speak. Please stay on the line until an interpreter joins the call. (This will take four to eight minutes.)