diversity of the American population. Data on HLA diversity in the American population requires further investigation. Of further interest and concern are the lower CD34+ counts among cord blood units from African-Americans reported by several banks.
At present, as described above, a transplant physician seeking a cord blood unit is required to search the cord blood unit databases of several organizations. The resolution and accuracy of HLA testing, the method of cord blood processing and even the quality of the unit itself can vary widely among these different banks. For this reason, some transplant physicians are unwilling to use units from banks with which they are not familiar or even to use cord blood in an HPC transplant. Organizations such as NYBC have attempted to make this process easier by implementing programs that facilitate the use of cord blood and increase the referrals for transplantation. Cord blood banks rely on the use of these units, as reimbursement comes with the clinical transplantation of a cord blood unit and not with the donation.
Banking organizations, patient advocacy groups, and adult donor registries like the National Marrow Donor Program have been hosting physician education programs and providing updates through publications and Web-based resources to increase the chances that a transplant physician will quickly be able to identify a suitable match for his or her patient. The registries also provide live support in the search process by providing access to qualified individuals with expertise in the relevant fields (e.g., HLA compatibility) to assist the physicians with selecting the best unit. The registries also often assist with the financial aspects of the search by offering suggestions for reimbursement and by educating the insurance companies as much as possible on the issues surrounding HPC transplantation.
The responsibility of caring for a patient waiting for an HPC transplant falls on the transplant physician and the staff at the transplant center. Registries and banks often assist these health care providers by providing informational brochures, videos, and audio programs that educate the patient and the patient’s family on the process, risks, and outcomes. These are designed to accommodate individuals who speak a variety of languages other than English and individuals with different comprehension levels to ensure that no matter what the health literacy level of the patient and his or her family, they will have a good understanding of the process. The registries also provide counseling services and act as a support mechanism in this very difficult process.