Every year in the United Kingdom about 38,760 people are diagnosed with a haematological malignancy such as leukaemia, lymphoma or myeloma (Haematological Malignancy Research Network [48]). A stem cell transplant is one possible treatment option for these diseases (Atkinson [5]). A stem cell transplant aims to replace a patient's own diseased bone marrow with healthy stem cells. Before the patient receives the stem cells, they receive a combination of chemotherapy and radiation to destroy their own bone marrow. The healthy stem cells are collected from a patient when in remission (autologous) or from a donor (allogeneic) (Richardson and Atkinson [98]). The stem cells are then introduced into the patient's bloodstream much in the same manner as a blood transfusion. If the donated stem cells ‘engraft’, they begin producing normal blood cells (Atkinson [5]). The principles and process of collecting bone marrow apply to both allogeneic and autologous donors.

The care of bone marrow donors is guided by a duty of care, encompassing the physical, emotional, psychological, social and spiritual dimensions of well‐being (Be the Match Registry [12]). Ethical considerations should be incorporated into local policy and guidelines are available that outline the expected standards of care for unrelated (Hurley and Raffoux [60], World Marrow Donor Association [115]) and related (van Walraven et al. [114]) donors. The procedure should be performed as a sterile procedure under general anaesthetic and all perioperative principles apply. Bone marrow harvests are performed under general anaesthesia because:

It is a requirement that practitioners performing this procedure have experience and training in bone marrow harvesting (FACT‐JACIE [40]). Competence must be demonstrated and documented.

Before consent is taken, donors should be carefully informed about the risks and benefits of the donation procedure in a manner that they understand. Although transplant centres usually have a preference for the source of stem cells, donors should be given a choice whether to donate bone marrow or stem cells by means of apheresis. Consent is an ongoing process and donors have the right to refuse to proceed (FACT‐JACIE [40]). They should, however, be warned what the consequences of this would be for the recipient, if they do so after the conditioning regimen for transplant has been commenced.

Children acting as donors require further consideration. Laws and regulations governing minors who act as a donor for a sick sibling differ from country to country. Rarely, adult donors with severe developmental or psychological problems rendering them mentally incapable of informed consent are considered as stem cell donors for a relative. These can be either donors who have always been mentally challenged (e.g. Down's syndrome) or those who are suffering from a psychiatric illness. It is advised to first establish whether the aspirant donor would be able to endure the donation procedure (both physically and mentally) before performing tissue type testing (van Walraven et al. [114]).

In the United Kingdom, evidence must be documented that the Human Tissue Authority ([56]) Code A: Guiding Principles and the Fundamental Principle of Consent has been applied. All information should be managed within a strict framework of confidentiality (FACT‐JACIE [40]).

Bone marrow harvest needles are usually 11 G with a removable introducer. Harvested bone marrow must be filtered to remove particulate matter prior to final processing and packaging for distribution or transplantation (FACT‐JACIE [40]). This process must be performed under sterile conditions in the operating room at the time of harvest or in an appropriate sterile setting in the processing laboratory (FACT‐JACIE [40]). Sterile in‐line filters are available commercially in a collection set. The filter size may range from coarse (500 µm) to medium (300 µm) to fine (200 µm). All harvested marrow should ultimately pass through a fine filter, while other sizes may only be necessary if the marrow has a large amount of particulate matter (FACT‐JACIE [40]).

The bone marrow harvest is performed under general anaesthesia and local policy with regard to perioperative care should be followed. Local anaesthetic, for example lidocaine 2%, is usually instilled into the harvest sites for postsurgery pain relief. Post‐operative pain should be monitored and is usually managed with non‐opioids and mild opioids. Iron supplements may be prescribed to facilitate haemoglobin recovery post harvest.

There should be donor evaluation procedures in place to protect the safety of the donor and recipient. All stem cell donors (autologous or allogeneic) should be given a medical examination to confirm they are physically and emotionally fit to undergo anaesthesia and the marrow harvest (Be the Match Registry [12]). The donor's medical history, physical examination and laboratory test results should be performed and documented according to the International Standards for Cellular Therapy Product Collection, Processing and Administration (FACT‐JACIE [40]). Both the potential for disease transmission from the donor to the recipient and the risks to the donor from the collection procedure should be assessed (FACT‐JACIE [40]). The allogeneic donor's suitability must be documented before the recipient's high‐dose therapy has begun.

The psychosocial needs of the donor should be assessed (Scott and Sandmaier [102]). Key areas for support are: childcare arrangements, transportation, past and present drug and alcohol usage, unique cultural, religious, literacy and language needs and employment issues (Scott and Sandmaier [102]). An appropriately trained healthcare professional should be available to offer donors counselling, reassurance and support.

It is widely agreed that donors require good‐quality information to reduce their anxiety, to enable them to give informed consent and to enable them to actively participate with the donation process (Chapman and Rush [20], NMC [86]). An increasing number of people are obtaining information from the internet and may be quite informed (or misinformed) based on the quality of the information they acquire. Transplant facilities and donor registries should develop their own centre‐specific information which can be posted on their website or mailed to donors in advance of their first clinic visit to meet some of the education needs (Scott and Sandmaier [102]).

Immediate post‐donation care includes:

Bone marrow harvests should be strictly regulated within a quality management system with clear standard operating procedures and documentation. Archived documentation should be maintained according to governmental, regulatory or institutional policy, whichever is longer (FACT‐JACIE [40]). Due to the strict regulatory nature of bone marrow harvests, a record‐keeping system must be in place to ensure the authenticity, integrity and confidentiality of all documents (FACT‐JACIE [40]). All nursing records must be clearly maintained to ensure accurate data (NMC [86]).

All donors should be informed that it is normal to experience some pain, bruising and stiffness, feel more tired than usual and run a low‐grade fever during the first week after donation. Soreness at the collection site usually eases off in around a week with pain relief (Be the Match Registry [12]). Further guidelines to be given to donors post procedure are detailed in Box 21.1.

Furthermore, all donors should receive written instructions to contact the hospital if they experience any of the following symptoms (Be the Match Registry [12]):