Decision-making experience for second donation in unrelated hematopoietic stem cell donors: a descriptive qualitative
Hangting Li1, Lingxi Chen2, Dijiong Wu1
1Hematology Department, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
Background:
A second allogeneic hematopoietic stem cell transplantation (allo-HSCT) is often the most effective treatment option for patients experiencing graft failure or disease relapse following a first round of allo-HSCT. Unfortunately, the consent rate for second donation is insufficient to meet treatment needs worldwide. The purpose of this study was to provide a comprehensive understanding of the decision-making experience of unrelated donors when considering making a second donation. This research is essential as it could inform the development of interventions to improve the consent rate for second donation.
Design:
This was a descriptive qualitative study that followed the COREQ checklist.
Methods:
A total of 16 unrelated hematopoietic stem cell donors who completed a second donation were selected by purposive sampling and underwent semi-structured interviews between September and December 2023. Data were analyzed using conventional content analysis.
Results:
Data analysis yielded four themes and 11 sub-themes: (1) initial reaction (unexpectedness, immediate consent); (2) locked-in dilemma (worried about the outcome of second donation, faced familial pressure, felt morally hijacked); (3) internal impetus (personal value of helping others, kinship tie, self-efficacy from the first donation, positive impact of the first donation), and (4) external reinforcement (pluralistic social support and societal influence).
Conclusions:
To improve the consent rate for second donations, it is necessary to implement targeted education and comprehensive support encompassing personal, familial, and social aspects, while ensuring autonomy. Our analysis suggested that optimizing the first donation experience and fostering positive feedback beliefs are crucial factors when considering a second donation.
Implications For Cancer Survivors:
By clarifying the decision-making experiences of unrelated donors, this research informs strategies to improve second donation consent rates. Enhanced donor retention directly expands life-saving options for patients with disease relapse or graft failure, potentially improving survival outcomes.
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