Donor Related Logistical Challenges in Hematopoietic Transplant: A Comparative Analysis of Related and Unrelated...

Mismatched donor platforms have expanded access to allogeneic blood and bone marrow transplantation (alloBMT), providing patients near universal access often with multiple viable donor options. Thus, identifying optimal donors has become increasingly important. Existing observational studies on the subject assess outcomes only among patients who successfully proceeded to alloBMT, leaving earlier, donor-related barriers, logistical challenges, and costs unexamined.

The primary objective was to evaluate and compare donor-related transplants logistics by donor types, including frequency, cause, and duration of donor-related delays and cancellations.

We conducted a retrospective analysis of patients with hematologic malignancies who underwent alloBMT with post-transplant cyclophosphamide (PTCy) at a single institution. We evaluated overall survival (OS) in all patients between 2018 and 2025 by donor type. We then assessed donor-related transplant delays or cancellations, as well as total transplant and graft charges by donor type in 374 consecutive patients transplanted between January 1, 2024, and December 31, 2025.

In 1298 patients, OS did not differ by donor-type. Compared to related donors (RDs), unrelated donor (URD) transplants in 2024-2025 were more likely to experience a donor-related delay (26% vs 2.2 %, p<0.001). Both URDs (OR 15.1, 95% CI 6.42 - 41.7; p <0.001) and Black patients (OR 2.98, 95% CI 1.27-6.66; p = 0.010) had significantly increased odds of donor-related delays on univariable regression. Charges for URD transplants were significantly higher than RD ($184,036 vs $150,716 p <0.001), driven by graft acquisition charges.

Using PTCy, survival outcomes were comparable across donor types. Related donors were more likely to advance to a timely donation, highlighting the need for further studies and interventions into donor and logistical barriers which could delay URD alloBMT.