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

Mismatched donor platforms have expanded access to allogeneic blood and bone marrow transplantation (alloBMT), providing patients with near universal access and often 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 transplant logistics by donor type, including the 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 at a single institution. We evaluated overall survival 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 receiving transplants between January 1, 2024, and December 31, 2025.

In 1298 patients, overall survical did not differ by donor type. Compared with related donors, unrelated donor (URD) transplants in 2024 to 2025 were more likely to experience a donor-related delay (26% versus 2.2%, P < .001). Both URDs (odds ratio, 15.1; 95% confidence interval, 6.42-41.7; P < .001) and Black patients (odds ratio, 2.98; 95% confidence interval, 1.27-6.66; P = .010) had significantly increased odds of donor-related delays on univariable regression. Charges for URD transplants were significantly higher than related-donor transplants ($184,036 versus $150,716, P < .001), driven by graft acquisition charges.

Using post-transplant cyclophosphamide, 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 that could delay URD alloBMT.