Factors That Influence Greeks’ Decision to Register as Potential

Bone Marrow Donors

P.A. Galanis, L.D. Sparos, T. Katostaras, E. Velonakis, and A. Kalokerinou

ABSTRACT
Hemopoietic stem cells can be used from bone marrow or blood or umbilical cord blood
of matched siblings or appropriately matched unrelated volunteers. Today, large bone
marrow registries have been established to help identify volunteer unrelated bone marrow
donors for patients lacking a family donor. Despite there being almost 10 million
registered potential bone marrow donors (PBMD) worldwide, only 50% of white patients
have a suitable bone marrow match. Growth in the number of PBMD increases the
likelihood of finding a compatible donor for a patient. The attitudes and knowledge of 250
registered PBMD and 315 not registered PBMD toward bone marrow donation, tissues
and organs donation, and blood donation were surveyed, using a questionnaire with 27
items. Multivariate logistic regression identified gender (females more often than males),
regular blood donation, having a relative or a friend who has already been registered as
PBMD, having a relative or a friend who needs bone marrow transplantation, family
discussion about tissue and organ donation, knowledge about bone marrow transplanta-
tion, information about bone marrow transplantation, and trust in health professionals
were independent predictive factors influencing people’s decision to register as PBMD.
Knowledge of these factors is important to target recruitment efforts.

O VER THE PAST 30 YEARS, allogeneic hemopoietic

stem cells transplantation has been used to treat an
increasing number of malignant and nonmalignant diseases.
Stem cells from bone marrow, blood, or umbilical cord
blood of matched siblings or appropriately matched unre-
lated volunteers have been used for transplantation pur-
poses, but many patients do not have a suitably matched
donor. Initially, cases of allogeneic bone marrow transplan-
tation (BMT) were limited to the use of HLA genotypically
identical related marrow donors. Unfortunately, based on
the inheritance of the major histocompatibility complex,
less than 35% of patients have an HLA-compatible family
donor.1 Several approaches are being used to transplant
patients who do not have an HLA-identical family donor.
Partially HLA-matched relatives have served as donors.
This, however, only extended allogeneic transplantation to
approximately another 10% of patients.2
In another approach, transplantations have been per-
formed using bone marrow obtained from HLA-identical
volunteers unrelated to the patient.3 In this case, one of the
major obstacles is the lack of potential unrelated bone
marrow donors. Today, large HLA-typed bone marrow
registries4 – 6 have been established to help identify volun-
teers for patients lacking a family donor. Despite the fact
that there are almost 10 million registered potential bone
marrow donors (PBMD) worldwide, only 50% of white
patients have a suitable bone marrow match.7 The likeli-
hood of finding a compatible donor is even less for ethnic
minority groups, which are poorly represented in the regis-
tries. In Greece, with a total population of 10,650,000 in
January 2007, only 16,000 persons have been included in the
Greek Bone Marrow Donor Registry. So, there are approx-
imately 15 PBMD per 10,000 Greek residents, which is
low and should be increased. To the best of our knowl-
edge, attitudes toward bone marrow transplantation
among Greeks are unknown. To address these issues, we
conducted a study on the factors that influence the
decision to be registered as PBMD.
From the Faculty of Nursing, Laboratory of Clinical Epidemi-
ology, University of Athens, Ampelokipoi, Greece.
Address reprint requests to Petros Galanis, Faculty of Nursing,
Laboratory of Clinical Epidemiology, University of Athens, 123
Papadiamantopoulou Street, Post code: 115 27, Ampelokipoi,
Greece. E-mail: petgalanis@yahoo.gr

© 2008 by Elsevier Inc. All rights reserved. 0041-1345/08/$–see front matter

360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2008.03.139

Transplantation Proceedings, 40, 1271–1274 (2008) 1271

1272 GALANIS, SPAROS, KATOSTARAS ET AL

METHODS confidence intervals. A two-sided P value of less than .05

A cross-sectional study was performed including 250 Greeks
who have registered voluntarily as PBMD in The Greek
Bone Marrow Donor Registry for comparison with 315
Greeks who have not registered as PBMD. All study
participants were of Greek ethnicity, having lived in Athens
for at least the last 5 years. They answered a questionnaire
consisting of 27 items regarding demographic features,
attitudes toward donation (blood, tissue, organ, and bone
marrow donation), and knowledge of BMT. From Septem-
ber to December 2005, the questionnaires were distributed
to participants and completed anonymously after appropri-
ate instructions were given by the investigators.
Continuous data were expressed as mean values (⫾stan-
dard deviations), while categorical or dichotomous vari-
ables were expressed as percentages. Logistic regression
analysis was used to examine the predictive factors that
influence Greeks’ decision to volunteer as PBMD. First, a
univariate logistic regression of each potential predictive
factor was performed; those factors with an independent
statistically significant association were included in a mul-
tivariate logistic regression analysis. A backward stepwise
elimination method was used for model development in a
multivariate logistic regression model. Multivariate analysis
was used to control potential confounder variables. The
predictive variables were identified as odds ratios with 95%
was considered statistically significant.
RESULTS
The mean age of PBMD was 35.6 (⫾0.6) years, while for
non-PBMD it was 35.2 (⫾0.6) years. Thirty-eight percent of
PBMD and 49.8% of non-PBMD were men. Also, 115
(46%) PBMD and 134 (42.5%) non-PBMD had children.
Only 9.5% of non-PBMD were regular blood donors, while
the respective percentage for PBMD was 71.2%. Moreover,
only 6% of PBMD and 3.2% of non-PBMD had signed an
organ donor card.
Upon univariate logistic regression analysis, significant
predictive factors influencing the decision to be registered
as a PBMD were gender (females more often than males),
education level, occupation, having children, number of
correct answers in four questions concerning knowledge
about BMT, regular blood donation, having a relative or a
friend who had already registered as a PBMD, having a
relative or a friend who needs a BMT, having discussions
with family about tissue and organ donation, fear for the
reception of bone marrow from bones, trusting in health
professionals, and information about BMT (Table 1).
Multivariate logistic regression analysis identified gender
(females more often than males), number of correct an-
swers in four questions concerning knowledge about BMT,

Table 1. Factors That Influence Greeks’ Decision to Get Registered as Potential Bone Marrow Donors
Univariate Model* Multivariate Model†

Independent Variables OR 95% CI P OR 95% CI P

Gender (male ⫽ 0, female ⫽ 1) 1.62 1.16–2.27 .005 2.2 1.01–4.65 .047

Education level .000
Primary school (reference category)
High school 1.84 1.09–3.10 .022
University degree 3.23 1.83–5.71 .000
Occupation .033
Health professional (reference category)
Worker 0.47 0.19–1.19 .110
Clerk 0.53 0.26–1.09 .083
Householding/unemployed 0.5 0.22–1.16 .107
Scientist 1.02 0.43–2.43 .959
Student 1.33 0.42–2.31 .4
Other 0.43 0.20–0.95 .036
Having children (no ⫽ 0, yes ⫽ 1) 1.6 1.14–2.22 .007
Number of correct answers 2 1.71–2.41 .000 1.9 1.3–2.9 .002
Regular blood donor (no ⫽ 0, yes ⫽ 1) 23.4 14.7–37.4 .000 25.8 10.4–63.9 .000
A relative or a friend who is registered PBMD (no ⫽ 0, yes ⫽ 1) 24 15.4–37.4 .000 14 6.3–31.6 .000
A relative or a friend who needs bone marrow transplantation 11.1 7.5–16.6 .000 8.1 3.7–18 .000
(no ⫽ 0, yes ⫽ 1)
Discussions with family about tissues and organs donation 11.3 7.6–16.9 .000 10.8 4.9–24.2 .000
(no ⫽ 0, yes ⫽ 1)
Fear of the bone marrow’s reception from bones (no ⫽ 0, yes ⫽ 1) 0.22 0.15–0.31 .000
Trusting health professionals (no ⫽ 0, yes ⫽ 1) 6.7 4.6–9.7 .000 6.4 2.9–14 .000
Information about BMT (no ⫽ 0, yes ⫽ 1) 36.8 16.8–80.4 .000 9.9 2.8–34.4 .000
OR, odds ratio; CI, confidence interval.
*Each line is a single model.
†
The entire column is a single model.
POTENTIAL BONE MARROW DONORS
regular blood donation, having a relative friend who had
already registered as PBMD, a relative or a friend who
needs a BMT, having discussions with family about tissue
and organ donation, trusting in health professionals, and
information about BMT as independent predictive factors
influencing a person’s decision to be registered as a PBMD
(Table 1). These eight variables together explained 87% of
the variation in the dependent variable.
DISCUSSION
Although allogeneic BMT from unrelated volunteer donors
can be curative for an increasing number of diseases, only a
few studies8 –11 have explored the factors that influence a
person’s decision to be registered as a PBMD. So the
limited bibliography in this topic limits considerably the
chance for comparisons with other studies. Unfortunately,
only McCullough et al9 used a comparable group of non-
PBMD. Concerning gender, there was a slight predominance
of females to be registered as a PBMD, but McCullough et al9
found that gender was not a significant predictive factor.
Those persons who had discussions with their family
about tissue and organ donation had greater probability to
be registered as a PBMD a finding confirms McCullough
et al.9 It seems that a positive attitude of the family plays
an important role in a member’s decision to become a
donor. Family is the first setting where someone is
informed and shapes his or her attitudes and opinions, so
a positive attitude of the family toward bone marrow
donation is required.
Also, persons with a relative or a friend registered as a
PBMD were more likely to volunteer. In that case, someone
may be informed by his relative or friend of the procedure
to be registered as a PBMD. This is important since in many
cases lack of encouragement and insufficient information
discourage a person from bone marrow donation.
Regular blood donors were more often registered as
PBMD, while McCullough et al9 obtained a different con-
clusion. Probably regular blood donors are more sensitive
and have stronger altruism and less fear compared with
non–regular blood donors. Additionally, regular blood do-
nors seem to be more informed since they more often come
in contact with health professionals.
Those persons with a relative or a friend in need of a
BMT were more likely to volunteer, as also confirmed by
McElligott et al.10 Probably these people are more sensi-
tized and informed about BMT. Obviously, contact with
patients in need of BMT influences someone, considerably
limiting barriers toward donation. It is important for the
public to understand that a procedure like bone marrow
donation with no significant risks for donor’s health could
save a patient’s life.
Those who have been informed about BMT were more
often registered as PBMD, a finding that was confirmed by
McCullough et al.9 Information is important in people’s
decision to be registered as a PBMD since a great number
of people do not understand the magnitude of problem.
1273
Also, many people do not know the approach to be
registered as a PBMD. People are mobilized and sensitized
by appropriate, complete information.
Finally, those who have known more about BMT and
declared to be trusting of health professionals showed
greater probability to be registered as PBMD. Confidence
in health professionals and sufficient knowledge of BMT
are important because they decrease the fear about unde-
sirable actions of bone marrow donation and make it easier
for people to volunteer.
As far as limitations of our study are concerned, we
believe that study of psychological factors that influence
people’s decision to be registered as PBMD requires more
research. Expert scientists like psychologists could contrib-
ute notably in this effort. Second, knowledge about BMT
was evaluated with four easy, simple questions; perhaps this
topic requires further study. Moreover, information about
BMT and tissue and organ donation is an important topic
that is not studied widely.
The study was conducted in Athens, the principal urban
area in Greece. Are the results also applicable to other
populations than those living in Athens; for instance, in
rustic areas or in other urban areas in Greece? Also, are the
results of this study applicable to other parts of the world?
Sociodemographic factors and factors concerning knowl-
edge and information might vary in different geographical
regions, but as far as attitudes are concerned, there may be
the same tendencies as in this study population.
In conclusion, knowledge of the factors that influence
people’s decision to be registered as PBMD should help to
target recruitment strategies. Efforts should be directed
toward establishing a donor pool sufficiently large to allow
a major trial of transplantation from unrelated bone mar-
row donors. Increased PBMD might be achieved by infor-
mation and sensitization of the population, by health edu-
cational programs in schools and universities, and by
motivation of health professionals. Information of the public
may be accomplished by using mass media, educational bro-
chures, lectures by health professionals, and recently on the
Internet. Finally, regional blood donors centers are particu-
larly well suited for recruitment of unrelated individuals as
PBMD.
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