Journal of Clinical Apheresis 18:1–9 (2003)

The Psychosocial Aspects of Donating Blood Stem

Cells: The Sibling Donor Perspective
Susan Williams,1 Rachel Green,2* Anne Morrison,3 Douglas Watson,2
and Sister Susan Buchanan2
1
Glasgow Caledonian University and Greater Glasgow Health Board, Glasgow, United Kingdom
2
Clinical Apheresis Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom
3
Southern General Hospital, Glasgow, United Kingdom

The collection of peripheral blood progenitor cells (PBPC) by apheresis has become common in related
allogeneic donors. However, the acceptability of the procedure to donors has not been documented. The
purpose of this baseline case series study was to evaluate the psycho-social dimensions of apheresis from the
perspective of healthy sibling donors and to explore issues surrounding fully informed consent including
voluntary donation. At the first interview to discuss donation, 17 consecutive human leucocyte antigens
(HLA) identical sibling donors who chose to donate PBPC were recruited to the study. They then completed
both scales of the State-Trait Anxiety Inventory. The state scale was completed again immediately before first
apheresis. At the end of the final apheresis, the donors were interviewed again by an independent researcher
using a standardised questionnaire. All aspects of the procedure were well tolerated, including levels of anxiety
and pain. Donors donated even if the relationship with their sibling was poor. However, some areas
for improvement were highlighted. Eight (47%) donors were asked to donate by their sibling or another
close relative, and this gave them no real volunteer status. Written information was judged important by
11 (65%) donors, but the material used was limited. The possibility of a poor outcome for the recipient was
not well understood. The content of the written documentation and the management of confidentiality
in terms of donor volunteer status needed to be addressed. A further study regarding the follow-up needs
of donors, including those where the outcome is poor, is underway. J. Clin. Apheresis 18:1–9, 2003.

2003 Wiley-Liss, Inc.

3 Key words: peripheral blood progenitor cell collection; donor acceptability; siblings

INTRODUCTION Since 1996, PBPCs have been collected from sibling

donors as part of a local ethically approved study.
Cytokine-mobilised peripheral blood progenitor
Many of the donor-related issues have concentrated
cells (PBPC) are increasingly being employed as an
on the feasibility and clinical effects of cytokine mo-
alternative to bone marrow for allogeneic transplan-
bilisation on healthy volunteers [8,9]. Normal donors
tation in patients with haematological malignancy
have a reliable and repeatable increase in white cells
[1–3]. Early sustained engraftment has been confirmed
4 in the allogeneic setting and makes the use of PBPCs and circulating PBPC. This allows collections of sig-
nificant PBPC in response to 6–12 lg/kg/day GCSF
very appealing [4]. The incidence of acute graft vs.
for 4–6 days. Leukopheresis does deplete platelet
host disease (GvHD) is no greater than in bone
count [10] and abnormalities of blood chemistries [11]
marrow transplants. However, there is evidence of
do occur in response to GCSF but most resultant
increased chronic GvHD [5,6]. This is in part related
abnormalities return to baseline levels within a week
to the higher number of T and NK cells that are
of completion of collections.
collected with PBPC and re-infused [7] but does give
At this time, however, GCSF was unlicensed for
the potential for increased graft vs. leukaemia effect.
use in the allogeneic setting and the long-term safety
The procedure of PBPC collection is relatively
simple. It requires 5–6 days of granulocyte colony
stimulating factor (GCSF) injections and 1–3 outpa-
*Correspondence to: Dr. Rachel Green, Apheresis Unit, Glasgow
tient apheresis procedures where the donor’s blood is Royal Infirmary, North Glasgow Hospitals University and
processed using a cell separator machine. In contrast, 1 NHS Trust, Castle Street, Glasgow G4 0SF, UK.
historically progenitor cells were collected from bone E-mail: rachelhagreen@hotmail.com
marrow whilst the donor was under a short general Received 22 March; Accepted 10 January 2003
anaesthetic and involved multiple bone marrow as- Published online in Wiley InterScience
pirates from the pelvic bones and at least one over- (www.interscience.wiley.com)
night stay in hospital. DOI: 10.1002/jca.10042

Ó 2003 Wiley-Liss, Inc.

 2 Williams et al.

issues in healthy donors were unknown. It was judged agreed to participate were given an explanatory letter
imperative that these donors should be fully informed and asked to sign a study consent form.
and consent to participate in an ethically approved
study. Consequently, their care was provided by in-
dependent staff who were not treating the recipient. In
our unit, it became practice for the potential donors Baseline Anxiety Measures
to be independently interviewed and examined in or- At the time of study recruitment, at the initial in-
der to assess their general health, and also to receive terview, participants were asked to complete both
detailed information about both methods of dona- state and trait anxiety scores of the original Speil-
tion. The donors then made the ultimate decision berger State Trait Anxiety Inventory (STAI) [13]. The
about which procedure they preferred for their do- STAI is a well-established and validated tool for
nations, providing they were medically fit. Any donor measuring anxiety. Normative population data is
with an underlying medical condition that required only available from North America (means -35 Trait
bone marrow harvesting rather than PBPC donation and 32 State). Its use in relation to allogeneic dona-
received medical follow-up but was excluded from tion of PBPC has not been documented. The only
comparative study. identified use of the STAI in PBPC donation involved
Standardised local guidelines were produced to patients using a French adaptation of the instrument
address the information that was given to donors. [12]. The original version of the STAI consists of two
By July 1996, our unit had dealt with 19 alloge- 20 statement self-report scales. One scale is designed
neic sibling donors and obvious differences between to measure state, and the other trait, anxiety [13].
the clinical needs of donors land recipients were State anxiety refers to the distress caused by a specific
identified. In particular, it was realised that some event, and trait anxiety refers to a personality ten-
sibling donors felt under considerable pressure to dency towards anxiety. For all statements, each par-
donate and in effect, they may have had no real ticipant marked one of four options that best related
choice. to how they felt. Each response was scored on a scale
The psychosocial aspects of PBPC donation in of 1–4 via a separate key. Scores for each of the scales,
siblings have not previously been documented al- therefore, range from 20 (lowest anxiety) to 80
though Auquier et al. [12] have explored pain and (highest anxiety).
anxiety associated with PBPC donation by patients.
Therefore, the purpose of this baseline study was to
indicate any clinical or support interventions that
would improve the care of sibling donors during the Procedural Assessments
period surrounding their PBPC donation. We aimed On the first day of stem cell donation, in addition
to assess the general acceptability of PBPC donation to routine care, the donors were asked again by a
to sibling donors, but particularly to record the pain member of staff to complete the State Anxiety Scale
and anxiety involved in donating. We also aimed to [13]. During the period of recuperation after the final
explore the circumstances surrounding the identifica- donation on the second day, donors were then inter-
tion, selection, and real choices available to sibling viewed by an independent researcher using a stan-
donors and to identify their information and support dardised proforma that contained both open and
needs. 6 closed questions (see Appendix B). These questions
related to the causes of anxiety and pain, the feeling
of closeness with the recipient sibling, experiences
of being a donor, and the information and support
MATERIALS AND METHODS needs of donors throughout all stages of the process.
The family dynamics were explored because it was
Donors and Recruitment postulated that feelings of closeness towards the
Over a 13-month period, from July 1996 to August recipient either during childhood or in adult life
1997, all HLA identical sibling donors were invited to might influence the enthusiasm to donate.
take part in this psychosocial study by a member of Perceived anxiety about the procedure was mea-
the apheresis unit staff at Glasgow Royal Infirmary. sured using a 4-point rating scale. This scale was se-
At this initial interview, using a standardised checklist lected at this time because it provided a context in
5 (see Appendix A), donors received routine health which to explore further the issues relating to anxiety.
screening and verbal information on both stem cell It also served as a quick secondary measure of anxiety
and bone marrow donation. Also at this interview, and, therefore, acted as a consistency check of the
donors were given an explanation of what would be STAI state anxiety score obtained immediately on the
involved in taking part in this study. Those who first day of donation. The perceived level of worst

TABLE I. Characteristics of Donors
Characteristic Male (n = 9)
Median age (range) 43 (28–59)
Marital status
Married 5 5
Single 2 1
Divorced 1 1
Cohabiting 1 1
Children (%) 7 (78)
Previous surgical admission (%) 5 (56)
Median sibling age gap [years (range)] 6 (2–11)
pain was measured using a 100-mm horizontal visual
analogue scale (VAS). These scales are a common and
well-established measure of pain [14]. They have been
shown to be readily understood by users and have
been shown to be more sensitive than graphic rating
scales. Horizontal scales have been shown to produce
a more uniform distribution of scores than vertical
scales [15].
Analysis
Data were analysed using SPSS. The small num-
bers involved and frequency distributions of re-
sponses indicated that analysis should be restricted to
descriptive statistics only.
RESULTS
Study Exclusions
All of the 20 potential donors agreed to participate
in this study. Three donors chose to donate bone
marrow and were, therefore, excluded from the study.
Personal Characteristics
Nine donors were male and eight female. Both men
and women donors were commonly in their early
forties. Half described themselves as married and just
over three-quarters had children. Fewer than half had
had a surgical admission to hospital (Table I).
Family Characteristics of Donation
Three donors donated for an elder brother, eight
for an elder sister, three for a younger brother, and
three for a younger sister. The age gap between do-
nors and recipients ranged from 1 to 11 years (Table
I). Circumstances surrounding the request to donate
were recalled by 16 donors. In six (35%) cases, con-
trary to guidelines, the donor was asked to donate by
the unit treating their sibling. Six (35%) other donors
were asked directly by their sibling. Two were asked
Sibling Donor Views on Blood Stem Cell Donation 32
Female (n = 8) All (n = 17)
43 (21–46) 43 (21–59)
10
3
2
2
6 (75) 13 (76)
3 (38) 8 (47)
4 (1–9) 5 (1–11)
by their mothers, one by another sibling, and in an-
other case the donor offered to donate. In terms of
family dynamics, 13 (77%) described themselves as
close or very close to their brother or sister now. The
other four described themselves as not close. Two had
had arguments and the other two felt that living some
distance apart had affected their relationship. Eleven
(65%) donors said that they and their siblings had
been close or very close as children. Generally
speaking, those who were close as children had
maintained that bond in adult life. Fourteen people
said they had no hesitation in offering to donate. This
included one donor who cited distance and the two
who had cited arguments as a reason for not feeling
close to their siblings.
When asked what influences the wish to donate for
a sibling, 13 (77%) donors cited as the main influence
the family bond no matter their current relationship
with the donor. Three people felt that if you could
help someone you should, and one person cited fear
of his/her father as the main influence.
A total of three donors felt pressurised about some
aspect of donating. Two felt pressurised into donating
by family members. One, a younger donor, by fear of
his/her father, and the other, who described being
close to his/her sibling, by the pressing needs of the
recipient. One donor felt under pressure because his/
her employers were uncooperative in allowing time off.
Social Support for Donors
Ten donors (69%) felt they had been particularly
supported by one person. Six (35%) others said they
had been particularly supported by a combination of
people and one person felt that he/she had had no
support from family or friends. In three cases (all
women), a friend was judged as being particularly
supportive; three men had been particularly supported
by their wives; two women had cited their mother as a
particular source of support, and another two men,
their female partners. Encouragement and under-
standing were cited as the main qualities of particular
support. Practical help, such as looking after children
4 Williams et al.
and accompanying the donor to the unit, was another
type of particular support thought useful.
Six (35%) donors said that someone had not been
supportive. In two cases, this was a husband, another
two cases a father, and for the other two, friends or
relatives. In four (66%) of these cases, including one
concerning a father, the donor thought the reason for
lack of support was because the person felt concern or
worry for the recipient. Another donor cited a diffi-
cult relationship with their father as the reason he/she
did not feel supported. The other donor cited a
friend’s fear of hospitals as the reason he/she was not
supportive.
Anxiety Surrounding the Procedure
At pre-procedure interview, the mean STAI score
for trait anxiety was 35 (SD 7) and the mean state
score was 30 (SD 8). The mean state anxiety score,
measured upon arrival at the unit on the first day of
donation, was 37 (SD 12). Mean scores for female
donors were higher than for males across all three
measures of anxiety (trait 39 vs. 33, state at recruit-
ment 33 vs. 29, state pre-donation 47 vs. 32).
These scores were consistent with responses to
questions about anxiety asked at the post-donation
interview. Four (24%) people who retrospectively
described themselves as being very anxious when they
had first arrived at the unit to donate had scored more
than 40 on the STAI state scale. The main sources
of anxiety were about fear of the unknown concern-
ing the procedure and about the pain associated with
the injections of local anaesthetic. Anxiety was gen-
erally reduced on the second day of the procedure.
Eleven (65%) said they were not anxious on the sec-
ond day and no one said they felt very anxious at
this time.
Allowing for small numbers, pressure to donate did
not appear to influence anxiety before procedure. One
person who felt under pressure to donate said they
felt slightly anxious as did four (29%) people who said
they did not feel under any pressure. The other two
donors who felt under pressure said they were not
anxious.
Pain
Using the continuous analogue scale, the mean
worst pain score was 41 mm (SD 20). Female donors
had a higher mean pain score (47 mm, SD 18) than
males (34 mm, SD 20).
Sixteen (94%) reported some pain. Generalised
bone pain following GCSF injections was the most
common cause of worst pain, experienced by 7 (41%)
people, and 5 (29%) people experienced most pain
TABLE II. Relationship Between Pain and Anxiety
Pain scores (mm)
Anxiety 0–25 26–50 51–75 76–100 Overall
Not anxious 3 3 1 1 8
Slightly 1 2 1 4
anxious
Quite anxious 1 1
Very anxious 1 3 4
Total 5 6 5 1 17
during administration of the local anaesthetic for
venepuncture at the time of donation. Two donors
had experienced most pain in their head but said this
was not a classic headache, and two had found the
sub-cutaneous injections of GCSF were most painful.
Seven patients took no analgesia to control their pain.
Paracetamol was used by 8 (47%) people; however,
half felt that their efforts to reduce pain had not
worked and that it had to be endured. One person,
who admitted to having a low pain threshold and who
was very anxious, took DF118 and was prescribed
valium. This combination was effective in reducing
pain and controlling anxiety.
In this small sample, there was no clear-cut asso-
ciation between pain and anxiety. Six (75%) people
who, at the post-procedure interview, described
themselves as not anxious at the start of the proce-
dure scored 50 mm or less on the pain scale. The
one person who scored 76 mm or more also de-
scribed themselves as not anxious (Table II). Con-
versely, the four people who said they were very
anxious rated themselves as experiencing medium
amounts of pain and scored 26–75 mm on the
pain scale.
Information
All donors valued the quality of the informa-
tion they had received and 9 (53%) described it as
excellent. Thirteen (77%) donors had received both
written and verbal information, although the written
information was designed for autologous donors. The
remaining four donors said they had received verbal
information only.
All donors reported that they had received this
information at the initial interview to discuss dona-
tion. In 14 (82%) cases, a consultant was cited as
the source of information, two donors said they
received information from a combination of consul-
tant and nurse, and one had been well informed by
their recipient sibling and the consultant. Sixteen
(94%) stated they had been given comprehensive
information about procedures, risks, and pain.
The other, a male who scored 60 mm on the VAS,

TABLE III. Relationship Between Anxiety and Satisfaction
With Information Giving
Need for more information
Anxiety Yes No Overall
Not anxious 4 4
Slightly anxious 4 4
Quite anxious 1 1
Very anxious 1 3
Total 5 12
felt that information had concentrated on possible
pain. All donors had found seeing the machine very
helpful.
Eleven (65%) donors said they had all the infor-
mation they wanted. Two, both of whom scored
higher than 50 mm on the VAS, would have liked
more information about pain. Two would have liked
more information about the benefits of stem cell do-
nation. One would have liked more information
about the effectiveness of the different procedures for
the recipient and the other would have liked more
information on the long-term effects of stem cell
donation.
Six (35%) people were happy with just verbal in-
formation but specific written information for allo-
geneic donors was judged to be important by the
other 11 (65%). Two people said that written infor-
mation needed to be comprehensive and the long-
term effects of growth factor injections should be
addressed. They would have liked more detailed in-
formation about what is involved in donation of both
stem cells and bone marrow. Information on self-care
was perceived as important, especially how donors
could prepare themselves, e.g., diet, rest, and so on
and how they should look after themselves following
the procedure. The main advantage of written infor-
mation was that it could be taken away and studied at
home but it was viewed as an adjunct, not a re-
placement, to verbal information.
There was no obvious relationship between anxiety
and satisfaction with information given (Table III).
Of the 8 people who, at the post-procedure interview,
described themselves as not feeling anxious before the
procedure, 4 (50%) felt they needed more information
and 4 (50%) thought they had all the information they
needed. Of the 4 who described themselves as very
anxious, 3 (75%) felt that they had all the information
they required.
Time for Consideration
All donors thought that they had been given en-
ough time to consider whether or not to donate, and
this varied from two weeks to several months. Gen-
erally, the donors indicated that they had made in-
Sibling Donor Views on Blood Stem Cell Donation 52
stantaneous decisions to help and once their minds
were made up, they wished to proceed as quickly as
possible in order to help their siblings.
8
Repeating the Experience
All said they would donate again for a family
4 member and 12 (71%) said they would also donate for
17 a stranger if the opportunity arose. Generally, the
donors reflected on earlier opinions that life is im-
portant and if you could help someone then you
should.
Comments
Ten (59%) people spontaneously stated that they
were well satisfied by the standard of their care. One
of these donors, upon reflection, had found it difficult
to remain in one place for 3 hours at a time and
wished he/she had chosen to donate bone marrow.
Only one donor expressed fear that the donation
might not work and that their sibling might die. Seven
people had no further comments.
DISCUSSION
Over the past 5 years, the use of allogeneic sibling
donor peripheral blood stem cells has grown expo-
nentially [1–3]. No published literature exists on
the donors’ perception of this form of donation.
Although this prospective baseline study was limited by
small numbers, it does represent the psychosocial
context of PBPC donation for a complete sample
of consecutive sibling donors over a 13-month period.
The overall attitude to the procedure was favour-
able. The fact that most donors experienced some
bone pain yet did not take analgesia nor request
further analgesia may reflect their belief that some
pain was required for stem cell generation. Moreover,
the pain was not severe enough to stop any of the
mobilisations. Anxiety levels were comparable with
the North American norms for men and women aged
19–69 years [13] and also similar to the data collected
by Auquier [12] on PBPC collection from patients. It
is conceivable that the low anxiety levels found in the
French patients may be due to the considerable stress
previously caused by their diagnosis and therapies,
making PBPC a relatively minor procedure in terms
of anxiety [12].
Although verbal information given at the time
of the initial interview was universally valued, our
study found that the written information was in-
adequate for donor needs. It was originally pro-
duced for patients and did not cover such issues as
6 Williams et al.
descriptions of both methods of donation or
GCSF administration and its potential long-term ef-
fects on healthy donors. The long-term effects on the
donor if their sibling dies in spite of their PBPC do-
nation could be devastating and donors need to be
prepared for the possible poor outcome for the
recipient.
Finally, this study highlighted one area of grave
concern. The method of identification and selection of
sibling donors did not always protect the donors’
interests. Most of the donors in this study were asked
to donate by either the recipient or another family
member. In effect, this gave the donor little oppor-
tunity to refuse. In this small study, we were unable to
demonstrate that this was an issue of importance to
donors. Furthermore, our study indicated that a do-
nor would be unlikely to refuse to donate for a sibling
and, in fact, donors were prepared to donate even
when relationships were not cordial. The theme of
family bonding and responsibility was recurrent and
strong.
CONCLUSIONS
From the sibling donor perspective, PBPC collec-
tion by apheresis is an acceptable procedure. However,
two important areas need to be addressed. Firstly, the
management of sibling donors in relation to the lack of
confidentiality was contrary to voluntary donor par-
ticipation in blood donation or in unrelated bone
marrow donor registries. In terms of medical ethics,
this state of affairs is disturbing. The only realistic way
of dealing with the problem is for donors to be seen
and counselled by clinicians independent of those
treating the recipients. The donor should be the first
person to be told that they are a match and their de-
cision whether or not to donate should then remain
confidential with their clinician. If their decision is not
to donate, then the clinician should deal with the sit-
uation so as to avoid guilt and alleviate obligation.
Secondly, written information should be provided
specifically for sibling donors and we recommend that
realistic measures of success for each individual sib-
ling pair be given at the initial interview.
Follow-up studies are ongoing to assess the infor-
mation needs and support required by sibling donors
irrespective of the outcome for the recipient.
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 Sibling Donor Views on Blood Stem Cell Donation 72
Appendix A. Allogeneic Donor Interview
Check list of topics to be covered
Yes No
• Confirm donor is willing to donate u u
• Ensure entirely voluntary u u
• Explain two methods of donation and mention:
Bone Marrow Donation
Need for a general anaesthetic–previous GA history u u
Hospital in-patient stay for two nights u u
Multiple puncture sites over pelvis u u
Post-operative pain/discomfort u u
Need autologous unit u u
If female must take contraceptive precautions for the month before bone marrow harvest u u
Blood Stem Cell Donation
Need for G-CSF injections u u
Naturally occurring substance but much higher doses than normal u u
No information available on potential long term side effects for donors u u
Bone pain and flu like symptoms may develop as a result of injections u u
If female must take contraceptive precautions 1 month prior to and for three months u u
after G-CSF
Two or possibly three donations by apheresis u u
Explain process of cells separation u u
Each donation takes approximately 3 hours u u
Bilateral cannulae (explain) u u
Need good veins u u
May still need to donate bone marrow if insufficient stem cells produced from collection u u
Recovery of sibling’s white cells and platelets may be faster after receiving stem cells u u
rather than bone marrow leading to less time in hospital and less time at risk of
infection but higher GVHD.
• Take blood samples–consent for HIV u u
• Give general health check examination, CXR, ECG u u
• Contact donor results to inform if OK or not u u
• Explain that outcome may be bad despite their best endeavours u u
8 Williams et al.
Appendix B. Bone Marrow/Stem Cell Donation
Semi-structured interview schedule
Name:
Hospital Number:
Date of Interview:
Thank you for agreeing to talk to me about donating bone marrow/stem cells.
How do you feel now? Is there anything I can do for you?
We are keen to help people donating bone marrow or blood stem cells all we can and the information you give will be
very helpful. Please feel free to say exactly what you think. I am not a member of staff and anything you say is
completely confidential.
1 First of all, could I ask you some preliminary details–like your:
DOB?
Marital Status?
Have you any children?
If so, what ages?
2 Is this the first time you have attended hospital? Y/N
3 Would you mind telling me what you have been in for before?
..........................................................................................
4 In what way were your previous attendance similar or different to your experiences in the last few days, do you think?
..........................................................................................
..........................................................................................
5 Who are you donating marrow or blood cells for?
..........................................................................................
6 What made you decide to donate cells?
(Prompt if necessary. Asked personally by patient or other relative etc)
..........................................................................................
..........................................................................................
7 How would you describe your relationship with your brother/sister/relative?
Very close/close/not particularly close/not close at all
8 Why do you say this, do you think?
..........................................................................................
..........................................................................................
9 Were you close as children?
..........................................................................................
10 How big an age gap is there?
..........................................................................................
11 What best describes how you felt?
(Give cards and ask to choose one that best reflects feelings)
• I did not hesitate and was delighted to help.
• I felt I had no choice and was pleased to help.
• I really did not want to do it but felt I could not refuse.
• I felt under obligation by my family to help.
12 Would you say you felt pressurised in any way? Y/N
13 Who would you say pressurised you? ....................................................
14 What about your family and friends-who have been particularly supportive to you?
..........................................................................................
15 In what way, would you say?
..........................................................................................
16 What would you say influences how people respond to a request to donate marrow or blood cells?
..........................................................................................
17 How did you feel when you arrived here yesterday?
..........................................................................................
18 What about when you arrived today?
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19 What would you say you were worried or anxious about, do you think?
Yesterday: ..........................................................................
Today: ..........................................................................
20 What about pain? Using this measure, could you indicate by drawing a line across the horizontal line, the worst pain you
experienced during the whole experience of donating marrow or blood cells.
| |
The worst pain you could imagine No pain at all
 Sibling Donor Views on Blood Stem Cell Donation 92

21 When was this worst pain?

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22 What else did you find painful?
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23 Is there anything that helped these pains or could have helped, do you think?
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24 How do you feel about the information you received when you first visited the Unit?
..........................................................................................
25 How were you given this information?
Verbally
Leaflet
Other ..........................................................................
26 When was this given? .................................................................
27 Who gave you information? .............................................................
28 What were you told about donating stem cells?
(Prompt–purpose, preliminary preparation, machine, pain etc)
..........................................................................................
29 What else do you think people should know about?
..........................................................................................
..........................................................................................
30 Thinking now about time, do you think people need more time after their first visit to the hospital, to think
about being a donor in the first place?
..........................................................................................
31 Thinking of your own experiences, who do you say this?
..........................................................................................
32 What would you say to other donors?
..........................................................................................
33 If necessary, would you donate bone marrow blood cells again?
Y/N
34 If not, would you mind telling me why?
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Thank you for your time. How do you feel now? Is there anything you would like to add?