The Good, the Bad, and the Ugly... Part 2!
Last year, we took a look at some of The Good, The Bad, and The Ugly portrayals of stem cell transplants in TV and movies – and afterwards, you shared plenty more examples for us to watch!
Since many of you know what stem cell donation and transplantation actually look like, whether through personal experience or simply from following our work, we weren't surprised that you spotted a whole lot of mistakes in their representation on screen.
So, thanks to your excellent suggestions, we’re back for round two. This time, we’ve got everything from the realities of finding a matching donor in EastEnders, to some surprisingly sophisticated transplant science in Grey’s Anatomy – along with a few portrayals that take artistic licence rather too far.
Once again, let’s separate fact from fiction with more of The Good, The Bad, and The Ugly of stem cell transplants in TV and movies.
The Good
Private Practice is a spin-off of iconic medical drama Grey’s Anatomy. While the plots in Private Practice can often be even more heightened than in Grey’s, there is one example of a stem cell transplant where they get the facts right.
A young patient with acute lymphoblastic leukaemia (ALL) is waiting for a transplant when his unrelated donor develops pneumonia and can no longer donate. Unfortunately, the patient has already undergone conditioning, leaving him with a dangerously weakened immune system and in urgent need of another source of stem cells.
Fortunately – and this is where things get very Private Practice – his mother happens to be pregnant with a baby conceived through IVF to be a genetic match for her son: a so-called ‘saviour sibling.’ She forces an early labour so the baby’s umbilical cord blood can be collected and used for the transplant. It works, and both children survive.
The circumstances are certainly extreme, but the underlying science is sound. Cord blood is a valuable alternative source of blood stem cells and can be used for patients who don’t have a suitable adult donor.
We should warn our cord collectors to look away during the collection scene, though. The surgeons squeeze the cord blood into a plastic cup, spilling some down the sides for good measure. In reality, our cord blood collections are carefully carried out in a dedicated room next to the operating theatre – with considerably more sophisticated equipment than a plastic cup.
EastEnders has recently introduced a blood cancer storyline for Denise Fox, who is diagnosed with acute myeloid leukaemia (AML). When she is told she may need a stem cell transplant, her family are tested – but none of them are a match.
It might seem like particularly rotten soap-opera luck, but this is actually very realistic. Only around one in three patients will find a matching donor within their family.
Stem cell matching is based on HLA type, which is inherited from your parents. Parents and children will always be a half match for each other, while full biological siblings have a 25% chance of being a full match. So Denise's daughters not being full matches isn't an unlikely plot twist – it's exactly what we'd expect in many real donor searches.
If a full match can't be found within the family, the search can move to the stem cell register. Even then, sometimes a well-matched unrelated donor can't be found, so the medical team may consider other options, such as a half-matched, or haploidentical, donor instead.
So the difficulty facing this EastEnders character isn't just there for dramatic effect. Denise's search for a matching donor reflects a challenge faced by many real patients who need a stem cell transplant.
The Bad
Medical drama New Amsterdam is known for taking some liberties with science, and it doesn't get stem cell transplants quite right.
In this episode, a patient is diagnosed with leukaemia and immediately needs a stem cell transplant. In truth, there will usually be other treatment before a transplant is considered. Her doctor then rules out her mother as a donor because their blood types don't match – despite stem cell transplants routinely taking place between people with different blood types.
Next comes the stem cell register, which we're told “could take months” to find a match. Searching the register can identify potential matches relatively quickly, but confirming that a suitable donor is available and able to donate can take longer. So this one isn't necessarily as far-fetched as some of the episode's other claims.
Eventually, the patient's father steps in to donate bone marrow, although we hear nothing about the required tests to establish whether he's a suitable donor in the first place.
And finally, having already collected his bone marrow, the doctor announces that it's time to start the patient's conditioning therapy. Usually, conditioning happens first, so the transplant can take place as soon as possible after donation, and the stem cells can be given fresh. However, stem cells can sometimes be frozen and stored when needed for medical or logistical reasons.
So New Amsterdam does eventually get its patient to a stem cell transplant. It just takes a rather imaginative route to get there.
When Grey’s Anatomy gives a patient two new arms and some bone marrow from the same donor for good measure (S7E6), you might reasonably assume the writers have got a little carried away.
Surprisingly, this one has a basis in real science.
Around the time this episode aired, researchers were trialling an experimental technique known as the ‘Pittsburgh Protocol’ in people receiving hand and arm transplants. Patients were given an infusion of bone marrow cells from the same donor, with the aim of helping their immune system tolerate the transplanted limbs while reducing the amount of long-term immunosuppressive medication they needed.
So why have we put it in The Bad?
Grey’s makes this extremely experimental treatment sound simpler than it actually is. In reality, donor bone marrow would be carefully collected, processed in a specialist laboratory and infused around two weeks after surgery as part of a complex immunosuppression protocol. The effectiveness of this intervention has not yet been confirmed, so the way Grey's represents the procedure is a little misleading.
To give Grey’s credit though, there is solid scientific reasoning behind performing a stem cell transplant alongside a solid organ transplant. In 2023, an eight-year-old girl at Great Ormond Street Hospital became the first child in the UK to receive a kidney transplant without needing lifelong immunosuppressive drugs. She had previously received a bone marrow transplant from the same donor – her mother – effectively reprogramming her immune system to recognise the donated kidney.
The Ugly
A little artistic licence is one thing. But when it risks making real people afraid to donate, we’re firmly into The Ugly.
In Seven Pounds, a 2008 film starring Will Smith, the main character is seeking to atone for causing a car accident that killed seven people. He decides to donate various parts of his body to people he believes deserve them – including his bone marrow.
The first problem is that he simply ‘picks’ a child to receive his bone marrow, who conveniently turns out to be a genetic match. Unfortunately, you can’t choose a stranger who needs a transplant and assume your stem cells will be suitable for them. The chances of two randomly selected people being a sufficiently close genetic match are extremely small.
As if that weren’t enough, he then asks for his bone marrow to be collected without anaesthetic, because part of his motivation is to suffer. In practice, bone marrow donation is performed under general anaesthetic, and you'd be hard-pressed to find a medical team willing to collect it without one.
And bone marrow collection isn't even how most people donate stem cells. Around 90% of donations are collected from the bloodstream in a process called peripheral blood stem cell (PBSC) collection – without an operation at all.
If you’ve ever wondered why so many people think stem cell donation is supposed to be excruciatingly painful, films like Seven Pounds probably haven’t helped. Portrayals like this don’t just get the process wrong – they risk reinforcing one of the biggest myths surrounding stem cell donation and putting potential donors off altogether.
We can’t wait to see a depiction of realistic stem cell donation by PBSCs in TV or movies!
Written by Jack Hooper. Revised for accuracy by our medical officers.
Share your bests and worsts
We’ve got plenty more examples to cover, so we’ll be back with another edition of The Good, The Bad, and The Ugly… In the meantime, have you seen a stem cell transplant in a TV show or movie that we’ve missed out? Let us know!
Learn more about stem cell donation
Our website has many resources on stem cell donation, and our donor services team can answer any of your questions – you can contact them here: register.support@anthonynolan.org
Become a potential lifesaver by joining the stem cell register – it only takes a few minutes! Complete a quick form and we’ll send you a cheek swab in the post. You could be the match a patient somewhere in the world is waiting for.