Anthony Nolan adheres to the European Federation for Immunogenetics’ standards (EFI), outlined below.
HLA typing of the patient must be undertaken in a laboratory accredited by EFI or by an agency with similar standards and accreditation process, such as the American Society for Histocompatibility and Immunogenetics (ASHI).
HLA typing of the patient and their selected donor must be undertaken on two independent samples. This allows verification of the HLA type prior to transplant.
HLA typing is performed using DNA based methods. This may be supplemented by serology to ascertain protein expression. HLA-A, -B, -C, -DRB1, -DRB3, -DRB4, -DRB5, -DQB1 and -DPB1 typing are considered essential for optimal matching. We recommend high resolution typing of all clinically relevant HLA genes.
We recommend that, when possible, patients and unrelated donors should be matched at high resolution. When such a match is not available, partially matched donors can be released, but all levels of HLA mismatch would be subject to review. The transplant centre may be required to justify their choice of mismatched donor and provide additional information relating to the transplant protocol. Where it is necessary to select a HLA mismatched donor for transplant, the patient and donor typing would be expected to be at high resolution so that the degree of mismatch throughout may be ascertained.
It is expected that the search will be extended internationally, when appropriate, so that the best matching donor can be identified. Reports from Bone Marrow Donors Worldwide (BMDW) are issued for each UK patient search request and access to BMDW online match programmes is available for UK transplant centres or their representatives.
It should be noted that registries in different countries have their own policies on donor release that may differ from that of Anthony Nolan.
For final selection of an unrelated donor, HLA typing of both donor and recipient must be repeated using a new typing sample from each so that each individual's typing and identity is confirmed. The final typing of each must be performed in the same laboratory (ie the transplant centre laboratory), using the same techniques, and tested within a reasonable timeframe of one another.
Anthony Nolan can advise on selecting donors for patients.
However, the final decision on donor suitability is always the responsibility of the transplant centre.
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