The process of narrowing down the choices to a single donor is well underway. We're so lucky that Elise has a large number of "10 of 10" HLA matches in the donor database, it means that they can be a little more selective which should help improve the outcomes.
They've narrowed the candidate pool down to seven candidates. All seven are 10 of 10 HLA matches with Elise. These seven are young (in their 20's) large (all male) and haven't donated previously. It turns out that young and large donors provide more stem cells which is important to help improve the odds of engraftment. About 5% of transplants don't engraft and I've been told this is largely due to the volume of the transplant itself. For example transplants from umbilical cords are very small and they have a significantly higher risk of non-engraftment. As for previous donors, this is important because they only let you donate 2 times (I'm not sure why). It's possible if you don't engraft the first time, they might want to try again which would mean a 2nd donation. If the donor's already donated once, then that option is ruled out.
So for these seven candidates they are gathering more detailed information. Two key things are whether they are cytomegalovirus (CMV) positive and blood type.
CMV is very common: between 50% and 80% of adults in the US test positive for CMV. And once you've got it then it stays with you forever. Healthy people can get flu-like symptoms when first infected, but it can be very serious for those with weak immune systems. The way it impacts transplants is if the transplant patient and donor aren't CMV matched (both negative or both positive), then a reinfection will commonly break out after the transplant. This infection puts the patient at increased risk because their immune system is weakened. There are ways to handle the situation so a mismatch isn't a complete deal breaker, but it does elevate the risk and potentially slow the transplant recovery process.
They also prefer to match the blood type of the patient with the donor when possible. Eventually the patient will take on the blood type of the donor but it's not immediate and the transition might slow the recovery process. Mismatched blood types aren't a deal breaker, but they prefer a match over a mismatch. It turns out that Elise is B+ like ~8% of the US and European populations.
They should have this additional information in another couple weeks and then we can start to nail down the transplant schedule. I've been told that the current timeline (start workups the week of 18 May '14) is still a good one to plan for, but there could be some hiccups. For example, the donor doesn't get a full medical workup until 30 days prior to donation, and even though everything else looks good there could be something found during workups that would send us back to a donor search.
So things are still moving forward.
