Choosing transplant donors: should we be keeping it in the family?

In this Point-Counterpoint article series, Ephraim Fuchs and Bronwen Shaw make cases for selecting haploidentical family donors or HLA-matched unrelated donors, respectively, for transplant patients without HLA-matched siblings. The success of haploidentical transplantation with posttransplant cyclophosphamide, as pioneered at Johns Hopkins, has made this a live and fascinating debate. Fuchs argues that in the setting of apparent equivalence, related haploidentical donors should be preferred on the basis of their rapid availability and cost-effectiveness. Shaw makes the point that unlike haploidentical transplantation, matched unrelated transplantation is a fully mature field with well-established and robust outcome data and should be preferred. Clearly, this is an important discussion that is just beginning, meaning that our transplant programs will likely need to approach donor selection and posttransplant immune suppression with a degree of flexibility for the foreseeable future.

Copyright © 2017 American Society for Hematology

Choosing transplant donors