Advanced H&I – Stem Cells —
Training activity: 2

Details

Perform an unrelated donor search, and review and select potential HLA matched unrelated donors for HSCT

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Considerations

• Local and national procedures
• Role of donor registries in the search process
• Factors affecting HSCT donor selection
• National and international standards and legislation relating to HSCT
• Relevant advisory groups for donor selection
• Sources of stem cells
• Local protocols for the clinical and laboratory work up of patients awaiting HSCT
• Malignant and non-malignant conditions treated by HSCT

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Identify what is expected of you in relation to effectively performing an unrelated donor search and selecting potential HLA matched donors that meet the criteria for Haematopoietic Stem Cell Transplantation (HSCT).
• Consider how the learning outcomes apply, specifically in relation to using HLA typing results, assessing donor suitability, and evaluating complex data.
• Discuss with your training officer to gain clarity of what is expected of you in relation to the key steps in performing an unrelated donor search and accurately assessing donor suitability.

What is your prior experience of this activity?

• Think about what you already know about conducting donor searches or reviewing HLA data, perhaps for related donors or solid organ transplantation (SOT).
• Consider possible challenges you might face during the activity, such as difficulty finding a suitable match or interpreting complex search results from international databases and tools.
• Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if the complexity of the search results requires interpretation outside routine procedure or if a suitable donor cannot be readily identified.
• Acknowledge how you feel about the responsibility of identifying potential life-saving donors.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as using donor search registries and applying stringent HLA matching criteria for unrelated donors.
• Identify the specific insights you hope to gain into the factors that influence the availability and selection of unrelated HSCT donors.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of similar donor search or data review activities.
• Identify important information you need to consider before embarking on the activity, such as the specific HLA matching requirements, acceptable mismatch criteria for unrelated HSCT, and relevant non-HLA factors e.g., CMV status, age, donor availability.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst performing an unrelated donor search and selecting potential HLA matched donors for HSCT?
• Are you encountering situations such as:
  • The donor search database is presenting unexpected results or difficulties in navigation?
  • There are fewer potential donors meeting the initial HLA criteria than you anticipate?
  • The donor data (e.g., resolution, associated information) contains ambiguities or complexities you are not prepared for?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to search strategy or interpretation approach?
• Consider the steps you are taking in the moment, such as:
  • Adapting your search strategy or interpretation approach
  • Adapting your selection criteria or internal prioritisation process if potential donors are limited or the data is complex
• How are you feeling in that moment? For instance, is it affecting your confidence in performing the donor search and selection independently?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you able to successfully complete the search and identify potential donors despite the unexpected events? Or are you needing support because you need to seek advice or help during the unexpected situation?
• What are you learning as a result of the unexpected development? For example, what are you learning in the moment of troubleshooting donor searches or interpreting complex data?

 

On action

What happened?

• Begin by summarising the key steps you took when performing the unrelated donor search, review, and selection for a potential HSCT recipient.
• Consider specific events, actions, or interactions which felt important, such as how you verified a top-ranked donor’s non-HLA information (e.g., CMV, age) or assessed complex HLA typing resolution for potential matches.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately revising your search parameters when the initial query yielded too few suitable candidates or halting the review process to consult an ambiguity in HLA resolution.
• How did you feel during this experience, e.g., did you feel confident navigating the search database or stressed by the complexity of matching criteria?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding performing unrelated donor searches and selecting suitable HLA matched donors. What strengths did you demonstrate, e.g., meticulous adherence to complex non-HLA factor guidelines?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with specific donor registry search functionalities or grading complex HLA mismatches?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in applying stringent selection criteria for unrelated HSCT candidates?
• Identify any challenges you experienced, such as a lack of suitable 10/10 matches or needing to seek advice or clarification on scope of practice regarding accepting a donor with ambiguous typing data, and how you reacted to this.

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to improving the efficiency and rigour of your unrelated donor selection process.
• What will you do differently next time you approach performing an unrelated donor search and selection, for instance, by proactively checking the resolution level requirements for specific patient cohorts before initiating the search?
• Do you need to practise any aspect of the activity further, such as using specific registry search tools or key learning outcomes related to applying stringent selection criteria?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of performing unrelated donor searches and selection since completing this specific training activity led you to revisit your initial approach or decisions during that activity?
• Considering what you understand about database structures, applying matching criteria, and evaluating donor suitability now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your unrelated donor search parameters and selection process based on further learning and experiences? For example, how you proactively reviewed and integrated the specific guidelines on prioritising non-HLA factors for unrelated donors based on further learning.
• Has discussing different search strategies, donor selection nuances, or navigating database complexities with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity?

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent unrelated donor search and selection experiences, contributed to your overall confidence and ability in effectively performing unrelated donor searches and selecting potential HLA matched donors for HSCT, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated ability in understanding database structures and applying matching criteria now enables you to confidently prepare for assessments such as ‘Conduct a search for an unrelated stem cell donor’ or ‘Advise a clinician on the likelihood of finding a suitable donor’ during an OCE assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to unrelated donor searches? How does this evolved understanding help you identify when a search or selection scenario is particularly complex, requires deviation from standard protocols, or needs expert input regarding specific donor findings, and when this is beyond your scope of practice requiring escalation?
• Looking holistically at your training journey, how has this initial donor search experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to using HLA typing results, assessing donor suitability, and evaluating complex data?

Relevant learning outcomes

#	Outcome
# 1	Outcome Apply the appropriate strategy for the investigation of patients being considered for haematopoietic stem cell transplantation (HSCT), interpret and report results of the investigation in the correct clinical context.
# 2	Outcome Assess the suitability of potential related and unrelated matched and mismatched donors for HSCT.
# 4	Outcome Practice effectively in partnership with other clinical specialisms and the wider multidisciplinary team in the investigation of HSCT to deliver safe and effective patient care.