Training activity information
Details
Perform a donor search for a patient with no ‘HLA-matched’ donors and select potential alternative related or 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
- Types of HSCT donor
- Factors affecting alternative 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
- Impact of blood product support through conditioning and impact on HLA antibody formation/need to screen for antibodies to aid donor selection (and timing of screening tests)
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 identifying and selecting potential alternative related or unrelated donors when a standard HLA-matched donor is unavailable.
- Consider how the learning outcomes apply, specifically in relation to using HLA typing results, assessing alternative donor suitability, and evaluating complex alternative donor data.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the criteria used to select alternative donors e.g., haploidentical donors or umbilical cord blood units and contributing to outlining a donor option strategy.
What is your prior experience of this activity?
- Think about what you already know about exploring alternative donor options in clinical contexts, and if you are familiar with the unique considerations for alternative donor types (e.g., umbilical cord blood units, haploidentical donors).
- Consider possible challenges you might face during the activity, such as balancing immunological risk with donor availability or interpreting complex alternative donor data.
- 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 faced with balancing immunological risk against the clinical urgency of a case involving a potential alternative donor, or if you encounter complex alternative donor data that requires specialist interpretation.
- Acknowledge how you feel about working on challenging cases where standard donor options are unavailable.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as searching for and evaluating alternative HSCT donor sources (e.g., cord blood banking).
- Identify the specific insights you hope to gain into the strategies and considerations involved in selecting alternative donors for patients with no HLA-matched options.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of reviewing complex or high-risk donor selection criteria.
- Identify important information you need to consider before embarking on the activity, such as the specific guidelines for evaluating alternative donors, the differential testing required (e.g., for haploidentical donors), and how the increased complexity and potential risk are factored into the donor selection process.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing a donor search for a patient with no ‘HLA-matched’ donors and selecting potential alternative related or unrelated donors for HSCT?
- Are you encountering situations such as:
- The search for alternative donors revealing types or options you are less familiar with than anticipated?
- The data for alternative donors (e.g., cord blood unit characteristics, haploidentical family typing) presenting unexpected complexities or issues?
- Specific non-HLA factors for alternative donors complicating the process unexpectedly?
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 or evaluation approach?
- Consider the steps you are taking in the moment, such as:
- Adapting your search or evaluation approach during the process because options are limited or complex?
- Handling ambiguity or unfamiliar data related to alternative donor types in the moment?
- How are you feeling in that moment? For instance, are you finding it difficult to adapt while navigating this complex search? Is it affecting your confidence in independently assessing suitability for alternative donors?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you able to identify potential alternative donors and apply the relevant criteria? Or are you needing support because expert input is needed for complex alternative donor options?
- What are you learning as a result of the unexpected development? For example, what are you learning in the moment about the specific challenges and considerations for alternative donor searches?
On action
What happened?
- Begin by summarising the key steps you took when performing the search for alternative donors (e.g., haploidentical or cord blood) and selecting potential options for an HSCT patient with no HLA-matched donor.
- Describe the types of alternative donors you considered (e.g., haploidentical, cord blood) and the specific challenges in evaluating their suitability.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately revising your evaluation metric when faced with limited data for a specific alternative donor type or seeking senior clarification on complex immunological risk data.
- How did you feel during this experience, e.g., did you feel challenged by the complexities of dealing with non-‘HLA-matched’ scenarios or focused on balancing risk and availability?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding searching for and selecting alternative HSCT donors. What strengths did you demonstrate, e.g., systematic evaluation of complex, non-standard donor data?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with specific cord blood unit criteria or interpreting the immunological risk of haploidentical donors?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in integrating immunological risk assessment for non-matched donors compared to standard matched searches?
- Identify any challenges you experienced, such as limited alternative options or needing to seek advice or clarification on scope of practice regarding the suitability of a specific alternative donor type due to high immunological risk, 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 your evaluation process for complex alternative donor types.
- What will you do differently next time you approach performing a search for alternative donors, for instance, by proactively reviewing the latest guidelines for acceptable cell dose thresholds for cord blood units?
- Do you need to practise any aspect of the activity further, such as evaluating specific alternative donor types or key learning outcomes related to assessing alternative donor suitability?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of performing a donor search for a patient with no ‘HLA-matched’ donors and selecting potential alternative donors since completing this specific training activity led you to revisit your initial approach or decisions during that activity?
- Considering what you understand about alternative donor types (e.g., haploidentical, cord blood) and immunological risk assessment 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 understanding of alternative donor criteria and selection strategies based on further learning and experiences? For example, how you proactively reviewed and implemented a decision-making framework for balancing cell dose versus HLA mismatch for cord blood units based on further learning.
- Has discussing the complexities and criteria for selecting alternative donors or the impact of using mismatched donors on clinical outcome 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 alternative donor search and selection experiences, contributed to your overall confidence and ability in navigating complex donor search scenarios and identifying suitable alternative options when standard matches are unavailable, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated ability in understanding unique characteristics and considerations for different alternative donor types now enables you to confidently prepare for observed assessments (DOPS or OCEs) such as ‘Conduct a search for an unrelated cord blood 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 alternative donor searches?
- How does this evolved understanding help you identify when an alternative donor scenario is particularly challenging, involves novel criteria, or requires expert input regarding specific alternative options, and when this is beyond your scope of practice requiring escalation?
- Looking holistically at your training journey, how has this initial alternative donor search experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to using HLA typing results, assessing alternative donor suitability, and evaluating complex alternative donor 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. |