Advanced H&I – Stem Cells —
Training activity: 6

Details

Outline a donor option strategy for a patient awaiting HSCT

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

Considerations

• Extended family members for HLA typing
• Alternative unrelated options
• Patient factors impacting options e.g. disease type, age, other co-morbidities and frequency of HLA haplotype within the donor population
• Local policy and national guidelines
• Resources to optimise donor’s selection, including algorithmic tools, computer software and AI/machine learning

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 knowledge of HLA matching, donor registries, and alternative donor sources (e.g., cord blood, haploidentical donors) will be essential for this activity?
• What specific insights do you hope to gain into the complexities of developing a comprehensive donor option strategy for HSCT patients?
• Think about your current understanding of the different donor options and the factors influencing their suitability. What specific areas do you want to explore further through this activity?
• What do you anticipate learning about the process of prioritising donor options based on patient-specific factors and clinical context?
• Discuss potential patient scenarios with your training officer to understand the range of factors that need to be considered when outlining a donor strategy.
• Consider potential challenges in identifying suitable donor options (e.g., rare HLA types, presence of HLA antibodies). How might you prepare for these scenarios (e.g., reviewing search algorithms, databases)?
• Reflect on your current level of confidence in formulating donor search strategies. What resources or information might help you feel more prepared?

In action

• What key patient factors (e.g., reason for transplant, HLA type) are you currently focusing on to develop the donor strategy?
• What potential donor types (e.g., related, unrelated, cord blood) are you actively considering?
• What criteria are you using to evaluate the suitability of different donor options at this moment?
• What aspects of formulating this strategy are feeling intuitive, and what requires more deliberate thought?
• Is your initial assessment of potential donor options narrowing down suitable choices?
• What difficulties are you facing in identifying appropriate donor strategies for this patient?
• What insights are you gaining about the complexities of donor selection for HSCT? How does the information available for this patient align with your existing knowledge of donor registries and HLA matching?
• Are you exploring alternative search strategies if initial options appear limited?
• Are you considering if input from other specialists would be beneficial at this stage?
• Are you ensuring that the outlined strategy is feasible and aligns with best practices for HSCT?

On action

• What were the key patient characteristics that significantly influenced your donor option strategy?
  • What were the main challenges or complexities you encountered when considering different donor types (related, unrelated, cord blood)?
  • What factors did you particularly focus on when evaluating the suitability of potential donors?
  • Were there any specific guidelines or protocols that played a crucial role in shaping your strategy?
• Did this activity deepen your understanding of the factors involved in developing a comprehensive donor option strategy for HSCT?
  • What did you learn about the advantages and disadvantages of different donor types in the context of this specific patient?
  • Did you gain a better appreciation for the importance of HLA matching and other relevant criteria in donor selection?
  • How did your reflection-in-action (during the activity) influence the donor options you considered?
• What aspects of developing donor option strategies do you feel you need to further develop?
  • How will you apply the lessons learned from this activity to future cases requiring donor selection?
  • What specific actions will you take to enhance your knowledge of donor registries, HLA matching algorithms, and alternative donor options?
  • Do you need to discuss donor option strategies with your training officer or other colleagues to gain further insights?

Beyond action

• Have you looked back at the donor option strategies you outlined for this case and considered the actual outcome for the patient (if known)?
• How does the real-world scenario compare to your initial plan? Have you been involved in outlining donor option strategies for other patients since this training activity?
• What similarities or differences did you notice in your approach?
• Have there been any changes in donor registries, HLA matching algorithms, or alternative donor options that would influence how you might approach this case now?
• Has this training activity improved your understanding of the factors to consider when developing a donor option strategy (e.g., patient characteristics, HLA matching, availability of donors)?
• How has this experience influenced your communication with clinical colleagues regarding donor options? Are you better equipped to explain the rationale behind your recommendations?
• How will the knowledge gained from this training activity help you to navigate increasingly complex donor selection scenarios, such as haploidentical or mismatched unrelated transplants?
• Will the experience of considering various donor types enhance your ability to contribute to discussions about the development of departmental protocols or best practices in donor selection?

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.
# 3	Outcome Perform clinical and laboratory monitoring of patients who have received HSCT.