When matched family donor is not available for blood and marrow transplantation—the Indian dilemma

Only 20–30% of patients requiring a blood and marrow transplantation (BMT) have a matched family donor. For the rest, alternative sources of graft are necessary to provide this curative procedure. Over the past 25 years, BMT from volunteer unrelated donors has undergone immense developments to be at par with matched family donor transplants. Similar developments have been witnessed in the field of unrelated cord blood transplantation. Thus, 90% of patients requiring a BMT in the developed worlds receive one from either of the two alternative graft sources. However, >11 million volunteer unrelated donors and 25,000 cord blood units worldwide do not solve the problem for patients from developing countries, due to lack of compatible human leukocyte antigen (HLA) match and enormous financial burden. Thus, Asian countries such as China and Korea have developed Haploidentical or mismatched family donor transplantation for their population with great success. In the light of these developments, this article discusses the options and opportunities for alternative donor BMT in the Indian scenario.