Abu Jafar Mohammed Saleh
Hematopoietic stem cell transplantation (HSCT) is a lifesaving, costly, and multistep procedure. It took more than 50 years from the first published attempt in 1957 to arrive at one million transplants by 2012 and currently more than 70,000 transplants are done annually in the world. Requirements for developing an HSCT program include the definition of infrastructure facilities; the availability of blood transfusion services and radiology, microbiology, pathology, and laboratory facilities for haematology, molecular biology, immunology, and HLA typing; and the presence of pharmacy facilities with access to chemotherapy and anti-infective agents. Staff availability and training are also extremely important, including adequately qualified physicians, nurses, laboratory technicians, and data managers. Education, training, and collaboration are also essential to attract staff members and increase national and international collaborations. Before implementing a transplant unit project, it is fundamental to have a proper estimate of the needed number of autologous and/or allogeneic transplants to be performed per year, and to determine whether the projected transplant volume would be sufficient to build adequate experience in transplantation and justify the initiation of such project. Next, it is important to establish a network of physicians and healthcare professionals to refer patients and ascertain adequate post-transplant care. Active communication and perhaps twinning with other established centres must be sought for advice and program development. Also, the evaluation of resources is essential for building the program; a new centre should determine in advance the priorities for patient selection, type of transplant, and patient follow-up. Plans for expanding the transplant program and increasing the number of transplants per year should, likewise, be determined in advance. For the long-term sustainability of the program, commitment is also of the utmost importance, not only by the head of the transplant program, but also by all the medical and non-medical personnel, administration, competent authorities, and payers. Getting started and containing costs while maintaining high-quality standards is the main challenge for developing a new transplant unit.
Correspondence: Abu Jafar Mohammed Saleh, Consultant and Co-ordinator, Haematology and HSCT, Apollo Hospitals, Dhaka. [email protected]