Problems of creating bone marrow donor registries in emerging economies

In November 2008 Sunil Parekh, a haematologist at Bombay Hospital, approached the multinational Tata Group to secure funding for a new stem cell registry in Mumbai, India. Unfortunately, the cards were already stacked against him. On the evening of 28 November, 10 men arrived on the coast of the Arabian Sea in inflatable speedboats, and in the next few days conducted 12 coordinated terrorist attacks throughout the city.

Parekh’s mission to establish a registry needed government support, but as the iconic Taj Mahal Palace Hotel burned, he knew his ambitions were about to vanish from the government’s radar. As he predicted, in the months that followed, India shifted its priorities to root out domestic terrorism. The economic crash of US markets that autumn then rippled out towards Asia. “Despite all that,” Parekh told the BMJ, “we still wanted to go ahead. I’ve been wanting to get this done for so many years.”

Although India is one of the most densely populated nations in the world, the country has only a tiny pool of stem cell donors. The National Marrow Donor Program in the United States has 10 million members, 7% of whom are Asian.1 Driven by the problem of small family sizes, nearby China has prioritised expanding its registry to almost 1.3 million unrelated donors in the Chinese Marrow Donor Program, and more than 2000 stem cell donations have been performed from this registry. In contrast, India has registered only about 40 000 donors, in several disparate registries in cities scattered across the subcontinent, and has facilitated only 25 transplantations from unrelated donors. And the country has no plan for a national registry.

The lack of …