Establishing Hematopoietic Stem Cell Transplant Unit in Resource Limited Setting: A Critical Analysis of Indian Council of Medical Research 2017 Guidelines

Abstract

The scope and application of hematopoietic stem cell transplantation are increasing. With advancement in science and close cooperation of health centers, HSCT units are coming up in new developing and underdeveloped countries. India hosts many HSCT units and often provides financially viable option for HSCT to foreign patients as well. Recently Indian Council of Medical Research (ICMR) issued a guideline about HSCT unit in India. This review article discusses establishment of new HSCT unit in resource limited setting. Subsequent implication of ICMR guideline has been done.

Setting up a Hematopoietic Stem Cell Transplantation Unit

“…Location : The area of HSCT should be away from dampness, infection wards, and construction site (Das et al 2018 ). Most hospitals locate their HSCT rooms on the top floors.…”

Haematopoietic stem cell transplantation in Tanzania

“…However, allogeneic and autologous HSCT activity is increasing worldwide with a mean 7% year-on-year increase in the last 25 years, and there is increasing demand for HSCT centres in low and middle income countries (LMIC). [1][2][3][4] The establishment of an HSCT centre requires optimal patient care before, during and after the transplant period, and appropriate laboratory facilities as well as donor care pre-transplant. All these may be difficult to achieve in LMIC because of inadequate infrastructure, funding and diagnostic services.…”

“…The first aspect is partnership: almost all case studies examining the establishment of a new HSCT unit in an LMIC mention the importance of pairing a nascent programme with a well-established centre elsewhere. 3,23,24 This can be facilitated by having on staff a medical director who is a haematologist, oncologist or immunologist with experience in HSCT. Bangladesh established their autologous HSCT centre in Dhaka with the support of Massachusetts General Hospital.…”

“…Both autologous and allogeneic stem cell transplants take place in HSCT centres worldwide, but they take place mostly in high‐income countries (HIC) because of the significant healthcare resources required. However, allogeneic and autologous HSCT activity is increasing worldwide with a mean 7% year‐on‐year increase in the last 25 years, and there is increasing demand for HSCT centres in low and middle income countries (LMIC) 1–4 . The establishment of an HSCT centre requires optimal patient care before, during and after the transplant period, and appropriate laboratory facilities as well as donor care pre‐transplant.…”

Establishing hematopoietic stem cell transplant programs; overcoming cost through collaboration

“…Centralizing such specialized service in few centers could negatively affect the operating cost and might result in staff burnout, long waiting lists that could lead to poor outcomes [5]. In an era of global financial constraints, innovative approaches to reach cost efficiency and optimal clinical outcomes still not readily available [6]. We sought to establish a collaborative process to expand the HSCT services in Saudi Arabia (KSA).…”