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週六, 11 四月 2015 00:00

感恩與祝福 骨髓捐贈釋疑

造血幹細胞之捐贈為自願、無報酬的善心之舉,但在捐贈之前必須確保幹細胞捐贈過程對於「受贈者」與「捐贈者」皆能安全無虞,故對於捐贈者必須有基本的醫療評估、處置與保障。慈濟骨髓幹細胞中心依據全球各國骨髓資料庫慣例,在確認捐贈者之後,向接受骨髓捐贈的病患收取取髓費用。

中心酌收取髓成本費用為新臺幣11萬3,735元,包括支付捐贈者身體檢查2萬元以及捐贈前抽取自備血、用藥、住院抽髓、健保無給付之醫療費、保險費、病房費、交通費……等相關費用,低於全球各骨髓庫收費標準(如附註1)。

通常捐贈者未如期抽取造血幹細胞主要是因為移植醫院通知病人病情有變化,因故延期,待病人病情穩定後,再由移植醫院向慈濟骨髓幹細胞中心另約取髓時間。目前依照全球通則造血幹細胞分離後,必須在四十八小時內完成移植,主要是因為時間延長,會造成幹細胞存活率下降,且可能有細菌感染的風險,目前國際慣例不建議冰凍保存。(如附註2)

若捐贈者已完成身體檢查,卻因受贈者病情變化無法完成捐贈,則由已配對病患支付2萬元健檢費用。

對於無法負擔取髓費用的受贈者病患,慈濟基金會皆會全力協助。申請流程簡易,只需由移植醫院向慈濟骨髓庫申請配對時,告知病患同意接受慈濟基金會關懷,慈濟志工隨即排程訪視病患,並進行補助評估;將十方大德的愛心,用在最需要的地方。

至於有關招募捐贈者、驗血、檢驗、資料處理和儲存、行政流程等費用,全數由中心支付。同時,中心提供捐贈者的捐後長達十年的健康追蹤,相關費用也由中心支付。因此,從建立資料庫至完成配對與捐贈,每例成本超過一百萬元新臺幣。


附註1:
海外收費範例:

骨髓庫/項目 捐贈者HLA+感染性疾病檢驗 取髓費用
美國骨髓庫 檢驗費每筆美金1,725元 美金48,480元(約合台幣145萬元)
若健檢後沒有完成捐贈,收取美金5,830。
英國骨髓庫 檢驗費每筆英鎊300元 英鎊13,800元(約合台幣66萬元)
若健檢後沒有完成捐贈,收取2,500英鎊。
日本骨髓庫 檢驗費每筆日幣7萬元
需另加聯絡費用每筆日幣10萬元
日幣2,070,000元(約合台幣53萬元)
若健檢後沒有完成捐贈,收取日幣395,000。
中華骨髓庫 檢驗費每筆人民幣9000元 人民幣79,000元(約合台幣39萬元)
若健檢後沒有完成捐贈,收取21,000人民幣。

此資料為2015年3月收費標準,若有調整將以最新資料為準。

台灣收費比較:

台灣慈濟骨髓幹細胞中心 勾選前五位捐贈者之主要HLA確認配型免付費,由本中心吸收 (檢驗費每位捐贈者新台幣12,000元),若額外檢側HLA其他位點則依檢驗項目及數量付費。 新台幣113,735元(台幣11萬3千多元)。
若捐贈者健檢合格通過後,受贈者因病情因素沒有完成捐贈,收取20,000台幣健檢相關費用,其餘費用退還。



有關於
1.申請造血幹細胞移植程序,請參照http://btcscc.tzuchi.com.tw/index.php?option=com_content&view=article&id=731&Itemid=523&lang=tw
2.造血幹細胞配對流程圖
http://btcscc.tzuchi.com.tw/index.php?option=com_content&view=article&id=1118&Itemid=524&lang=tw
3.臺灣病患收費辦法及相關補助
http://btcscc.tzuchi.com.tw/index.php?option=com_content&view=article&id=1119&Itemid=526&lang=tw
4. 海外造血幹細胞配對與費用說明
http://btcscc.tzuchi.com.tw/index.php?option=com_content&view=article&id=1182&Itemid=567&lang=tw




附註2:
法國骨髓捐贈網頁
http://dondemoelleosseuse.fr/transplantation-indications-preparation-and-procedure

How is the transplant carried out ?
Generally, the haematopoietic stem cells are injected 24-48 hours after the end of the preparation procedure.
The bone marrow is transplanted into the patient by intravenous injection, like a transfusion, as soon as possible after collection (between 12 and 36 hours).
In rare cases, frozen stem cells are thawed by immersing them in sterile water at 37°C and immediately injected into the patient’s blood.

How is the bone marrow transported ?
Bone marrow does not keep for long. It is therefore transferred from the donor to the patient as quickly as possible (between 12 and 36 hours).
Generally, after collection, the bone marrow is maintained at ambient temperature during its transfer to the place of transplantation. If the journey is too long, it may be refrigerated at 4°C.
Under specific circumstances, the bone marrow cells may be frozen for reasons purely connected with logistics’ difficulties.

資料來自 Agence de la Biomedecine 法國生物醫藥局
http://www.agence-biomedecine.fr/About-us?lang=fr

Granulocytes (Neutrophils)
Description - Granulocytes (neutrophils) are obtained by an apheresis procedure from an ABO-Rh compatible donor. Since there are large numbers of red cells in granulocyte concentrates, compatibility testing must be performed between the donor unit and the recipient. Granulocyte concentrates from donors who have been stimulated by G-CSF, a practice currently under study, contain much larger numbers of leukocytes. Granulocyte concentrates are always irradiated to prevent graft versus host disease. Granulocytes should be administered as soon as possible after collection. If this is not possible, storage should be at room temperature for no longer than 24 hours after collection. A four hour expiration time is placed on the granulocytes once issued from the Blood center.

Indications - Granulocytes should be considered for patients with severe neutropenia (<200/µl) and a documented life-threatening bacterial or fungal infection not responsive to appropriate antibiotic therapy. Additional indications include neonates with clinical sepsis and patients with infections who have neutrophil function defects. After granulocyte therapy is initiated, it is generally continued once daily until the infection clears or the neutrophil count begins to recover.

Therapeutic Effect - Even though there may be a clinical effect, there may not be an increase in the recipient’s neutrophil count.
來源:COMMON BLOOD PRODUCTS BLOODBOOK.COM

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