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Overcoming obstacles to collect a donated bone marrow from Taiwan amid the pandemic

Despite the enforcement of travel restrictions in many countries amid the pandemic, a charter flight from Singapore had flown to Hualien Airport in late April to complete the collection of a rare non-relative donated bone marrow via transit without entry.


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The worsening of the COVID-19 pandemic has driven countries around the world to close their borders to foreign visitors. However, a charter flight from Singapore has flown to Hualien Airport in late April to complete the collection of donated bone marrow via transit without entry while fulfilling with all the stringent preventive measures. (Photo credit to Hualien Tzu Chi Hospital) 

With the COVID-19 pandemic looming globally, nations around the world have taken the measure of restricting their borders to visitors to curb the spreading of the disease. At such a time, the transport of a donated bone marrow in Taiwan went through many obstacles to reach a leukemia patient in Singapore.

Lin Shinn-Zong, Superintendent of Hualien Tzu Chi Hospital, said that since the establishment of the Buddhist Tzu Chi Stem Cells Center (BTCSCC), this is the first time a bone marrow collection was carried out via transit without entry to Taiwan. It was also the first encounter of such nature for Hualien Airport and the Hualien Aviation Police Bureau. The collection would not have been successful without the support from Hualien County Government, the Health Bureau and all relevant parties involved in this mission.

Lin also shared that after a successful pairing of bone marrow stem cells, the leukemia patient will have to go through a series of treatments including chemotherapy before doing the transplant. The transplant must also be performed within the scheduled time, failing which, the patient may become seriously infected or even pass away.

Hualien Tzu Chi Hospital said that the patient who sought for the hematopoietic stem cells is a nearly 40-year-old woman suffering from acute myeloid leukemia (AML). After exhausting all possibilities of finding a suitable donor at the Singapore bone marrow registry, the patient approached Tzu Chi Foundation (Singapore) which later turned to BTCSCC in Hualien to search for matching stem cells.

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The bone marrow collector returned to Singapore within one hour after receiving the bone marrow at Hualien airport. (Photo credit by Hualien Tzu Chi Hospital)  

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To comply with the preventive measure, the staff of Hualien Tzu Chi Hospital put on personal protective equipment to complete the bone marrow handover. (Provided by Hualien Tzu Chi Hospital)

Worldwide border control has complicated the collection of the bone marrow 

Under normal circumstances, the country of the bone marrow recipient will assign a representative to collect the bone marrow from the country of the donor. However, the ongoing preventive measures amid the pandemic has made the collection of bone marrow complicated. The cancer patient in Singapore was originally scheduled for a stem cell transplant at the end of March and the Taiwanese donor had also arranged for a bone marrow extraction procedure at Hualien Tzu Chi Hospital around that time. However, the plan was interrupted by the sudden enforcement of border restriction in both countries, thus causing a delay in the preparatory work for the bone marrow collection.

Taiwan and Singapore have taken the restrictive measure of baring the entry of visitors starting 19 March and 23 March respectively, resulting in the cancellation of most flights. Besides, either person who delivers the bone marrow to Singapore or collects the bone marrow from Taiwan would have to serve a 14 days quarantine order upon arrival. As such, they must think of a different way to speed up the process of collecting the bone marrow.

After the family members of the leukemia patients have proposed to charter a plane from Singapore to collect the bone marrow, BTCSCC and Tzu Chi volunteers started contacting 6 ministries in Taiwan, and they were given the needed assistance from the officers of the various ministries concerned. In the end, both parties agreed to arrange for a plane departing from Singapore in late April to complete the bone marrow collection procedure at the landing airfield of Hualien Airport.

In order to meet with the preventive measures and immigration procedures, BTCSCC had done a site recce followed by a drill at the Hualien Airport two days before the arrival of the chartered flight, just to make sure that there would not be any mistake in the handover process. The plane that took off from Singapore arrived in Hualien after 4.5 hours. The personnel from Singapore took less than 1 hour to collect the bone marrow before heading back to Singapore. During the handover process, all personnel were fully geared with personal protective equipment as they witnessed the transnational handing over of the bone marrow.

Hualien County Health Bureau Chief, Chu Chia-Hsiang pointed out that having a transnational bone marrow donation amid a pandemic is a very commendable act.

"Singapore's nurses and Tzu Chi medical team have adhered fully to the preventive measures. Apart from the medical team, others including the aviation police station, airport terminal staff have also followed the instructions of the infection control officer in abiding every preventive measure. The whole process is very heart moving, I believe this is a pioneering achievement for everyone involved," said Chu.

The compatibility rate of non-relative bone marrow pairing is very low, chances of getting such a match is 1 in 10,000 to 100,000. According to the statistics from BTCSCC, there are about 500 people working hard behind each bone marrow collection, including volunteers, medical staff, and most importantly, the bone marrow donor and the consent from the donor’s family. However, due to the ongoing pandemic, the efforts involved in this transnational donation have far exceeded 500 people.

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The representative from Singapore on his way back after collecting the bone marrow. (Photo credit to Singapore Bone Marrow Donation Programme Center) 

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Upon arriving at Singapore, the bone marrow is passed to the healthcare personnel in charge. (Photo credit to Singapore Bone Marrow Donation Programme Center) 

The first transnational bone marrow donation happened 26 years ago 

Buddhist Tzu Chi Stem Cells Center (BTCSCC), formerly known as Tzu Chi Marrow Donor Registry, is the first and only bone marrow donor databank in Taiwan. The data bank was established in October 1993 under the advocacy of Master Cheng Yen, the founder of the Tzu Chi Foundation. For 26 years, Tzu Chi volunteers have been appealing to the public to donate bone marrow and that has made bone marrow donation a common thing in Taiwan.

The Bone Marrow Donor Programme Centre in Singapore was established four months earlier than BTCSCC. During that time, Tzu Chi Singapore was one of 29 groups that supported the establishment of the bone marrow centre. At the beginning of its establishment, Tzu Chi Singapore had often co-organized seminars with the Bone Marrow Donor Programme Centre to promote the awareness of bone marrow donation and raise fund for the latter.

On 26 September 1994, the first "non-relative" transnational bone marrow transplant operation of BTCSCC was also completed at a hospital in Singapore. The recipient was a 16-year-old girl from Malacca. At that time, Malaysia did not have a national bone marrow database and the General Hospital in Malaysia was unable to complete the non-relative bone marrow transplant. Through Tzu Chi Malacca, the girl’s family found a bone marrow donor in Taiwan, a 19-year-old girl surnamed Chen. After the bone marrow arrived in Singapore, the transplant operation was also performed at a Singapore Hospital.

26 years later, donated bone marrow is flown from Taiwan to Singapore once again to complete a transplant operation. In a pandemic situation, despite all the difficulties, both parties have accomplished their mission of saving lives in the spirit of great love.

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The first transnational bone marrow donation that happened in 1994. (Photo by Tzu Chi Singapore) 

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Tzu Chi held the 5th bone marrow donation blood testing campaign on 19 November 2000 at its former address in Chinatown. (Photo by Huang Ji Kun) 


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