Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

NATIONAL MARROW DONOR PROGRAM 

PROGRESS IN MINORITY RECRUITMENT 
OFFICE OF INSPECTOR GENERAL 

The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, is to 

protect the integrity of the Department of Health and Human Services programs as well as the 

health and welfare of beneficiaries served by them, This statutory mission is carried out through a 

nationwide program of audits, investigations, evaluations, sanctions, and fraud alerts. The 

Inspector General informs the Secretary of program and managementproblems and recommends 

legislative, regulatory, and operational approachesto correct them. 

OFFICE OF EVALUATION AND INSPECTIONS 

The OIG’SOffice of Evaluation and Inspections(OEI) conductsshort-term management and


program evaluations(called inspections)that focus on issues of concern to the Department, the


Congress, and the public. The inspection reports provide findings and recommendationson the


efficiency, vulnerability, and effectivenessof departmentalprograms.


OEI’SBoston Regional Office prepared this report under the direction of Mark R. Yessian, Ph.D.,


Regional Inspector General. Principal OEI staff included:


Boston Retion Headquarters


Russell W. Hereford, Ph.D., Project Leader Alan Levine, Program Specialist


Elizabeth Robboy, Program Analyst


To obtain a copy of this report, contact the Boston Regional Office by telephone at


(617) 565-1050 or by fax at (617) 565-3751.

Department of Health and Human Services 

OFFICE OF


INSPECTOR GENERAL


NATIONAL MARROW DONOR PROGRAM


PROGRESS IN MINORITY RECRUITMENT 

#.- -d’ 9 

$V JUNE GIBBS BROWN ~ 

s

% $ Inspector General 

‘%d~~ DECEMBER 1996 %J2

# 0EI-01-95-O0120 
EXECUTIVE SUMMARY 

PURPOSE 

To assess the performance of the Natioml Marrow Donor Program in increasing the 

representation of potential donors from racial and ethnic minority groups on the registry of 

volunteer unrelated marrow donors. 

BACKGROUND 

Bone marrow transplantation is a treatment for blood borne diseases such as leukemia and 

lymphoma. For a transplant to be successful, the patient’s and donor’s blood cell proteins, 

referred to as human leukocyte antigens, must match as closely as possible. Because 

different populations have quite different genetic traits, it is much more likely that a patient 

will find a match from within his or her own racial group. 

The National Marrow Donor Program (NMDP),is a nonprofit organization based in 

Minneapolis, Minnesota, that finds matching donors for patients seeking a transplant. It 

operates the congressionally authorized marrow donor registry under contract with the Health 

Resources and Services Administration (HRSA). One major fimction of the registry is to 

“increase the representation of individuals from racial and ethnic minority groups. ” 

The NMDPaccredits local donor centers that recruit volunteers to join the registry. As of 

October 1995, the registry contained almost 1.5 million donors from 97 domestic centers. It 

also has accredited 11 recruitment groups to help recruit minority donors. This report is 

based on mail surveys of 88 of the 97 domestic donor centers and all 11 recruitment groups; 

statistical data maintained by NMDP;and site visits to 9 donors centers and 4 recruitment 

groups across the country. 

FINDINGS 

The number and proportion of donors on the registry from racial and ethnic minority 

groups has grown substantially. However, the proportion of black donors and Hispanic 

donors still falls short of their representation in the U.S. population. 

In the two and one-half years between April 1993 and October 1995, the number of 

donors from racial and ethnic minority groups increased by 180 percent, from 

127,663 to 356,420. Minority donor representation on the registry grew from 

17 percent to 25 percent. 

The NMDPreached the goals specified in its contract with HRSAregarding minority 

recruitment for the year May 1994-April 1995, with the exception of Hispanic 

recruitment, where it fell short by about 20 percent (7,000 donors). 

i 
As of October 1995, blacks comprised 9 percent ofdonors on the registry (vs. 12 

percent in the general population), and Hispanics comprised 8 percent of donors on 

the registry (vs. 9 percent in the general population). 

Even as donor centers’ recruitment of minorities has increased, the overall retention 

rate for these donors has remained about the same. However, retention rates among 

donors from racial and ethnic minority groups continue to lag behind those for whites. 

Few donor centers have a proportion of minority donors that equals or exceeds the 

proportion of minorities living in their service area. The NMDP,however, does not have 

in place performance indicators to measure individual donor centers’ progress in 

recruiting minorities. 

Seventy-four of the 97 donor centers had a smaller proportion of Hispanics on their 

lists than reside in their service areas. Sixty-five donor centers had a smaller 

proportion of black donors than reside in their service areas. 

The distribution of minority donors is concentrated in a few donor centers. Twelve 

donor centers accounted for more than 50 percent of all donors from minority groups. 

Donor centers responding to our survey identified three major obstacles to recruitment 

of minorities to the national registry: 

Lack of awareness of marrow donation among minorities 

Mistrust of marrow domtion among minority groups 

Language and/or cultural barriers 

The NMDP has developed strategies to overcome these obstacles. Each of these 

strategies, however, contains some vulnerabilities that may limit their effectiveness. 

Publications. Eighty-six of the 88 donor centers responding to our survey report that 

they are using materials prepared by NMDPto increase awareness and decrease 

mistrust about marrow donation among minorities. However, during our site visits, 

donor center and recruitment group staff raised concerns about these materials’ 

sensitivity to local conditions and, in some cases, the accuracy of translation. 

Recruitment Groups. Thirty-nine of the 88 donor centers responding to our survey 

reported that they work with NMDP-accredited recruitment groups as one way of 

overcoming language and cultural barriers. Seventeen centers reported that they rely 

on these recruitment groups for more than half of their minority recruitment. Despite 

turning to recruitment groups to play a major role in recruiting minority donors, 

NMDP does not have in place performance indicators to measure their ongoing 

effectiveness. 

ii 
RECOMMENDATIONS 

Performance Indicators for Donor Centers. Inthe next contract, the Health Resources and 

Services Administration should require that the National Marrow Donor Program develop 

and implement performance indicators that measure the progress of individual donors centers 

in recruiting donors from racial and ethnic minority groups. We urge that these indicators be 

implemented within the first year of the new contract. 

Performance Indicators for Recruitment Groups. In the next contract, the Health 

Resources and Services Administration should require that the Natioml Marrow Donor 

Program develop and implement performance indicators that measure the accomplishments of 

recruitment groups. We urge that these indicators be implemented within the f~st year of 

the new contract. 

Contingency Plans. The HRSAshould identify steps to be taken should the NMDPcontinue to 

fall short on the recruitment goals specified in its current contract, as occurred among 

Hispanic donors in the first year. 

Sharing Effective Practices. The NMDPshould draw on the expertise of those donor centers 

and recruitment groups that have succeeded in recruiting minority donors as one way of 

providing assistance to other donor centers. 

COMMENTS ON THE DRAFT REPORT 

The Health Resources and Services Administration (HRSA),the Assistant Secretary for Health 

(ASH), and the National Marrow Donor Program (NMDP)commented on the draft report. 

HRSA concurs with our recommendations regarding performance indicators, except that the 

agency believes it is not possible to implement these indicators before signing the next 

contract. We agree that more time might be needed. We changed our recommendations to 

require the NMDP to develop and implement these indicators in the next contract. We 

continue to believe that developing, implementing, and enforcing performance standards for 

recruitment of donors from minority groups and for performance of recruitment groups are 

important, and need to be accomplished as quickly as possible. 

NMDP’S comments were similar to HRSA’S. In our view, all donor centers have a role to play 

in improving the chances for minority patients awaiting transplant to find a donor. For this 

reason, we recommend some type of linkage between recruitment goals and the minority 

population in each donor center’s service area. 

The Assistant Secretary for Health comments that the recommendations contained in this 

report are important and should be implemented as quickly as possible. We have changed 

the language in the report in several places as ASHrecommends. 

...

111 
TABLE OF CONTENTS


EXECUTIVE SUMMARY


INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1


FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...4


�increase inrninoritydonors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...4


�Minol-ity representationon donorlists . . . . . . . . . . . . . . . . . . . . . . . . . . ..’7


�obstacles torninority recruitment . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...9


.Strategies forrninority recruitment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11


RECOMMENDATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13


COMMENTS ON THE DRAFI’ REPORT . . . . . . . . . . . . . . . . . . . . . . . . . 15


APPENDICES


A: Survey Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..A-1


B: Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..B-l


C: Textofcornments onthedraft report . . . . . . . . . . . . . . . . . . . . . . . . . ..C-1


D: Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..D-l

INTRODUCTION 

PURPOSE: 

To assess the performance of the National Marrow Donor Program in increasing the 

representation of potential donors from racial and ethnic minority groups on the registry of 

volunteer unrelated marrow donors. 

BACKGROUND: 

Bone Marrow Transplantation 

Bone marrow transplantation is a treatment for blood borne diseases such as leukemia and


lymphoma. About 16,000 people are diagnosed each year with leukemia and other fatal


blood diseases. 1 Many of these people could benefit from a bone marrow transplant, a


procedure in which the patient’s diseased bone marrow is destroyed and marrow from a


healthy donor is infused into the patient’s blood stream. Bone marrow produces platelets,


red blood cells, and white blood cells, the agents of the body’s immune system. For a bone


marrow transplant to be successful, the patient’s and donor’s antigens must match as closely


as possible. About 30 percent of the time the patient has a sibling with matching antigens.


In the other 70 percent of cases the patient must seek an unrelated donor.


Three pairs of blood cell proteins, known as the Human Leukocyte Antigen (HLA)-A,


-B and -DR, are important in determining whether a match will be successful. One antigen in


each pair is inherited from an individual’s mother, the other from the father. Because there


are numerous antigens at each HLA-A,-B, -DR locus, more than 600 million combinations are


theoretically possible.2


The National Marrow Donor Program 

The National Marrow Donor Program (NMDP)is a non-profit organization based in 

Minneapolis, Minnesota. The NMDPoperates the Congressionally authorized marrow donor 

registry under contract with the Health Resources and Services Administration (HRSA). The 

contract is funded at $40,471,000, from July 1994 through April 1997. 

The registry’s major functions are to: (1) establish a system for finding marrow donors 

suitably matched to unrelated recipients for bone marrow transplantation; (2) recruit potential 

donors; and (3) increase the representation of individuals from racial and ethnic minority 

groups in order to enable an individual in a minority group, to the extent practicable, to have 

a comparable chance of finding a suitable unrelated donor as would an individual not in a 

minority group. 3 

The NMDP began operations in September 1987 as a non-profit organization funded through a 

contract from Office of Naval Research. The NMDPwas created through a cooperative effort 

of the American Association of Blood Banks, American Red Cross, and Council of 

1 
Community Blood Centers. The NMDPbegan search operations with 10 transplant centers, 

49 donor centers and 8,000 donors listed on the registry. As bone marrow transplantation 

came to be seen as viable technique, the U.S. Navy recognized that it was inappropriate for 

the military to maintain a civilian registry. In 1989, responsibility for the contract was 

transferred to the National Heart, Lung, and Blood Institute in the National Institutes of 

Health. Contract oversight for the NMDPwas again transferred in 1994 to HRSAin 

recognition that NMDPwas a service delivery program, rather than a basic research initiative. 

Donor Recruitment 

Recruiting volunteer donors, particularly minority donors, is a major responsibility of the 

registry. The NMDPaccredits local donor centers that recruit volunteers to join the registry. 

As of October 1995, the registry contained almost 1.5 million donors in 97 domestic donor 

centers, and an additional 450,000 donors from 6 foreign centers. Eighty-one of the 

domestic centers are blood centers, either Red Cross-affiliated or part of community blood 

centers; 13 centers are departments of hospitals, and 3 are free-standing centers. Six of the 

domestic centers have more than 50,000 donors on their list; another 35 centers have 

between 10,000 and 50,000 donors each. The remaining 56 centers have fewer than 10,000 

donors. 

The NMDP also has accredited 11 recruitment groups to help recruit donors. Because of their 

ties to particular segments of the local community, recruitment groups theoretically are able 

to recruit donors from those segments with more success than donor centers. Upon 

recruiting a potential donor, the recruitment group must “turn over” the donors it has 

recruited to the donor center with which it works. In the event that one of these donors is 

needed for further testing leading to actual donation, the affiliated donor center is responsible 

for all contact with the donor. 

Issues in Mhority Recruitment 

Even with a registry of 1.5 million donors, it remains difficult for minority patients to find 

matching donors. This problem is particularly acute for African-Americans, due to the 

increased number of HLA combinations occurring in this group. Consequently, the 

legislation establishing the registry requires it to “increase the representation of individuals 

from racial and ethnic minority groups ... in order to enable an individual in a minority 

group, to the extent practicable, to have a comparable chance of finding a suitable unrelated 

donor as would an individual not in a minority group.”4 Of the 3,198 transplants that the 

NMDP has facilitated since it began operations in September 1987, less than 10 percent were 

for minority patients. 

Previously, the Office of Inspector General examined racial disparities in access to domted 

solid organs (The Distn”bution of Organs for Transplantation: Expectations and Practices, 

OEI-01-89-00550, March 1991). In that report, we found that blacks on kidney waiting lists 

wait almost twice as long as whites for a first transplant. There has been some improvement 

in access to organs among minorities. In 1994, 39 percent of recipients of cadaveric kidneys 

were minorities, versus 35 percent in 1988. The percentage of cadaveric kidney donors who 

2 
were minorities increased in that same time period from 16 percent to 22 percent.5 

Bone marrow transplantation differs from solid organ transplantation in many important 

respects. However, both procedures require compatibility in donor and recipient human 

leukocyte antigens to improve chances for a successful match. Because the combimtion of 

blood cell proteins tends to follow racial and ethnic lines, a patient has the best chance of 

finding an appropriate donor from within his or her own racial group. 

In a 1992 report, the General Accounting Office (GAO)found that the proportion of black and 

Hispanic potential donors for marrow domtion still lagged considerably behind their 

proportions in the U.S. population. The GAOrecommended that for the NMDPto achieve its 

goal of a representative racial and ethnic distribution, the NMDPwould have to at least double 

the proportion of blacks and Hispanics on the Registry.G 

SCOPE AND METHODOLOGY: 

This report addresses the 97 domestic donor centers. The report is one of four companion 

reports addressing the National Marrow Donor Program. The other three reports are: 

National Marrow Donor Program: Effectiveness in Retaining Donors (OEI-01-95-00121); 

National Marrow Donor Program: Geographic Overlap Among Donor Centers (OEI-Ol-95-

00122); and National Marrow Donor Program: Financing Donor Centers (OEI-Ol-95-

00123). 

This report is based on five primary data sources: 

1) The NMDP’Sregistry statistics extending over a two and one-half year period, from April, 

1993 through October, 1995. 

2)	 A mail survey of the 97 domestic donor centers. We received 88 responses, a response 

rate of 91 percent. 

3) 1990 U.S. Census Data at a county level. 

4)	 The NMDP’SDonor Center Access Directory, in which each donor center displays a map 

of the geographic area that it covers. 

5) Site visits to donor centers and recruitment groups in California, Massachusetts, 

Minnesota, New Jersey, North Carolim, and South Carolim. 

Appendix B provides a more detailed description of our methodology. 

We conducted this study in accordance with the Quwlity Standards for Inspections issued by 

the President’s Council on Integrity and Efficiency. 

3

FINDINGS 

THE NUMBERANDPROPORTIONOF DONORSON THE REGISTRYFROMRACIALANDETHNIC 

MmORITY GROUPSHASGROWNSUBST
 ANTIALLY. HOWEVER,THE PROPORTIONOF BLACK

DONORSANDHISPANICDONORSSTILLFALLSSHORTOF THEIRREPRESENTATION
 IN THE 

U.S. POPULATION. 

�	 In the two and one-half years between April 1993 and October 1995, the number of 

donors from racial and ethnic minority groups increased by 180 percent, from 

127,663 to 356,420. Minority donor representatz”onon the regt”strygrew from 

17 percent to 25 percent. 

The NMDP tracks five broad racial and ethnic categories of donors: White, black, Hispanic, 

Asian/Pacific Islander, and American Indian/Alaska Native donors.7 The NMDPconsiders 

the non-white donors to be minority donors. The total number of donors on the registry 

grew by 91 percent, from 757,769 to 1,447,324, in the two and one-half years between April 

1993 and October 1995. Minority donors accounted for about one-third of that increase. 

The number of white donors increased by 77 percent, from 595,942 to 1,054,396. 

Pig’m’el 

NhiDPRegiScy, 1995 

.41i=i-W 

W Nuke 

� Apdl*. 

InawseitlMiMityDculoIaon A@ 1993tooctober

� cka!&rm 

-“ 

B18ck0 2s,aoo So,ooo 75,000 KKl,ooo1Z5,000lS0,000 

Nuduof Douc?s 

In our site visits to donor centers and NMDPheadquarters, we heard of two overarching 

reasons for the growth of minority donors on the registry. The first reason is a general 

emphasis on the need for more minority donors in order to make bone marrow 

transplantation available to patients from minority groups. One way in which the NMDP 

promotes awareness is through national campaigns directed at specific minority groups. The 

NMDPhas launched two such campaigns thus far, one targeted at black donors and the other 

4 
targeted at Asian/Pacific Islander donors. 8 The NMDPalso emphasizes the need for a 

diverse registry through promotional literature and brochures aimed at the general public. 

The second reason for the growth of minority donors on the registry is the financial 

incentives built into the system. A grant from the Department of Navy pays for tissue typing 

of minority donors. White donors who wish to volunteer for the registry must pay the cost 

of tissue typing themselves, or through privately generated funding. These typically range 

from $4S to $60 for the initial HLA-A and -B typing. 

More recently, the NMDPhas begun paying donor centers a higher fee for recruiting minori~ 

donors than for white donors. The NMDPpays the 62 donor centers reimbursed on a fee-forservice basis $28 for each new minority donor and $10 for each new white donor. The other 

35 donor centers, which are funded on contract basis, have finds earmarked for minority 

recruitment staff. 

.	 l%e NMDP reached the goals specified in its contract with HRSA regarding minority 

recruitment for the year May 1994-April 1995, with the exception of Hispanic 

recruitment, where it fell short by about 20 percent (7,000 donors). 

The NMDP’S3-year contract with HRSAstipulates that 150,000 new donors must be recruited 

annually. At least 30,000 of these new donors should be black, 18,800 should be Asian/ 

Pacific Islander, and 32,000 should be Hispanic. The contract does not specify an annual 

recruitment goal for American Indian/Alaska Natives. Table 1 compares the level of NMDP 

minority recruitment with HRSArecruitment goals. The table also presents data on 

recruitment for the first half of this second contract year. 

Racial/EthnicGroup 

Blacks 

Asian.iPacific 

Islanders 

Hispanics 

All Donors 

MINORITY GtMIS 

Numberof donors 

recruitedby NMDP 

betweenMay 1, 

1994andApril 30, 

1995 

38,275 

22,492 

25,147 

288,989 

Table 1 

smtmxED IN HRSA CONTRACT 

Annualrecruitment 

levelspecifiedin 

the HRSA contract 

30,000 

18,800 

32,000 

150,000 

Numberof donors 

Difference recruitedby NMDP 

betweenthe HRSA betweenMay 1, 

contractand the 1995and October 

actuallevelof 31, 1995 

recruitment 

8,275 20,183 

3,692 14,194 

(6,853) 17,183 

138,989 142,109 

DataSource: NMDP RegistryStatistics,April 1994throughOctober1995. 

Analvsis: Officeof InsuectorGeneral(OIG). 

5

The absence of a natioml campaign targeted on Hispanic donors may provide one 

explanation for NMDP’Slimited success in recruiting Hispanic donors as compared to their 

success with donors from other minority groups. However, the NMDPreports that plans are 

underway for a national campaign that targets Hispanic donors in four areas of the country.9 

.	 As of October 1995, blacks comprised 9 percent of donors on the re~”stry (vs. 

12 percent in the general population), and Hispanics comprised 8 percent of donors 

on the re~”stry (vs. 9 percent in the general populah”on). These propo~”ons 

represent substantial increases, from 5 percent for blacks and 6 percent for 

Hispanics in April 1993. 

As figure 2 depicts, the proportion of Asian/Pacific Islanders and American IndiatiAlaska 

Natives on the registry already exceeds their proportion in the population. Asian/Pacific 

Islanders account for 6 percent of the donors on the registry (vs. 3 percent in the general 

population); American Indian/Alaska Natives account for 2 percent (vs. 1 percent in the 

population). 

Flgurc2 

M@&~bm~PR@@V 

15% 

14% 

13% 1993 

12% 

11% 1995 

10% 1990 

9% 

8% 

7% 

6% 

5% 

4% 

3% 

2% 

1% 

o% 

Blsck - w ~-

Ahsb Native 

LshIMkz 

For this amlysis we compared the percent of minority representation in the registry with 

1990 U.S. population census data. This analysis is conservative for two reasons. First, the 

number of blacks and Hispanics may be under represented in the 1990 U.S. census. 10 

Second, because of the 5-year gap between the 1990 census and the 1995 NMDPstatistics, 

minorities may account for an even higher proportion of the U.S. population today. As a 

result, the disparity between the proportion of minorities on the registry vs. those in the U.S. 

population may be even wider than reported here. 

6

Even asdonor centers 'recmi~ent ofminorities has increased, the overall retention rate 

for these donors has remained about the same. However, retention rates among donors 

from racial and ethnic minority groups continue to lag behind those for whites. 

F	 Retention ofmtiority donors at first level follow-up testing (DRtyping) improved to 

66 percent for the year ending September 1995, up from 55 percent for the year 

ending September 1993. 

F	 However, retention ofminori~donors atsecond level follow-up testing (cTtestkg) 

declined to60percent for the year ending September 1995, down from 67 percent for 

theyear ending September 1993. 

Donor retention rates measure the proportion of donors who proceed to followup testing, 

when their names appear as potential matches. Inour companion report, National Marrow 

Donor Program: Effectiveness in Retaining Donors (OEI-01-95-O012 1), we examine donor 

retention in detail. 11 Among white donors, the retention rate at DR was 76 percent for the 

year ending September 1995; the CT retention rate was 81 percent. 

As we discuss in the companion report, a likely important explamtion for the increase at DR 

testing and decline at CT testing is the recently initiated-practice of DR-typing virtually all 

minority donors at registration. As a result, the difficulties associated with contacting and 

obtaining permission for donors that previously were found at DR-typing are now arising at 

CT. 

The lower retention rate among minority donors has important implications for recruitment of 

donors from these groups. The large number of HLAcombinations among some minority 

groups makes it difficult for patients from these groups to find a matching donor; in itself, 

this means that donors from these groups need to be over-represented on the registry to 

provide an equitable chance of finding a match. Second, the lower retention rate means that 

an even greater number of donors from these groups is needed in order to find a match who 

is willing to proceed all the way to actual marrow collection and transplant. 

FEW DONOR CENTERS HAVE A PROPORTIONOF MINORITYDONORSTHATEQUALSOR 

EXCEEDSTHE PROPORTIONOF MINORITIESLIVINGIN THEIR SERVICEAREA. 

.• As of October 1995, 74 of the 97 donor centers had a smaller propoti”on of 

Hispanics on their lists than reside in their service areas. Sixty-five donor centers 

had a smaller propoti”on of black donors than reside in their service areas. 

We compared the service area of each donor center at the county level with county level 

population data from the 1990 U.S. Census. 12 We then compared the percent of minori~ 

donors on each donor center’s list with the percent of minority donors residing in their 

service area. Table 2 (following page) depicts the number of donor centers falling short of 

or exceeding the proportion of minorities in their service area. 

7

8 

Table 2 

DONOR CENTERS IN WHICH THE PROPORTION OF MINORITIES ON THEIR LISTS EXCEEDS 

OR FALLS SHORT OF THEIR REPRESENTATION IN THE LOCAL SERVICE AREAS 

Ethic and RacialGroup 

Hispanic


Black


Asian/PacificIslander


AmericanIndLm/AlaskaNative


Numberof donorcenterswith 

listsfalling shoti of the 

proportionof minoritiesin their 

serviceareas 

74 

65 

38 

31 

Numberof donor centerswith 

lists exceedingthe proportion 

of minoritiesin their service 

areas 

22 

31 

58 

65 

N=96 DonorCenters. ExcludesU.S. Navy’sBillYoungMarrowDonorCenterbecauseof that center’s 

uniquefocuson militarypersomel worldwide. 

DataSource:NMDPRegistryStatisticsfor October31, 1995;donorcenterserviceareasdefinedin 

NMDP’s “DonorCenterAccessDirectory”for October,1995;and 1990U.S. CensusPopulationData. 

Analvsis:Officeof InmectorGeneral(OIG). 

We further amlyzed the donor centers’ lists to determine the extent to which centers fall 

short on minori~ recruitment. Our analysis shows that 27 donor centers had lists which 

reflected less than half the percentage of Hispanics in their service areas. Thirty donor 

centers had lists which reflected less than half the percentage of blacks in their service areas. 

Twelve donor centers had lists which reflected less than half of the percentage Asian/Pacific 

Islanders in their service areas, and seven donor centers had lists which reflected less than 

half of the American IndiadAlaska Natives in their service areas. 

Our analysis revealed that 11 donor centers had lists which fell short of the proportion of 

minorities in their service area for all 4 minority groups. Five centers had donor lists which 

reflected or exceeded the proportion of all minority groups in their service area. We did not 

fmd anything particular about either of these two groups. However, in our companion report 

National Marrow Donor Program: Financing Donor Centers (OEI-01-95-O0123), we report 

that contract centers are more likely than fee-for-service centers to have a proportion of 

minorities that equals or exceeds the proportion of minorities that reside in their service 

areas. 

.• The distn”bution of minority donors is concentrated in a few donor centers. As of 

October 1995, 12 of the 97 donor centers account for more than 50 percent of all 

donors from minority groups. 

These same 12 centers accounted for 42 percent of all donors on the registry. Eight of these 

donor centers are large, with donor lists of over 20,000. The other four have smaller lists 
9 

but are in areas of the country with high numbers of minority populations. 

Ouranalysis of these 12centers showed significant differences between these 12 centers and 

other 76 centers responding to our survey in two areas: use of minority staff and use of 

bilingual staff. According to self-reported survey data, all 12 of these centers employ 

minority staff (vs. 45 of the other 76 donor centers). In 11 of the 12 centers, staff and 

volunteers speak a second language (vs. 24 out of the other 76 donor centers). 

�	 Despite the attention being @“vento recruitment of donors from minority groups, the 

NMDP does not have in place performance indicators to measure individual donor 

centers’ progress in recruiting minorities. 

The NMDP has developed nine Continuous Process Improvement (cPI) indicators in five areas 

to measure the performance of its donor centers. The CPI indicators monitor how quickly 

donor centers register new donors and how effective donor centers are at retaining donors. 

Staff at the NMDPtold us that the indicators are designed to measure only those variables that 

a donor center can control. Given the attention on minority recruitment, we find striking the 

absence of a CPI indicator measuring any aspect of minority recruitment. 

DONOR CENTERS RESPONDINGTO OUR SURVEY IDENTIFIEDTHREEMAJOROBSTACLESTO 

RECRUITMENTOF MINORITIESTO THE NATIONALREGISTRY: 

� Luck of awareness of marrow don~”on among minorities 

In their survey responses, 98 percent of the donor centers and all 11 recruitment groups 

called lack of awareness of marrow donation among minorities an obstacle. On our site 

visits to donor centers and recruitment groups, staff told us that bone marrow donation tends 

to receive less attention from the leadership in minority communities than in white 

communities. One possible explanation for the lack of awareness among minorities may be 

that they see little applicability to their lives, or to the lives of minority patients because 

minority patients have received a smaller share of bone marrow transplants. 

In addition, patients from minority groups are less likely to have success as they progress 

through the process from initiating a preliminary search for a donor to actual transplantation. 

Black patients, for example, initiated 8 percent of prelimimry searches, but received only 3 

percent of transplants. Table 3 (following page) depicts the percentage of known ethnic and 

racial groups who initiated preliminary searches and who received transplants from the 

beginning of the NMDPprogram in December 1987 through October 1995. 
Table 3 

NUMBEROF SEARCHES AND TRANSPLANTS FOR PATHINTS FROM ALL RACIAL AND ETHNIC 

GROUPS FROM DECEMBER 1987THROUGH OCTOBER 1995

Ethnicand Racial 

Group 

White 

Hispanic 

Black 

Asian/PacificIslander 

American 

Indian/AlaskaNative 

Other, unknown 

Totals: 

Preliminary Percentof Numberof Percentof 

Searches Preliminary Transplants transplants* 

Searches* 

18,265 83% 3,259 91% 

1,422 6% 169 5% 

1,675 8% 104 3% 

654 3% 49 1% 

104 < 1% 19 < 1’% 

3,139 * 275 * 

25,259 3,875 

* Searchesand transplantsfor patientswhoserace is unknownare excludedfrom thesepercentages, 

whichare calculatedon denominatorsof 22,120for preliminarysearchesand 3,600 for transplants. 

Source: NMDPRegistryStatisticsfor October1995.


Analysis: Officeof InspectorGeneral(OIG).


Note: Thesedata includesearchesand transplantsfor m donor centers,both foreignand domestic.


. Mistrust of marrow donatz”onamong minority groups 

In their survey responses, 94 percent of the donor centers and 10 out of 11 recruitment 

groups called mistrust of marrow donation among minority groups an obstacle. For 

~xarnple, donor center and recruitment group staff told us during site visits that mistrust of 

Western medicine can be a problem in Asian communities. Their resistance stems from a 

fear of strangers, and in particular fear of doctors. Another issue donor centers confront is 

distrust of the medical establishment. The donor centers we spoke with told us that they try 

to reach out to minority groups; however, access to minority establishments (e. g., churches, 

fraternal organizations, or cultural centers) can be a problem if donor center staff do not 

have a personal link to a particular establishment. 

. Language and/or cultural barriers 

Eighty-six percent of donor centers and 10 out of 11 recruitment groups called language 

and/or cultural barriers an obstacle. Specific examples of cultural and language barriers we 

learned about during our site visits include: 

F	 The Vietnamese believe that spinal cord contains vital life fluids. If the fluid is 

removed, a person may become crippled or unable to bear children. 

10

�	 While 36 donor centers reported in the survey that they employ bilingual staff and 

volunteers, we were told that it is difficult to find people fluent enough in both 

languages to explain complex medical terms. 

THE NMDPHAS DEVELOPED STRATEGIES TO OVERCOME THESE OBSTACLES. EACH OF 

THESE STRATEGIES,HOWEVER, CONTAINS SOME VULNERABILITIESTHAT MAY LIMIT 

THEIR EFFECTIVENESS. 

�	 NMDP Publications. Eighty-six of the 88 donor centers responding to our survey 

report that they are using materials prepared by NMDP to increase awareness and 

decrease mistrust about marrow donah”onamong minorities. 

The NMDP has developed a variety of promotioml materials, including pamphlets, posters 

and videos. Most of these hems are customized for different ethnic and minorhy 

communities. 

In addition to the NMDPmaterials, 34 (39 percent) of the donor centers reported developing 

their own educatioml materials specifically for minority donors. Thirty-six (41 percent) of 

the donor centers reported using educational materials developed by other donor centers for 

minority donors. 

�	 However, during our site visits, donor center and recruitment group staff 

raised concerns about these maten”als’ sensitivity to local conditions and, in 

some cases, the accuracy of translation. 

The staff members we spoke with on our site visits pointed out that a recruitment strategy 

changes with the target market. Subtle differences, such as whether the donor lives on the 

east or west coast, can effect the donor center’s or recruitment group’s marketing strategy. 

Staff told us that although they fmd NMDPmaterials useful, the generic materials are less 

effective than ones that are tailored to local needs and concerns. 

We also heard that materials origimting from NMDPheadquarters can be inaccurate. Staff at 

one recruitment group pointed to a brochure in Vietmmese that had more than 20 mistakes. 

.• Recruitment Groutm. Thirty-nine of the 88 donor centers responding to our survey 

reported that they work with N~DP-accredited recruitment groups as one way of 

overcoming language and cultural bam”ers. Seventeen centers reported that they 

rely on these recruitment groups for more than half of their minority recruitment. 

The NMDPsponsors 11 recruitment groups to help recruit minority donors. 13 To date, these 

11 recruitment groups have recruited 60,657 new donors, or slightly less than 4 percent of 

the NMDPregistry. Of these 11 groups, 1 focuses on Hispanic donors; 3 on Asian/Pacific 

Islander donors; 2 on black donors; the rest are general in their orientation. 

The 39 donor centers that work with recruitment groups reported mixed experiences. Staff 

at some donor centers responded with statements such as “recruitment groups effectively 

11 
bridge the cultural gap. ” Staff at other donor centers told us that “we work better without 

them” and that “it requires too much work to jointly handle a drive. ” Throughout our site 

visits it became apparent that for donor centers with on-going relationships with recruitment 

groups, the experience could be positive, resulting in increased access to minority 

communities. However, it also became apparent that many donor center and recruitment 

group staff were unclear on exactly how to work together. Typically contentious issues 

include who should monitor drives and how should fees be split. 

Importantly, the reimbursement system appears to have a significant effect on the extent to 

which donor centers hold drives together. The 62 donor centers reimbursed by NMDPon a 

fee-for-service basis receive a fried amount for each donor they recruit ($10 for each white, 

$28 for each person from a racial or ethnic minoriw). Because these recruitment fees are the 

fmncial base of any fee-for-service donor center, the incentive to be the sole sponsor of a 

drive is very strong. Sharing recruitment fees has a direct, negative impact on any of these 

donor centers’ bottom line. 

F	 Despite turning to recruitment groups to play a major role in recruiting 

minority donors, NMDP does not have in place pe~ormance indicators to 

measure their ongoing effectiveness. 

The performance of NMDPdonor centers is assessed every month using CPI indicators. 

Because no comparable indicators exist for recruitment groups, the NMDPhas no on-going 

way to measure their activities. Just as donor centers must be measured on aspects they can 

control, the recruitment groups feel that the same policy should hold if CPI-type indicators 

are instituted. 

Some donor center staff told us that the current system of performance measurement unfairly 

penalizes donor centers that work with unreliable recruitment groups. Once the donor is 

handed over to the donor center, that donor’s performance becomes part of the donor 

center’s CPI indicators. One donor center we visited had a fairly large donor list, a fifth of 

which came from a now-extinct recruitment group. When they f~st acquired donors from 

that group their CPI indicators showed that as many as 70 percent of their donors failed to 

come forward for followup testing. 

12

RECOMMENDATIONS 

Since its inception in 1987, the National Marrow Donor Program (NMDP)has come a long 

way in increasing the proportion of minority donors on the registry. Minority donors 

accounted for about 6 percent of the registry in December 1989.14 Today, minority donors 

represent 25 percent of the donors on the registry. 

However, our fiidings from this report show that the NMDPneeds to continue and build upon 

the progress made to date in recruiting--and retaining--donors from racial and ethnic minority 

groups. We raise these concerns because the current racial and ethnic distribution of the 

registry does not appear to meet the requirements of the Transplant Act: that a patient in a 

minority group have a comparable chance of finding an unrelated donor as a patient who is 

not in a minority group. 

We developed our recommendations to encourage 1) further improvement in minority 

recruitment and 2) the development of performance indicators for monitoring minority 

recruitment. We believe that effectively carrying out our recommendations will require a 

partnership approach between HRSAand NMDP,and between NMDPand its donor centers. 

Consequently, we direct our recommendations to both HRSA,in its role as contractor for the 

registry, and to NMDP,as the holder of that contract. 

PERFORMANCE INDICATORS FOR DONOR CENTERS. In the next contract, the Health 

Resources and Services Administration should require that the National Marrow Donor 

Program develop and implement performance indicators that measure the progress of 

individual donors centers in recruiting donors from racial and ethnic minority groups. 

We urge that these performance indicators be implemented within the first year of the new 

contract. Donor centers falling short on these indicators should be subject to disciplimry 

actions, up to and including withdrawal of their participation agreement with the NMDP. 

We offer the following options as indicative of approaches that might be considered. We 

encourage HRSAand the contractor to develop additional ideas to implement our 

recommendation of establishing minority recruitment goals as a way to improve access to 

transplantation for members of racial and ethnic minority groups. 

.	 A reasomble beginning expectation would be that the proportion of minority donors 

on a center’s list must reflect, at a minimum, the proportion of minority donors 

residing in its service area. 

�	 The HRSA and NMDP could choose to be more aggressive and give additional impetus 

to minorhy recruhment by requiring that a donor center’s list must exceed by some 

factor the proportion of minority donors in the local service area. 

.	 An alternative approach would require that donor centers recruit some specified 

percentage of the minority populations living in their service area. Rather than peg 

that percentage to the donor center’s list, as our previous option does, this approach 

13 
would, in effect, set a target number of donors from minority groups. That target 

number would be based on the number of minority residents living in the center’s 

service area. 

PERFORMANCE INDICATORS FOR RECRUITMENT GROUPS. In the next contract, the Health 

Resources and Services Administration should require that the National Marrow Donor 

Program develop and implement performance indicators that measure the 

accomplishments of recruitment groups. We urge that these performance indicators be 

implemented within the first year of the new contract. Recruitment groups falling short on


these indicators should be subject to disciplinary actions, up to and including withdrawal of


their participation agreement with the NMDP.


Just as the NMDPmeasures donor centers on aspects they can control, the recruitment groups


should also be measured on aspects of the recruitment process that they can control.


Possible performance indicators for recruitment groups include:


�	 Tracking the percentage of donors recruited by each recruitment group that are 

retained at subsequent attempts to contact them in the donation process. 

�	 Measuring the time it takes each recruitment group to return consent forms to the 

appropriate donor center. 

.	 Monitoring the number of forms that are properly filled out by each recruitment 

group. 

CONTINGENCY PLANS. The HRSA should identify steps to be taken should the NMDP 

continue to fall short on the recruitment goals specified in its current contract, as 

occurred in the first year among Hispanics. We urge the NMDP to continue with its plans 

for a campaign focused on Hispanic donors. If performance indicators for recruhrnent 

groups show that they are indeed an effective recruitment source, the HRSA and NMDP might 

want to consider accrediting and/or funding more groups focusing solely on Hispanic donors. 

We also encourage HRSA to consider speci&ing recruitment goals in the contract for 

American Indians/Alaska Natives. 

SHARINGEFFECTIVE PRACTICES. The NMDP should draw on the expertise of those donor 

centers and recruitment groups that have shown success in minority recruitment as one 

way of providing assistance to other donor centers in their minority recruitment efforts. 

These donor centers and recruitment groups could assist the NMDP in planning and executing 

national campaigns, in providing contacts to national minority organizations, and in creating, 

editing, and pretesting foreign language educatioml materials. The NMDP could also draw on 

their expertise in designing cultural competency training, improving bilingual capacity, 

developing family education strategies, and mamging multiracial drives. 

14

COMMENTS ON THE DRAFT REPORT 

We sought comments on the draft report from the Health Resources and Services 

Administration (HRSA),the Assistant Secretary for Planning and Evaluation (ASPE),and the 

Assistant Secretary for Health (ASH). In addition, HRSArequested comments on the report 

from the National Marrow Donor Program (NMDP). 

HRSA concurs with our recommendations, with the exception that the agency believes that it 

is not possible to implement performance indicators before signing the next contract. HRSA 

expects to issue the request for contract to operate the registry in December 1996, with a 

contract award expected by April 30, 1997. Our goal in recommending the adoption of 

performance indicators prior to awarding the next contract was to convey the urgency with 

which this issue needs to be addressed. We strongly urge HRSA and the NMDP to move with 

utmost speed to develop such indicators, as a way of increasing the chance for donors from 

racial and ethnic minority groups to find matching donors. 

Although these performance indicators will not be in place prior to awarding the contract, we 

are pleased that the contract will require “specific information about the development and 

implementation of the plan [for the development of performance indicators] with appropriate 

due dates and disciplinary actions. . . The request for contract for the next contract period 

will require that performance indicators and disciplinary actions be developed and that 

agreements with” donor centers be modified to include the performance indicators and 

disciplinary actions that will be taken if the center fails to meet the indicators. Accordingly, 

we modify the language of the recommendation from our draft report to reflect HRSA’s 

concerns. We add language in our recommendation urging that the indicators be 

implemented within the first year of the new contract. We believe that such a time frame is 

adequate to achieve these changes. 

We add time lines because we are concerned that an open-ended time frame could result in 

unnecessary delays. We wish to go on record as stating clearly that developing, 

implementing, and enforcing performance standards for recruitment of donors from minority 

groups are important, and need to be accomplished as quickly as possible. 

We fully agree that individual donor center goals should be based upon the minority 

population in the area served by the donor center. In our draft report, we listed three 

options that were indicative of approaches that might be considered. We continue to list 

those options in this final report, but we also add language encouraging HRSAand the 

contractor to develop additional ideas to implement our recommendation to establish overall 

minority recruitment goals as a way of improving access to transplantation for minority 

patients. We have no objection to numerical performance indicators over percentages. 

HRSA agrees that performance indicators for recruitment groups should be in place, but notes 

that there is not enough time to develop these prior to awarding the next contract. We 

therefore are changing our recommendation to reflect HRSA’Sconcerns. We add language in 

our recommendation urging that the indicators be implemented within the first year of the 

15 
new contract. 

HRSA agrees with our other two recommendations--to develop contingency plans for cases in 

which recruitment falls short of goals, and to share effective practices. 

NMDP’Scomments were similar to HRSA’s. We do, however, wish to address one point in 

particular, NMDP’S comments on goals for recruitment of donors from minority groups. We 

agree that recruitment of minorities should be a significant segment in evaluating the 

effectiveness of a donor center. We do not, however, agree with the NMDP’Scaveat that this 

should only be a criteria in an area where “it makes sense to recruit a given minority. ” In 

our view, all donor centers have a role to play in improving the chances for minority patients 

awaiting transplant to fmd a donor. For this reason, we continue to recommend some type 

of linkage between recruitment goals and the minority population in each donor center’s 

service area. 

The Assistant Secretary for Health comments that the recommendations contained in this 

report are important and should be implemented as quickly as possible. ASHalso comments 

that cultural competency training and bilingual capability be included in the HRSAcontract, 

and that educational materials be pretested with a sample of the target population prior to 

their use. Although we do not include these items as separate recommendations, we do add 

them as topics to be included in sharing effective practices. 

ASH raises other points upon which we wish to comment. Determining why whites constitute 

91 percent of transplants but only 83 percent of preliminary searches--and, conversely, why 

members of minority groups constitute 18 percent of preliminary searches but only 9 percent 

of transplants--was outside the scope of our study. lt is, of course, possible to hypothesize a 

number of factors, including antigen matching and financial barriers, that may limit access to 

transplants among members of minority groups. Even though, as ASH notes, Asian/Pacific 

Islanders on the donor list represent a larger proportion of donors than in the general 

population, they had received only one percent of the transplants through October 1995. 

Fimlly, ASH questions why the HRSAcontract does not include recruitment goals for 

American Indian/Alaska Native populations, as it does for other members of minority 

groups; we would have no objection to HRSA’Sadding goals for this group within the 

forthcoming contract. 

ASPE had no comments on this report. 

16

APPENDIX A 

SELECTED FINDINGS FROM THE MAIL SURVEYS 

From the donor center surveys: 

We would like your assessment of the relative importance of the following obstacles to minority recruitment 

in the area you serve. Please indicate the degree to which you believe these to be obstacles. If you feel that 

an obstaclenot listed here is important, please write it in the space provided. 

Lack of awareness of marrow donation among minorities 1(l%) 16(18%) 70(80!%) 

Lack of good educational materials targeted toward minorities 40(46%) 31(36%) 16(18%) 

Language and/or cultural barriers 12(14%) 38(44%) 37(42%) 

Mistrust of marrow donation among minority groups 5 (6%) 24(27%) 58(67%) 

Lack of dedicated staff for minority recruitment 42(48%) 22(25%) 23(26%) 

Lack of volunteer support for minority recruitment 32(37%) 36(41%) 19(22%) 

Small minoriq population in the service area 50(57%) 19(22%) 18(21%) 

lote: N =87 responses 

Donor center staff speak 2nd language 35 (40%) 53 (60%) 

Donor center employs minority staff 57 (65%) 31 (35%) 

Donor center works with recruitment groups 49 (56%) 39 (44%) 

Donor center works with minority organizations or institutions 83 (94%) 5 (6%) 

Donor center sponsors drives targeted specifically at minority groups 82 (93%) 6 (7%) 

Donor center uses educational materials designed by NMDP specifically for 86 (98%) 2 (2%) 

minority donors 

Donor center has developed its own educational materials specifically for 34 (39%) 54 (61%) 

minori~ donors 

Donor center uses educational materials developed by other donor centers for 36 (41%) 52 (59%) 

minority donors 

[ote: N =88 responses 

A-1

Did your donor center work with any NMDP accreditedrecruitmentgroups 

betweenJulyl, 1994andJune30, 1995? 39 49 (56%) 

(Ifyou answered `>es, ''please answer therest of thequestions onthispage; ~you (44%) 

answered “no’’pleasegotothenextpage.) I I 

?ote: N =88 responses 

The following questions pertain to the 39 donor centers working with NMDP accredited 

recruitment groups: 

We relied on them for well over half of our recruitment 8 (20%) .-

We relied on them for about half of our recruitment 9 (22%) 3 (9%) 

We rarely worked with them 19 (51%) 11 (29%) 

We never worked with them 3 (7%) 25 (63%) 

Donor availability at confirmatory 14 (37’%) 9 (22%) 1 (2%) 15 (39%) 

testing 

Actual donation/marrow collection 8 (20%) 11 (27%) 1 (2%) 19 (51%) 

Note: N=39 responses 

A-2

--

--

--

From the recruitment group surveys: 

We would like your assessment of the relative importance of the following obstacles to minori~ recruitment in 

the area you serve. Please indicate the degree to which you believe these to be obstacles. If you feel that an 

obstacle not listed here is important, please write it in the space provided. 

Lack of awareness of marrow donation among minorities .. .- 11 

Lack of good educational materials targeted toward minorities 4 5 2 

. 

IILanguage 

I 1 

Mistrust of marrow donation among minority groups ! 

1 

I 

3 

I 

7 

Lack of dedicated staff for minority recruitment ! 

5 

I 

3 

1 

3 

Lack of volunteer support for minori~ recruitment I 

3 

1 

5 

1 

3 

Small minority population in the service area I 

8 2 1 

andlor cultural barriers ! 

1 5 5 

II

II

II

Note: N= 11 responses 

Recruitment group staff speak 2nd language 7 4 

Recruitment group employs minori~ staff 8 2 

Recruitment group works with recruitment groups 8 3 

Recruitment group works with minority organizations or institutions 11 

Recruitment group sponsors drives targeted specifically at minority groups 11 

Recruitment group uses educational materials designed by NMDP specifically 11 

for minority donors 

Recruitment group has developed its own educational materials specifically for 7 3 

minori~ donors 

Recruitment group uses educational materials developed by other donor 3 7 

centers for minority donors 

rote: N= 11 responses 

A-3

APPENDIX B 

METHODOLOGY 

Data Analysis 

~equantiwtive pofiiom ofthisrepoti are based ontiee sources: (l) Registry data 

maintained by the NMDP;(2) NMDP’S“Donor Center Access Directory” for October, 1995; 

and (3) 1990 U.S. Census data. 

(1) We examined monthly summary statistics from the NMDP,from April 1993 through 

October 1995. These reports contain a center-by-center breakdown of the number of donors 

on the Registry by five racial and ethnic groups: Black, white, Hispanic, Asian/Pacific 

Islander, and American Indian/Alaska Native. (2) We used the NMDP’S“Donor Center 

Service Access Directory” to identify the service area of each donor center at the county 

level. (3) We used county level population data from the 1990 U.S. Census to determine the 

population distribution by racial and ethnic group of each donor center’s service area. 

We used data bases constructed in Lotus 1-2-3 to compare the racial and ethnic distribution 

of each center’s donor list as of October 1995 with the 1990 Census population distribution. 

The number of donor centers on the NMDPRegistry is in a continual state of flux, with 

centers merging and others being added. For comparative purposes, we used a denominator 

of 97 donor centers. Where centers have merged we combined appropriate data files. 

Where we analyzed geographic service areas, we omitted the Bill Young Marrow Donor 

Center because it contains military donors throughout the world. In such cases, the base-line 

denomimtor was reduced to 96. 

Mail Surveys of Donor Centers and Recruitment Groups 

In July 1995 we mailed a pre-tested survey to each of the 98 donor centers then in operation 

and to all 11 recruitment groups. We received surveys from 88 of the donor centers and all 

11 recruitment groups. Because one of the donor centers has since merged with another 

center, we chose to omit the responses of that center from our analysis. 

The donor center survey addressed four areas of donor center operations: donor center staff 

and activities; donor recruitment; search and work-up activities; and financial information. 

The recruitment group survey addressed recruitment group staffing and donor recruitment. 

This report draws on material from the second and third sections of the donor center survey 

and the recruitment group survey. A non-respondent analysis showed no difference among 

those donor centers that participated and those that did not. 

Site Visits to Donor Centers and Recruitment Groups 

We conducted site visits with staff at nine donors centers and four recruitment groups. We 

B-1

chose a judgmental sample of donor centers and recruitment groups that were geographically 

diverse; varied in size and composition of the donor lists; funded on both contract and fee 

bases; and located in a variety of settings, including free-standing centers, blood banks and 

hospitals. Using an open-ended questions we interviewed staff about barriers and strategies 

to minority recruitment, performance indicators, and use of recruitment groups. 

B-2

APPENDIX C


TEXT OF CO MNIENTS ON THE DRAFT REPORT 

Health Resources and Services Administration . . . . . . . . . . . . . . . . . . . . . . . . . C-2 

Assistant Secretary for Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. C-8 

National Marrow Donor Program.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. C-10 

Note: The Health Resources and Services Administration and the National Marrow Donor 

Program provide combined comments on four draft reports that examined the National 

Marrow Donor Program. This appendix includes only those portions of their comments that 

are relevant to the report entitled “Natioml Marrow Donor Program: Progress in Minority 

Recruitment. ” 

c-1 
TO: 

~ .,,.*, G # Public Health Service ; DEPARTMENT OF HEALTH a HUti SERVICES
 :


:


‘;\- J@

HeelttI Resources and 

FROM: 

SUBJECT : 

CCT ~ 3 jgg; Sewices Administration 

Rockville MD 20857 

Inspector General, DHHS 

Deputy Adxuinistrator 

Office of Inspector General (OIG) Draft Repo-rts, 

~cNational Marrow Donor Program (NMDP) : 

1) Financing Donor Centers 0EI-01-95-O0123 

2) Progress in Mino,rityRecruitment OEI-01-95-00120 

3)•Geographic Overlap Among Donor Centers 

OEI-01-95-00122 

4) Effectiveness in Retaining Donors 0EI-01-95-00121S1 “. 

Attached is HRSA’S response to your memorandum requesting 

comments on the four subject draft reports. 

we appreciate the OIG conducting the review, “Bone Marrow Program 

Inspection.” The draft reports were forwarded to the NMDP for 

comment. Their comments have been incorporated into our


response. HRSA and NMDP will be performing further analysis and€

examination regarding some issues, such as restructuring of donor€

centers, implementation of performance indicators, and€

specification of retention rates, before specific changes are€

made. HRSA plans to utilize the findings and recommendations


contained in these reports as an integral part of the development€

of the contract.€

Questions may be referred to AD irdre Wakfihon x35181. ‘€

Attachment€

c-2 
OIG Report: Proqress in Minoritv Recruitment 0EI-01-95-00120 

GENERAL COMMENTS 

The concerns raised in this report warrant careful Consideration.


fiRSA agrees that the contractor needs to Continue to expand


recruitment and retention of donors from racial and ethnic


minority groups because the current racial and ethnic


distribution of the registry does not appear to provide a member


of a racial/ethnic minority an equal chance of finding an


unrelated donor as a patient Who i.s not in a minority group.


OIG RECOMMENDATION: .


PERFORMANCE INDICATORS FOR DONOR CENTERS. The Health Resources


and Services Administration, prior to awarding any future


contract for the registry~ should require that the National


Marrow Donor Program have in place a performance indicator that


measures the progress of individual donor centers in recruiting


donors from each of the four racial and ethnic groups. Donor


centers falling short on this indicator should be subject to


disciplinary actions, up to and including withdrawal of their


participation agreement with the NMDP.


HRSA RESPONSE 

HRSA does concur with the recommendation that the contractor have 

in place a performance indicator that measures the progress of 

individual donor centers in recruiting donors from each of the 

four racial and ethnic groups. However, HRSA does not concur 

that a performance indicator should be required prior to awardinq 

any future contract for the re~istrv. The current contract 

expires April 30, 1997 and there is not sufficient time to 

adequately develop performance indicators and implement plans for 

disciplinary actions. 

HRSA agrees that the contractor needs to develop and implement 

performance indicators with respect to minority recruitment and 

be held accountable for achieving the performance standards. The 

OIG has provided some alternative approaches, implying that the 

performance measures will need careful consideration. It is 

doubtful that performance indicators and disciplinary actions can 

be implemented with appropriate care Drier to awarding the next 

HRSA contract. 

Developing performance indicators for the individual donor 

centers and implementation plans could not be completed prior to 

the award of the next contract. NMDP has contracts and subcontracts with the donor centers and these would need to be 

modified to fully implement a plan. The target date for the 

Request for Proposal is December, 1996 with the award by April 

c-3 
30, 1997. These dates provide insufficient time for the 

contractor to develop a performance indicator and implementation 

plan for individual donor centers with input from the donor 

centers. 

However, HRSA concurs that having a performance indicator for 

minority recruitment is a worthwhile activity. HRSA will require 

a plan for the development of performance indicators and 

implementation plans. Specific information about the development 

and implementation of the plan with appropriate due dates and 

disciplinary actions should be included in the next contract. 

.--— The request for_contract for the next contract period will 

require that performance indicators and disciplinary actions be 

developed and that agreements” with donor centers be modified to 

include the performance indicators and disciplinary actions. 

Therefore, HRSA suggests the following modification: 

HRSA should require that performance indicators and 

implementation plans with appropriate due dates be included 

in the next contract. 

HRSA does agree that the contractor needs to Continue to recruit 

and retain donors from racial and ethnic minority groups because 

the current demographic distribution of the registry does not 

provide a member of a racial/ethnic minority an equal chance of 

finding an unrelated donor as a patient who is not in a minority 

group. 

HRSA and the contractor should evaluate the alternative 

approaches and reach consensus with donor centers. For example, 

the contractor could require that a donor center’s list must 

exceed by some factor the proportion of minority donors in the 

local service area. An alternative approach, requiring that a 

donor center recruit some specified percentage of the minority 

populations living in the service area, is a preferable approach 

because it allows for the contractor to target a specified number 

of donors (or percentage) from the populations in the area and 

would allow more flexibility. 

By targeting the percentage of the population that resides in the 

service area, HRSA would not be taking into account large family 

drives that force down the percentage of minorities in a file. 

The most important consideration is imDrovinq the likelihood for 

a minority patient to find a donor and i.ncreasinq the percentage 

of new donors from minority groups. Percentages are not 

necessarily relevant. 

Expressing mi.nori.ty recruitment goals as a percentage of the 

population may be subject to misinterpretation. A target number 

of new donors from each minority group for each donor center 

c-4 
would be a more useful measure. 

A modified recommendation would stress that overall minority 

recruitment goals should aim at providing improved access for 

minority patients. Individual donor center goals should be based 

upon the minority population in that area. 

OIG RECOMMENDATION: 

PERFORMANCE INDICATORS FOR RECRUITMENT GROUPS. HRSA, “prior to 

awarding any future contract for the registry, should require 

that NliDP have in place performance indicators that measure 

accomplishments of recruitment groups. 

HRSA RESPONSE: 

HRSA agrees that the contractor should have in place performance 

indicators for recruitment groups~ but this recommendation does 

not allow time for the development or the implementation of these 

performance indicators. Developing the indicators, disciplinary€

actions, and modifications of contractual agreements with€

recruitment groups will require more time than is available prior€

to the award of the contract. HRSA expects that the Request for€

Proposal for the next contract will require that agreements with€

recruitment groups be modified to develop or include specific


performance indicators, implementation plans, and di.sci.plinary


actions.


The alternatives offered a= operational and will be considered 

as performance indicators are developed. The NMDP has made 

initial recommendations to f=mploy forms monitoring and timeliness 

of consent forms submission as measures of recruitment group 

performance and would improve efficiency in minority recruitment. 

HRSA recommends the following modification: 

HRSA should work with the contractor to develop performance 

indicators and irnpl@rnentation plans for recruitment groups . 

OIG RECOMMENDATION: 

CONTINGENCY PLANS. HRSA should identify steps to be taken should 

the NMDP continue to fall short on the recruitment goals 

specified in its current contract, as occurred i.n the first year 

among Hispanics.


HRSA RESPONSE: 

HRSA agrees with this recommendation. HRSA expects that the next 

RFP will include a requirement that the contra&or submit a 

report at least annually on recruitment group activities with a 

c-5 
,, 

determination of whether recruitment goals for minority groups 

are being met and whether any shortfall is permanent or 

temporary. The report will include recruitment group specific 

information about goals and achievements and allocations of staff 

time for minority versus Caucasian recruitment. The proposal 

will specify a corrective action plan for recruitment groups that 

are deficient on recruitment goals and will require the


contractor (currently NMDP) to be responsible for developing and


ixnplementing these performance goals.


OIG RECOMMENDATION:


SEARING EFFECTIVE PRACTICES. The NMDP should draw on the


e=ertise of those donor Cenfers and recruitment groups that have


sh&#n success in minority recruitment as one way of p;oviding


assistance to other donor centers in their minority recruitment 

efforts.


HRSA RESPONSE: 

HRSA supports the recommendation that the contractor should 

undertake demonstration projects aimed at increasing the 

retention rate among minority donors. We agree that the 

contractor should make better use of the expertise of donor 

centers and recruitment groups that have had success in 

recruiting donors. 

HRSA agrees that recruitment of minorities should be a 

significant factor in the evaluation of the effectiveness of a 

donor center, particularly in areas with high numbers of 

minorities. HRSA agrees that Continuous Process Improvement 

monitoring should be an important part of the evaluation process. 

HRSA agrees that the next Request for Proposal will require a 

plan to identify and conduct projects to demonstrate the 

effectiveness of specific innovative strategies for improving 

retention and effectiveness. 

NMDP has included workshops at its annual Council meeting to 

address retention of donors. The 1996 Council meeting included 

two workshops on “Planning for a Long Registry Life: Donor 

Retention”and Several activities related to special initiatives 

for minority groups, including recognition of the Asian/Pacific 

Islander and the African Americans United for Life campaigns, the 

minority initiatives (Hispanic, African American, American 

Indian/Alaskan Native, and Asian/Pacific Islander) . These 

workshops featured representatives from donor centers and 

recruitment groups with expertise and success in improving 

recruitment and retention among minorities. 

The contractor has four standing committees that address donor 

center and recruitment group activities, particularly with 

C-6

minorities -- Membership and Process Improvement, Minority 

Affairs, Donor Recr’Jitmenct and Patient ‘ervices= These 

cm.mittees include representatives from donur centers, 

recruitment groups, and minority populations. 

C-7

,. 

DEPARTME~ OF HEALTH AND HUMAN SERVICES Office of the Secretar 

AUG28 1= Assistant Secretary for Healt 

Office of Public Health and Scianc

General Washington O.C. 20201 TO: Inspector 

FROM: Assistant Secretary forHealth 

SUBJECT: OIG Drall Reports ontheNational Marrow Donor Program

. 

Thankyou for the oppotitytoreview theoffice oftheInspector General’s DrafiReports on 

the National Marrow Donor Program. 1 am pleased that in general the reports show that much 

progress has been made. However, the reports aiso showed that there are additional areas where 

the Department mustfocus its attention. The recommendations contained in these reports are 

important and shouid be implemented as quickly as possible. 

Attached are several areas which 1 beiieve should be addressed in the reports. Thank you for the 

opportunity to review these important reports. If you have any questions on the concerns raised. 

please call Mr. Matthew Mu.rguia of the Office of Minority Health at 301443-9923. 

/7/2jM_LPhillip R. Lee, M.D. 

Attachment 

C-8

--

--

--

--

--

--

--

OIG IXLWT REPORTS ON


THE NATIONAL MARROW DONOR PROGIGWI


� REPORT: Progress in Minority Recruitment 

.- Theuseof the terms “Caucasian” and“whites” areinterchangeably usedthroughout
 the 

report. OIG may considerusing the OMB Directive 15 classification fo$ describing the 

various racial/ethnic groups, which are “white, black, Asian/Pacific Islander, American 

Indian/Alaska Native, and Hispanic,” 

There should be some discussion as to why the HRSA contract does not speci~ annual 

recruitment goals for Native Americans (page 6). 

There should be some discussion as to why whites constitute 83% of preliminary 

searches, but account for 9170 of transplants (Table 3, page 10). 

The discussion of mistrust by Asians on page 10 is contradicted by the discussion on page 

5 which indicates that Asians are over represented in the donor pool. 

On page 11, is cultural competency training, including bilingual capability, included in 

the HRSA contract? If not, this avenue should be explored as a means to find bilingual 

staff, especially those knowledgeable about medical terms. 

On page 11, OIG should consider arecommendation whichwouldrequire apre-test with


asampleofthetarget populationfeducational materials prior totheir
 use.


� REPORT: Effectiveness in Retaining Donors 

The use of the terms “Caucasian” and “whites” are interchangeably used throughout the 

report. OIG may consider using the OMB Directive 15 classification for describing the 

various racial/ethnic groups, which are “white, black, Asian/Pacific Islander, American 

Indian/Alaska Native, and Hispanic.” 

Figure2, page 12, shows that 10-17 percent of donor centers indicate that language 

barrierspresent an obstacle to search and workup. However, this issue does not appearto 

be discussed, nor are any recommendations to addressthis area contained in the report. 

Given the large percentage of centers reportingthis as a problem, and the stated fact that 

it is more diflicult to maintain minority donors, an examination of this issue would be 

appropriate. 

c-9 
National MiuTow 

Donor ProgriIrn 

Notional Coomlinating Ccntm 

XH Brndwuy Sued N.E SUitcXXI 

Mjnnqrniis. MN 55413 

612-G27-WX 

I-X(K)-526-7MOJ 

FAX: 61>627.5899 

bad ofmm 

Hcrtruz A. Perkinx, M.D.. (%UU 

Jnrrdrun R bong, Vice C&r;~ 

Clam PsdilIa An&ews 

kichd H Au.?L M.D. 

IAXWICC D. AIIs, J.U. 

Jnuph “~.Bell M.D. 

b Dupwu. JM.D., Mc. 

Rogcr W. t%nm, P?@. 

Ban S. !-id=. J.D.. Ph.D. 

David B. Fmhnm*ycr. J.!). 

J. @l)fOll Gordon. J.D. 

JohnA. [{amen, M.n. 

+-cdemk J, HarrtL M. S.F-E. M.B.A. 

. MLBVM. Hrirtirz M.D.. MS. 

Ermt R. Jtif. M.f% 

NnJICyA, Kcm- M.D. 

susJrrkitrnwr. MD. 

Niclrtrk J. Neuhouscl.J.D..M.SM. 

peteri- PYIRGMN. 

CIUrkX A. (CAP) Pdicr 

r- PccIuwrI, M,(3.. Ph.D. 

L[. Gcn. Frank Li. f%crw. k. 

Kobcrt K. Ross M.D. 

&fw,ud P. Scon. M-l). 

David F. Strontxk M.D. 

J&n S. Thompson. Mm. 

wm H. Wdlns. M.D. 

StemI N. WOIIT.M.D. 

Amruneue K Yanct.y.M. O.. M.RH. 

Admiml E-R. ZUmW~L JrGaig W. S.l-irwG M.(3.. Ph.D. 

C4iqf Ezmwlivc Ofi(:ef 

~mim F.nwitEw 

Rntrcrxc. OruvcS.D.V.M. 

Atktiid E. R. Zumwak. Jr. 

~0~ @mc16 Awnrtt: 

The HnmmtblcC. W. ‘.~il~ young 

JohnA. Han.w M.D. 

(UIIC&ZbWiI12L MD. 

A cdldr-uw efforr of the 

Amencait’t Association 

ufnld -

Amcri- Red CrCnoncil of CotnmnW 

Blood Cen@m 

With funding (rum: 

Hcshh R&numcs and Scmiccs 

Adrnintfimtwn ad 

Navzl MI%IIcd Remmh nnd 

m_VViC1~CTtt command 

September
4,1996


1 JtiIthBraslow 

Director, Division of Organ Transplantation 

/	 Health ResouRes and services AdministratioII 

Park bWIl Building 

5600 Fishers Lmc - Room 729 

Rochiile, MD 20857 

Dear Ms. Bradow: 

I 

Thank you very much for providing the National Marrow Donor 

Program@ (NMDP) with an opportunity to review the draft reports of the 

Office of Insp@or GeneraJ (OIG), Depa=eti of H=M and Human 

Scmices. The draft reports were sent to members of the MinoriW Affkirs, 

Membership and Process Improvement, Donor Rccmitment and Executive 

Committees as well as the NMDP’s Network EYaiuationAdvisoryPanel


and seieeted members of the stat% 

The comments received have been collated and a synthesis of the 

responses is presented below. The intent of the NMDP is not to criticize 

the draft reports, but rather to add information from a variety of 

respondents, all of whom have been involved with aspects of donor center 

operations ador donor recruitmem. & you know the NMDP is well 

along in its awn analysis of donor center fimctiom, the findings of which 

should provide further usefid rmxnrnendations. 

Followingthesummaryof comments on each draft report we have

provided our own list of rccomrncndations for modification of the OIG 

document. 

MinorIv Recnxiuncnt 

Several issues wereraised
about this draft report. It was pointed out that expressing 

minority recruitment goals as a percentage of the population was subject to 

misinterpretation and that a target_ based upon previous experience, while stil 

subject toerror,would be a more useful measure. An example of the problem in usi 

a Per~tage of ~ PoPfi~on @deli= is fo~d in the fact that the NMDP’s 

ruitment of Ashn-Pacific Islanders (A-PI) aiready exceeds thepercentage of this

acial groupinthegeneral populationandyetthehlMDP doesnothaveenoughA-PI. 

F 

I 

i 
to provide A-PI patien~ e~?l access to u=lated hansplants. A similar comment 

emphasized that the NMI?P ISbetter able to identi~ donors for Hispanic patients than 

for AfricanAmerican patfents because Hispanics are more likely to match witi 

Caucasiandonors. Thus r=mitment goais commensurate with providing more equal 

access for minority patients my be a better basis for this calculation. 

Several respondents made reference m the idea that not every donor center should 

necessarily be expectedtOk ~ eqtiy effective
 minoritydonor rectuiter. It was 

suggested that resources (and exp=mtions) be dispropcmionately higher in regions of 

large minority poptiatiom as a possible way to increase cost effectiveness. 

There was agreement witi tie@ report in considering minority remitment as a part 

of a center’s overall performance. There wa5 also feit m be a need to monitor the 

effectiveness of rectitmti IYOUPSSinCSsome donor centers rely solely upon these 

groups to recruit minori~ donors. 

A rwuitment group mpmetitive felt that the draft report proposals to employ forms 

monitoring and timeliness of consent forms submission as measures of recruitment 

group perforrnanw were valid and would improve the NMDP’s efficiency in minority 

donor recruitment. - W= also support for the recommendation to undertake 

demons-tion projects aimed at increasing the retention rate among minority donors. 

It was of interest that in the c% of this particular remitment group, work with their 

donor centers to improve retenhon was already in progress . 

Another point of agreement with the H report was to repeat several of the analyses 

in the face of the rapidly increasing recruitment of minority donors and to make better 

use of “the expertise of those donor centers and recruitment groups that have succeeded 

in recruiting minority donors. ” 

In considering changes in thc methods of financial support for donor centers, a medical 

director expressed a note of caution: Them is a real danger that certain successfid 

models for minority -tment efforts -d be jeopardize by decreased funding. 

It is again important to point out an NMDP initiative that is currendy in its early 

stages, but promises to add strategic data and recommendations for minority 

recmitrnent: The NMDP’s study of optimal registry size. Usingavailable information 

about the likelihood of finding a successfid match for patients of all races and 

reauitmetiretention statistics and projections, a panel of biostatkticti will provide 

quantitative information about future recruitment requirements. 

Recommended Modifications to the Draft Report: 

�	 Minority recruitment goals should not be targeted to the percent in the 

population semxi. A-PI recruitment already exceeds the percent in the 

population, yetwe haveinsufficient A-PI donors to give them an equal chance 

of finding a compatible donor. Large Caucasian family drives force down the 

percent of minorities in a fiIe. These are only a few of the arguments. 

Numerical targets are more meanin@]. 

C-II

�	 We agree th~ =~iw of min~~ti~ s~uld ~ a Si@ifi=M segment in our -

evaluation of tie ~~veness of a donor center, provld~ tie center is located 

in m area where N makes smse torecruita givenminority. 

�	 continuousP-SS ~pmv-nt ~On-i~@ shouldbe ~ ~pomint partof thc 

evaiuatioIx pr0@5s. 

we m tiy cmb~ked upon comimi:g the effo~ be~ with these OIG draft reports. Our 

OWn detailed evaiuaaon of cap m recfult donors and remeve them for donation is well under 

way. The effects of geographicoverl~ = be~ e~~~~. @ our Network Evaluation 

Advisory Panel and by several committees. Minority mcmmnent approaches and donor 

retention are areas of high conurn, king adhs=d by ow MinoritY Affairs Committee, the 

Donor Recruitment Committee, and the Mmbtiip and Process Improvement Committee. 

These are aIl high priority items for our Board of Directors, which til be reviewing these 

documents at its regular meeting in several weeks. 

We hope that you fti these co-em, heipfd. ~. NMQP thanks you for sharing these draft 

~rts and looks forward toa continuing cdlaborauon in Improving all aspects of donor 

center and recruitment gruup operations. 

&-A-dJ= /

. 

Herbert A. Perkins, M.D. 

NMDP Board Chair 

. 

c-12 
APPENDIX D


ENDNOTES 

1. Z7ze
Living Gift of Life, a pamphlet by the National Marrow Donor Program. 

2.Bone Marrow Transplants - A Book of Basics for Patients (reprinted by NYSERnet, Inc. 

with permission from BMT newsletter), chapter 4, pp. 35-36. 

3. 42 U. S.C.~k(b)(l)-(7) 

4.42 U.S.C. $274k(b)(l)-(7) 

5. Table 2 (page 20) and Table 11 (page 38) in 1995 Annual Repon of the U.S. Scientijc 

Registry for Transplant Recipients and the Organ Procurement and Transplantation Network, 

Transplant Data: 1998-1994, United Network for Organ Sharing, Richmond, VA, and the 

Division of Transplantation, Bureau of Health Resources Development, Health Resources and 

Services Administration, U.S. Department of Health and Human Services, Rockville, MD. 

6.	 U.S. General Accounting Office, Bone Marrow Transplants: National Program Has 

Greatly Increased Pool of Potential Donors, GAOIHRD-93-11, November 1992, p. 11. 

7.	 Persons of Hispanic origin may be of any race. The NMDP also categorizes donors as 

Unknown, Decline, or Other. Donors categorized as “others” increased from 34,164 to 

36,181. In determining the percentage of minorities on the list, we calculated minorities as a 

percentage of the total number of donors on the registry. Because we could not ascertain the 

race or ethnicity of donors listed as Unknown, Decline, or Other, we included them in the 

denominator but did not assign them to any racial or ethnic group. 

8. African Americans Uniting for Life was the first campaign to be launched. The 

metropolitan areas selected for this campaign included: Atlanta, Baltimore, Chicago, Dallas, 

Houston, Jacksonville, Kansas, Memphis, New Orleans, Tampa/St. Petersburg, and the 

District of Columbia. Asian/Pacific Islander Donors Can Save Lives is the title of the NMDP 

campaign focusing on Asian and Pacific Islander donors. The target markets for this 

campaign included: Northern and Southern California, New York, Seattle, Hawaii, and 

Chicago. 

9.	 Target markets for this campaign include: Los Angeles/Orange County, California; 

southern and eastern Texas; and Puerto Rico. 

D-1

D-2 

10. New York City, Los Angeles, Chicago and other cities have alleged that the 1990 U.S. 

Census undercounts minorities. The U.S. Government has acknowledged that it missed 

about 1.6 percent of the nation’s population, including about 4.8 percent of blacks and 5.2 

percent of Hispanics. In March 1996, the Supreme Court has decided that the 1990 census 

countdoesnotneedtoberevised.


11. We present herea copyofTable5 fromthatreport, whichpresents
 dataon the


retention rateby racial andethnic
group:


Caucasian 71 % 76 % 83 % 81 % 

Hispanic 56 % 63 % 70 % 62 % 

African American 55 % 68 % 70 % 59 % 

Asian and Pacific Islander 47 % 62 % 59 % 51 % 

Native American 71 % -74 % 69 % 76 % 

Totals: 66 % 72 % 81 % 76 % 

Source: NMDP Registry Statistics 

Analysis: OffIce of Inspector General (OIG). 

12. Because we compared 1995 recruitment levels with population data from the 1990 U.S. 

census,thetrueproportion of minority donors in each center’s service area may be 

underestimated. This should be considered a conservative estimate. 

13. The NMDP has recently accredited a new recruitment group called SAMAR. This 

recruitment group targets Asian Indian donors. 

14. U.S. General Accounting Office, Bone Marrow Transplants: National Program Has 

Greatly Increased Pool of Potential Donors, GAO/HRD-93-l 1,November 1992.