There are 325 million Arabs in 22 Middle Eastern countries and other lands, but
the first and so far only registry for potential unrelated Arab donors of bone
marrow or stem cells – which have the ability to cure certain cancers and other
serious disorders – is at Hadassah University Medical Center in Jerusalem’s Ein
Compatibility is determined by the human leukocyte antigen (HLA)
system, which is quite varied due to the large number of genes controlling human
immune system function; tissue types of the major histocompatability complex are
much more complicated than than the A, B, O and AB and RH+/- blood types that
have to be matched for blood transfusions. Arab HLAs are generally very
different from those of Americans, Africans and Europeans, and are closer to
that of Jews, who are also Semites. But while some Jews can donate adult stem
cells and bone marrow to some Arabs (and vice versa), an ethnic-specific Arab
registry was urgently needed for the rest.
Only about 10 percent of Arab
patients who need these tissue transplants succeed in finding an HLA-matched
unrelated donor, compared to over 80% in Caucasian patients who find matched
unrelated donors in the international registries.
In 1987, Prof. Chaim
Brautbar established Israel’s first general unrelated bone marrow donor registry
at Hadassah; upon his retirement, he was succeeded by Dr. Shoshanna Israel.
Today, the general registry has over 80,000 people listed. Two years ago, he set
up the Arab registry with veteran immunologist Dr.
Amal Bishara. Since
then, data from over 9,000 Israeli Arabs (initially obtained only from
peripheral blood and more recently also from buccal cells taken from the inside
of the cheek) have been stored in its computers and fed into the international
database in Leiden, Holland so that compatible Arab HLAs for would-be recipients
can be more easily found. Yet many more samples are needed to find potential
donors for those who are ill.
BISHARA, an Arab woman born in Tarshiha
near Ma’alot who lives with her physician husband in Jerusalem, devotes much
effort to creating awareness in Israeli Arab cities such as Nazareth, towns and
villages in the Galilee and elsewhere of the need to be tested. She tells
residents that 40% of Arab patients who need bone marrow/stem cell transplants
need a stranger to provide them. Until the establishment of the database, Arabs
both inside and outside Israel were able to obtain them mainly from family
“There is nothing in Islam or Christianity against being tested
and giving bone marrow and stem cells,” says Bishara in her windowless, tiny
office in the hospital. “It’s a problem of awareness, and increasing it is part
of my job.” She reveals that due to her work, she has not taken a day’s vacation
in two years. She received her master’s and doctoral degree from the Hebrew
University of Jerusalem and went to a Harvard-affiliated lab in Boston to do her
postdoctoral work. She has worked in the Hadassah lab since 1988.
a pioneer,” comments Brautbar, “and this program is a pearl. Going to the Arab
communities, both Muslim and Christian – and persuading them to give samples is
no easy task. It is very sensitive. But Amal managed to persuade kadis, sheikhs
and priests to endorse it, and Muslim religious leaders have even issued fatwas
to do it, after giving blood themselves.
She has given talks at
universities, hospitals, community centers and schools, and interviews with
numerous Arabic media, and even translated information booklets into Arabic.
Hers is holy work.”
Brautbar regards the database as an “important bridge
He adds that it was initially quite difficult to open
the hearts and minds of the Israeli Arab population to the lifesaving plan of
donating stem cells/bone marrow for their own people in need. But Amal managed
to overcome the skepticism and apathy of the Arab communities, who by now have
“come to appreciate the benefits this will bring to their people and are very
supportive of our project.”
ONE POSTER distributed in Arab towns and
villages shows two children who are candidates for transplants, standing in
front of the intentionally faded images of two children who had died when there
was no Arab unrelated bone marrow/stem cells registry. The 9,000 samples from
healthy Arabs aged 18 and over were laboriously collected in 60 campaign drives
in Israel. Fifty-six percent of the donors were males with a mean age of 33 and
the rest were women, who are two years younger on average.
special thanks to the brothers Arwa and Sami Masarweh for their hard work in
planning and conducting the 2009 December drives, in which more than 5,000
potential Arab donors joined the registry.
Many people also donate their
time and effort to help organize testing drives, or have printed pamphlets and
posters at their expense. She also expresses her thanks and appreciation “to
Prof. Brautbar for his valuable support and efforts, especially in fundraising,
and to my family for their help and limitless support.”
“We would like to
collect at least 50,000 potential donors for the database,” says
So far, the registry has found 24 would-be donors who are
perfect matches for Israeli Arab and Jewish patients and some others abroad.
Four Israeli Arab donors have donated stem cells in the past few months, and the
patients are doing well; two donors will donate within a few weeks, while two
others have been reserved for specific patients. Another three transplants were
cancelled because of the patients’ declining conditions. Previously, patients
who could not find a donor almost inevitably died.
analysis showed that if this project had started three years earlier, tens of
Israeli Arab patients would have been saved,” says Bishara. “The study actually
proved our initial assumption that Arab genetics differ from that in other
ethnic groups. This analysis made me even more determined to further the
A few weeks ago, Bishara presented the work of the Arab
registry at the Bone Marrow Donors Worldwide Organization (BMDW) meeting in
Minneapolis and aroused much interest.
Bishara notes that transplanted
tissue that does not result in graft-versus-host disease can cure over 100
diseases, including leukemias, lymphomas and various genetic and immunological
disorders. The success rate among children – who more often need actual bone
marrow removed from a hip bone rather than stem cells from ordinary peripheral
blood – is somewhat higher than in adults. The prevalence of certain genetic
diseases is higher among Arabs than in the general Israeli population, says
Bishara, because of consanguinity (inbreeding between cousins) remains quite
Today, there is an option for Arabs in other countries – even
those officially at war with Israel – to find a compatible Israeli donor and
come to Hadassah for a transplant, or send the bone marrow or stem cells abroad
to the transplant center. However, this has not yet occurred.
can’t search for a donor for themselves.
There are search coordinators at
hospitals that perform transplants, with each using a password for entry. The
coordinators do searches and send us requests when they come across Arabs and
Jews in need of bone marrow or stem cells. Sometimes we receive requests from
the independent international organization as well,” notes Bishara, who
personally knows all the Israeli Arab children seeking donors and many
She has not tested Beduin in the Negev, she notes, because her
center lacks funds. Donations of funds to cover the costs of processing samples
have come from the Austrian branch of Hadassah International and other precious
sources, including the Karl Kahane Foundation, but more are eagerly sought. Neither the Health Ministry nor the health
funds have offered funding for the project, even though it saves lives. It costs
$50 to process each test, which is performed en masse in the US where it is
cheaper. Thus Bishara and Brautbar are constantly seeking donors.Dr.
Amal Bishara can be contacted via e-mail to [email protected] or by phone at
+972-2-6777690 and Prof. Chaim Brautbar to [email protected] or by
cellphone at +972-50-8673958.