The National Marrow Donor Program’s Symposium on
Hematopoietic Cell Transplantation in 2020: A Health
Care Resource and Infrastructure Assessment
Navneet S. Majhail,1,2Elizabeth A. Murphy,1Ellen M. Denzen,1
Stacy S. Ferguson,1Claudio Anasetti,3Arthur Bracey,4Linda Burns,5Richard Champlin,6
Norman Hubbard,7Miriam Markowitz,8Richard T. Maziarz,9Erin Medoff,10
Joyce Neumann,6Kim Schmit-Pokorny,11Daniel J. Weisdorf,12Deborah S. Yolin Raley,13
Jeffrey Chell,1Edward L. Snyder10
Hematopoietic cell transplantation (HCT) is the only known curative therapy for many patients with life-
threatening hematologic and oncologic diseases. It is estimated that the National Marrow Donor Program?
(NMDP) will facilitate 10,000 transplants by 2015, double the current number. To better understand the ex-
isting personnel and center infrastructure for HCT in the country and to address system capacity challenges
to the future growth of HCT, the NMDP convened a diverse group of stakeholders and thought leaders rep-
resenting HCT physicians, physician assistants, nurse practitioners, nurses, pharmacists, other healthcare
providers, HCT program directors, hospital administrators, payors, andprofessional organizations. Working
groups were formed to identify: capacity issues because of shortages in human resources, structural con-
straints, andpatient accessbarriers including diversity andhealthcaredisparity challenges;recommendations
to address challenges; and stakeholders to engage. This report details the deliberations and recommenda-
tions of a national symposium, ‘‘Hematopoietic Cell Transplantation in 2020: A Health Care Resource and
Infrastructure Assessment,’’ held in September 2010.
Biol Blood Marrow Transplant 18: 172-182 (2012) ? 2012 American Society for Blood and Marrow Transplantation
KEY WORDS: Hematopoietic cell transplantation, System capacity, Workforce shortage, National Marrow
Hematopoietic cell transplantation (HCT) is the
only known curative therapy for many patients with
life-threatening hematologic and oncologic diseases.
Approximately 20,000 autologous and allogeneic
HCT are performed in the United States each year
. It is anticipated that need and utilization of
HCT will continue to grow in the future . The Na-
tional Marrow Donor Program?(NMDP) estimates
the current number. Several factors are expected to
contribute to the increase in demand for HCT. These
include increasing utilization of reduced-intensity
conditioning regimens, increasing diversity and avail-
ability of unrelated donors and umbilical cord blood
as graft sources, improvements in supportive care,
and expanding indications for HCT.
The most critical system capacity barriers to the
man resources, structural constraints, and patient ac-
cess barriers. Human resource constraints include
aprojected shortage of physicians,physician assistants,
From the1National Marrow Donor Program?, Minneapolis, Min-
Research, Minneapolis, Minnesota;
Center & Research Institute, Tampa, Florida;4St. Luke’s Epis-
copal Hospital, Houston, Texas;
Medical Center, Minneapolis, Minnesota;6University of Texas,
MD AndersonCancer Center, Houston, Texas;7Seattle Cancer
Care Alliance, Seattle, Washington;8Children’s National Med-
ical Center, Washington, DC;9Oregon Health & Science Uni-
versity, Portland, Oregon;10Yale University/Yale-New Haven
Hospital, New Haven, Connecticut;11University of Nebraska
Medical Center, Omaha, Nebraska;12University of Minnesota
Medical Center, Fairview, Minneapolis, Minnesota; and
13Dana-Farber Cancer Institute, Boston, Massachusetts.
Financial disclosure: See Acknowledgments on page 179.
Correspondence and reprint requests: Ellen M. Denzen, MS, Super-
visor, Health Services Research, National Marrow Donor
Program, Office of Patient Advocacy, 3001 Broadway Street
NE, Suite 100, Minneapolis, MN 55413 (e-mail: edenzen@
Received August 19, 2011; accepted October 1, 2011
? 2012 American Society for Blood and Marrow Transplantation
3H. Lee Moffitt Cancer
5University of Minnesota
nurse practitioners, nurses, pharmacists, and other
healthcare professionals who make up the HCT work-
force [3-10]. Structural constraints include availability
of adequate facilities, efficient and safe care delivery
models, and the infrastructure required to meet the
demand of HCT [11,12]. Key patient access barriers
include availability of suitably matched donors or cord
blood units, transportation and financial burdens, lack
of caregiver support, and limited access to transplant-
related patient information [13,14]. Capacity issues
may also limit access to HCT for minorities and
underserved populations. The increasing number of
transplant survivors will be an added burden to
the transplant centers providing care to patients
undergoing transplantation as well as to the entire
healthcare system. Furthermore, increasing access to
transplantation for medically underserved patient
populations such as low-income individuals, underin-
sured persons, and racial and ethnic minorities is a crit-
ical area yet to be addressed. Although data are
limited, studies project a future shortage of transplant
physicians and center capacity in the United States
[2,3,11,12]. A future shortage of advanced practice
and nursing professionals in the United States is also
To better understand the existing personnel and
center infrastructure for HCT in the country and to
address system capacity challenges to the future
tiyear symposia to collaboratively develop creative op-
tions for complex issues affecting thedelivery of HCT.
Participants were comprised of key professionals, aca-
demic organizations, experts,and stakeholders. This
report details the deliberations and recommendations
of a national symposium, ‘‘Hematopoietic Cell Trans-
plantation in 2020: A Health Care Resource and Infra-
structure Assessment,’’ held in September 2010.
The NMDP convened a diverse group of stake-
holders and thought leaders representing HCT physi-
cians, physician assistants, nurse practitioners, nurses,
other healthcare providers, HCT program directors,
hospital administrators, payors, and professional orga-
nizations. Based on their area of expertise, each stake-
holder was assigned to 1 of 6 working groups:
Physician Workforce, Advanced Practice Profes-
sionals Workforce, Nursing Workforce; Care Deliv-
ery Model; Facilities/Bed Capacity; and Financial.
The workgroups convened via monthly teleconfer-
ences over the 8 months before the Symposium—
Year I. Each group systematically conducted an
analysis of its topic area, which included identifying
capacity issues including diversity and health care dis-
parity challenges; recommendations to address chal-
lenges; potential capacity impact; stakeholders to
engage; resources needed; barriers to carrying out rec-
ommendations and metrics.
By utilizing a deliberative process, the NMDP was
able to effectively facilitate a well-planned national
collaborative approach to address HCT system capac-
ity challenges to the current utilization and future
growth of HCT therapy.
Working Group Surveys
To verify whether the working group deliberations
reflected industry perspectives,thePhysician, Nursing,
and Advanced Practice Professional (APP) Workforce
Working Groups and the Facilities/Bed Capacity
veys were distributed to HCT physicians, nurses, ad-
vanced practice professionals, and transplant center
ety of Blood and Marrow Transplantation (ASBMT),
the Oncology Nursing Society (ONS), or the NMDP
network. The goal of the surveys was to: (1) ascertain
care system to support the needs of HCT through the
year 2020, and (2) characterize system capacity chal-
lenges that will prevent optimal utilization of HCT.
Working Groups first prioritized their respective
findings. Subsequently, their deliberations on the
United States HCT system’s ability to meet the rising
demand of HCT therapies were presented at the
NMDP-sponsored ‘‘Hematopoietic Cell Transplanta-
tion in 2020: A Health Care Resource and Infrastruc-
ture Assessment Symposium’’ in Chicago, IL on
September 15-16, 2010. The 1.5 day meeting was at-
tended by nearly 100 national stakeholders and
thought leaders. In total, 46 academic, professional,
patient advocacy organizations, and transplant centers
across the United States were represented, as well as 2
government agencies (Table 1).
The goal of the Symposium—Year I was to under-
stand theworkforceand capacity challenges of thecur-
rent healthcare system to enable full access to HCT
therapy for all patients who are in need of this curative
working group findings, audience polling, and dia-
logue. Round table discussions focused on the devel-
opment of strategies to address challenges during
Challenges and Recommendations by Working
The challenges and prioritized recommendations
made by the Working Groups are summarized in
Biol Blood Marrow Transplant 18:172-182, 2012
HCT in 2020: A Resource and Infrastructure Assessment
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