Aboriginal Australians - Unique Issues in Hematopoietic Stem Cell Transplant

The 2006 Census estimates that the total Aboriginal Australian population is 458,520 which is 2.4% of Australia’s population.  As with other indigenous peoples worldwide this population has been shown to have unique and significant health requirements.   These necessitate cohesive partnerships between the health care teams and the Aboriginal people to further improve health outcomes.  Much of the literature about health needs of Aboriginal Australians is concerning primary health care. There is a paucity of evidence surrounding the management of Aboriginal people undergoing a Hematopoietic Progenitor Cell (HPC) transplant, including identification of suitable donors and appropriate therapeutic medical management.

Currently there are few donors who identify themselves as of Aboriginal descent.   The powerful ethnic bias in the European, North American and Australian bone marrow registries towards northern Caucasian descent hinders the identification of suitably matched donors.  In an attempt to address the deficiency of suitable donors for the Aboriginal person, the Sydney Cord blood bank developed an initiative to collect cord blood units in regional and rural areas to increase the cord blood units collected with the unique tissue typing found in Aboriginal people.

The difficulties in donor identification and increased transplant complications were evident when a 17 year old Aboriginal man presented with secondary acute myeloid leukaemia requiring HPC transplant.  The search process will be discussed, specifically addressing the complexities in identifying a suitable donor and the unique pharmacokinetics in Aboriginal people which may change the efficacy and toxicity profile of commonly prescribed medications.

Throughout the transplant timeline the HPC team integrated the principals of cultural safety when managing this young Aboriginal man and his family. This was achieved by recognising the principles of awareness, safety and security unique to Aboriginal Australians.