What are the cons of being a bone marrow donor?

September 25, 2025 •

4 min read

While hundreds of thousands of people join the bone marrow registry each year, it is a serious medical commitment with potential drawbacks. This guide explores what are the cons of being a bone marrow donor? by detailing the risks, recovery challenges, and personal considerations involved with both donation procedures.

Quick Summary

Donors may experience temporary pain, fatigue, and flu-like symptoms, with recovery times varying by donation type. Potential issues related to anesthesia or medication exist, though serious complications are rare. Non-medical cons include the significant time commitment and emotional impacts of the process.

Key Points

Pre-Donation Injections: PBSC donors must receive daily filgrastim injections, which can cause flu-like symptoms such as bone pain and headaches before the procedure begins.
Recovery Discomfort: All donors face a recovery period with temporary discomfort; marrow donors often experience soreness and bruising in the lower back for days to weeks, while PBSC donors recover more quickly.
Anesthesia and Surgical Risks: Marrow donation is a surgical procedure requiring anesthesia, which carries its own set of risks, though rare.
Time and Logistics: Both donation types require a significant time commitment for testing, the procedure itself, and recovery, which may include travel to a specialized center.
Emotional Burden: Donors can experience emotional challenges, including anxiety and the immense psychological weight of knowing a patient's life depends on their decision to follow through with the donation.
Serious but Rare Complications: Though overall very safe, both procedures have a small risk of serious complications, including infection, bleeding, or rare reactions.
Temporary Side Effects: Side effects like fatigue, nausea, and headaches are common in the days following donation for both methods but generally resolve quickly.

Understanding the Two Donation Methods

Donating blood-forming stem cells is a life-saving act, but it is important to understand that there are two different methods, and each has its own set of potential cons and recovery paths.

Peripheral Blood Stem Cell (PBSC) Donation

This is the most common donation method, accounting for about 90% of all donations. It is a non-surgical procedure similar to donating plasma.

The main con of this method lies in the preparation process. Before the collection, donors receive daily injections of a medication called filgrastim for several days. The purpose of this drug is to increase the number of blood stem cells circulating in the bloodstream. While effective, the injections can cause a variety of side effects.

Flu-like symptoms: Donors often report bone pain, muscle aches, headaches, and fatigue, which are similar to having a cold or the flu. These symptoms are temporary and typically resolve within a few days of the final injection.
Collection process discomfort: The donation procedure, called apheresis, involves filtering the blood through a machine. Some donors experience tingling around the mouth and extremities or mild muscle cramps, caused by an anticoagulant used during the process.
Central line risk: In rare cases where a donor's arm veins are not suitable, a central line may be required, which carries its own small risk of complications.

Marrow (Surgical) Donation

This is a surgical procedure done in a hospital operating room, typically for about 10% of donations.

The primary drawbacks of this method are linked to the surgical nature of the procedure.

Anesthesia risks: The donation is performed under general or regional anesthesia, and like any surgery, this carries some risk, though serious complications are rare. Common anesthesia side effects include sore throat from the breathing tube or mild nausea.
Pain and soreness: The marrow is collected with a needle from the back of the pelvic bone. As a result, donors commonly experience soreness, bruising, and aching in the lower back and hips after the procedure. This discomfort can last anywhere from a few days to several weeks.
Longer recovery: The median time to full recovery for marrow donation is 20 days, significantly longer than for PBSC donation. While many return to work or school within a week, full physical recovery takes longer.

Comparison of Donation Methods: Risks and Recovery

To better understand the differences, here is a comparison of the key cons for each method.


Feature	Peripheral Blood Stem Cell (PBSC) Donation	Marrow (Surgical) Donation
Pre-Donation Prep	Daily injections of filgrastim for several days, causing flu-like symptoms like headaches and bone pain.	No pre-donation medication injections.
Procedure	Outpatient apheresis, taking several hours, may require multiple sessions.	In-hospital surgical procedure under anesthesia, typically 1–2 hours.
Associated Pain	Bone and muscle aches from injections before donation; tingling/cramps during apheresis.	Post-operative pain and soreness in the lower back/hips, similar to a fall.
Recovery Time	Usually 1 to 7 days, with flu-like symptoms subsiding within 48 hours post-donation.	Median recovery time of 20 days, with soreness and fatigue lasting longer.
Anesthesia Risk	Not required for the procedure itself, but local anesthesia may be used for a central line if needed.	Requires general or regional anesthesia, carrying standard surgical risks.
Serious Complications	Very rare. Includes potential reaction to filgrastim or risks from central line if needed.	Extremely rare, but includes risks of infection, bleeding, or nerve damage at the collection site.

Emotional and Time Commitment Cons

Beyond the physical aspects, there are other important factors that can be considered cons of being a bone marrow donor.

Significant time commitment: The entire process, from initial testing to recovery, requires a considerable time commitment that can span weeks. This includes medical appointments, travel time, and time off work or school for the procedure and recovery.
Travel requirements: Donors must often travel to a specialized donation center, which can be in a different city or state. All donation-related travel and expenses are typically covered, but it is still a logistical consideration.
Emotional impact: Donors may experience a range of emotions, including stress, anxiety, and even a sense of anti-climax after the donation. Access to counseling and support is available, but the emotional journey is a reality of the process.
Psychological pressure: Knowing that a patient's life depends on your donation can be emotionally demanding. While donors can back out at any time, doing so after the patient has begun preparation for the transplant could be fatal for the recipient. This creates immense psychological pressure to follow through.

Weighing the Decision

The decision to become a bone marrow donor requires a careful evaluation of the potential cons. The experience is different for every individual, but nearly all donors report some level of temporary discomfort or inconvenience. The risks of serious complications are very low, but not zero, as with any medical procedure.

Ultimately, the gravity of a donor's contribution is profound. While the cons are real and should be considered seriously, they are often temporary. The potential to save a life is a powerful motivator that many donors find far outweighs the temporary challenges. For more comprehensive information on donor safety and procedures, visit the NMDP website.

Conclusion

Understanding what are the cons of being a bone marrow donor is a crucial step for any potential volunteer. The physical cons are temporary side effects like pain and fatigue, which differ based on whether the donation is surgical or non-surgical. The non-medical cons include significant time and emotional commitment. While the process is not without challenges, the risks are generally small and well-managed by medical professionals. The decision should be a personal one, made with full awareness of both the drawbacks and the incredible potential to save a life.

Frequently Asked Questions

Pain and discomfort vary by donation method. For a surgical marrow donation, you will not feel pain during the procedure due to anesthesia, but you will likely experience back or hip pain afterward that can last for several days to weeks. For a PBSC donation, pain is often described as bone or muscle aches from the filgrastim injections in the days leading up to the collection.

Recovery time depends on the donation method. Most PBSC donors return to normal activities within a week, with side effects from injections subsiding within 48 hours. For surgical marrow donation, a full recovery can take up to 20 days, though many donors feel better within a week.

The risks of bone marrow donation are generally low, but no medical procedure is without risk. Surgical marrow donation carries the risks of anesthesia, infection, bleeding, or rare nerve damage. PBSC donation has risks associated with the stimulating drug and the apheresis procedure itself, such as temporary tingling or a decrease in platelet count.

PBSC donation can cause flu-like symptoms, including bone pain, muscle aches, and headaches, from the filgrastim injections before the procedure. During the collection, tingling or cramping can occur due to the anticoagulant. Fatigue, nausea, and tiredness are also possible.

Long-term side effects for donors are extremely rare. Studies have shown no evidence of an increased risk for cancer, autoimmune diseases, or long-term immune system issues following donation. Your body naturally replaces the donated stem cells within a few weeks.

The time commitment is a notable con. It includes initial testing, multiple appointments, and the donation process itself, which can require days or weeks away from normal activities. There may also be travel involved, though expenses are typically covered.

Yes, you have the right to change your mind at any point before the procedure. However, the decision carries significant emotional weight, especially once the recipient has begun preparing for the transplant. This psychological burden is a key cons of being a bone marrow donor.