a procedureBone marrow transplant

The blood-forming system is destroyed by chemotherapy, with or without radiation, and replaced with stem cells — the patient's own, harvested and stored beforehand, or another person's. Milliman's terms are the usable ones: autologous, "where the donor is the recipient", and allogeneic, "where the donor may be related or unrelated to the recipient". The cells are given through a drip, not implanted. What follows is weeks of no immune system, and, in the allogeneic case, a lifetime of watching for the graft attacking the patient.

This treatment travels for a reason no other page in this directory carries: the thing that is scarce is a person.

An allogeneic transplant needs a tissue-matched donor. About a quarter to a third of patients have a matched sibling; the rest are searched for in the international registries, which are federated and queried as one. The World Marrow Donor Association's front-page counter gave 44,206,627 volunteer donors and cord blood units in the global database when it was read on 16 September 2026 — a count of registrations, not of people who will answer the phone.

The registries are not evenly composed, and that is the second scarcity. Modelling the US registry for 21 racial and ethnic groups, Gragert and colleagues found in the New England Journal of Medicine in 2014 that "the likelihood of finding an optimal adult donor varies among racial and ethnic groups, with the highest probability among whites of European descent, at 75%, and the lowest probability among blacks of South or Central American descent, at 16%". A patient's ancestry, in other words, sets the odds that the world's donor pool contains them. Cord blood closes part of the gap: units mismatched at one or two loci "are available for almost all patients younger than 20 years of age and for more than 80% of patients 20 years of age or older, regardless of racial and ethnic background".

Trade practice — the workaround that changed the map is the half-matched, or haploidentical, transplant from a parent or child, which needs no registry at all. Units in India and Türkiye built large haploidentical programmes, and patients from countries with no transplant unit travel to them.

Inference — a search that crosses borders is ordinary here in a way it is nowhere else in this directory: the patient may stay put while the graft flies. Cells are couriered between registries under time limits, and the courier is the part of the journey nobody writes a package price for.

Conditioning chemotherapy first, for days; then the infusion; then the wait for the new marrow to start making blood, during which the patient has almost no immune defence and is nursed in isolation. Milliman's 2025 estimate of the average US hospital stay is 33.3 days for an allogeneic transplant and 20.3 for an autologous one. Trade practice — transplant units commonly ask allogeneic patients to remain close to the centre for roughly the first hundred days after discharge, with a full-time carer, which is the sentence that decides whether a transplant abroad is possible at all. Graft-versus-host disease, infection and the immunosuppression that follows are managed for months to years afterwards.

The only publicly readable price for this record is an actuarial estimate of what American hospitals bill. Milliman's February 2025 report puts average 2025 billed charges at 1,261,800 US dollars for an allogeneic transplant and 577,000 for an autologous one, covering 30 days before admission to 180 days after discharge. The report is explicit that this is not what anyone pays: "billed charges are unlikely to equal the actual amount paid for the transplant services due to the presence of negotiated reimbursement arrangements such as case rates, prescribed fee schedules, discounts, or other agreements in place." No hospital price list for a self-paying foreign patient was read for this record on 16 September 2026.

This page describes a treatment. It is not advice about whether to have one, or where.