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Professor Galen Switzer

Featured Researcher

Professor Switzer is an expert regarding the motives and experiences of individuals who join an adult stem-cell donation registry. In collaboration with the U.S.-based National Marrow Donor Program, U.K.-based Anthony Nolan Registry, and German-based D.K.M.S., his research group has become internationally known for its findings about registry members’ experience at critical points leading to donation, as well motivations for joining the registry and factors associated with opting-out after having preliminarily matched a patient in need of a transplant. 



Professor Switzer continues to lead the investigation on donation experiences from the donor perspective and advancing the understanding of health-related quality of life of pediatric stem cell donors and their families.


Quick facts about Professor Switzer

I would be camping in the Rocky Mountains.  I grew up in Kansas and I love the plains and wide-open spaces.  However, every summer, my family would make the trek to the Rockies to camp for a week or so, and those are some of my best memories.  There  is something about the air, the smell of a campfire, and wind in the pines that always gets me.

The Princess Bride, of course!  “Hello. My name is Inigo Montoya. You killed my father. Prepare to die.”

I have been lucky enough to have so many good travel experiences.  The most interesting, fun, and transformative – although I wouldn’t call it a vacation – was the year I studied in Germany.  I learned so much about how large, diverse, and colourful the world is and how insular my growing-up experience had been.

All of them – I know that doesn’t really answer the question, but for me, this question is unanswerable.  I like most every kind of food although I just can bring myself to like eggplant or okra – I think it is the slimy texture.

Both my parents grew up on farms in the Midwest US (Colorado and Nebraska) and I am certain that the farming gene somehow got passed along to me.  I have a big vegetable garden and city chickens, but I am always looking for more opportunities to be outside working and growing things.  I suspect a small organic farm would be just the right fit.

Some of my favourite words of advice come from the speaker/actor/comedian Stephen Fry who said “We are not nouns, we are verbs.”   I think this means that we need to embrace change, and to consider transition a chance to reinvent ourselves.  I think I would have told my early self to be calm and to embrace uncertainty.  Well……and to take more vacations.

In his recent DoRN Week of Talks presentation, Professor Switzer gives a brief overview of the stem cell donation process, and talks about research on unrelated donors. Hematopoietic stem cell transplant involves collecting stem cells from healthy living donors and giving them to patients with blood-related diseases. There are three ways to donate stem cells: cord blood donation (collected from the umbilical cord after birth), bone marrow (marrow drawn from lower back) & Peripheral Blood Stem Cell donation (PBSC; drug stimulates stem cells to be released to peripheral blood).


To learn more about stem cell donation and Professor Switzer’s work, please click on the free video below:

Q & As

The DoRN Week of Talks provided a unique opportunity to engage in an easy and convenient Q & A with presenters. Below we have listed the questions that we received for Professor Switzer, along with his answers. 

This is a great question and our team has given it lots of thought.  I think that first and foremost, it is critical to employ recruitment techniques that maximize the probability that individuals who join the registry are actually committed to donation should they be called upon.  Although it is challenging to screen people based on their motivation to join the registry at recruitment, there are steps that can improve the likelihood that people are joining based on “internal” motive types as I discussed in the presentation.  These motive types are linked to deeply held beliefs about helping others and can be grounded in moral or religious principles.  Examples of these techniques might include things like removing external incentives and social pressure in recruitment settings – we know, for example that things as seemingly mundane as providing free food at recruitment drives can motivate people to join the registry without thinking through what they are volunteering to do.  We also know that situations that may involve social pressure to join – e.g., having competitions among university fraternities/sororities to see how many new members they can register – are likely to lead people who are not fully committed to join the registry.  Similarly, (and ironically) things that may make it easier to join a registry may lead to less-committed individuals joining.  For example, we know that many potential members have a fear of needles.  In the past, when joining a registry required a blood draw, this likely excluded individuals for whom this would be a potential barrier to actual donation.  Buccal swab typing has eliminated that potential barrier to joining and may have increased the likelihood that these individuals may join the registry but not be available for donation.  We believe that minimizing external incentives to join a registry, avoiding recruitment contexts that may invoke social pressure to join, and potentially asking new members to reconfirm their commitment to donation at some point soon after they have initially indicated willingness to join, should all help to increase the likelihood that those who join are committed to donation.

The second part of the question has to do with individuals who are already members of a registry but who may not be fully committed to donation.  We have worked with the National Marrow Donor Program to use a 4-item “commitment” measure among existing registry members.  We know that the score on that measure is associated with likelihood of being available when called as a potential match.  However, most registries are large enough that collecting this information from all registry members is impractical – and it is difficult to know exactly how to act on this information once it is collected.  What we have suggested is that registries find ways to get members to perform some action that reaffirms commitment.  Maybe that is responding yearly with a recommitment statement – e.g., “I am still interested in being a member of the registry” – or confirming contact information.  A central problem is that there isn’t an ongoing action that members perform to demonstrate active commitment as there is with many other types of helping acts.  In fact, we know that many members cannot even remember joining a registry until they are called as a potential match for a patient.  As noted in the presentation, we know that among blood donors, first-time donors are often motivated by external social pressures.  However, if those donors can be persuaded to continue donation, they develop an internal “donor self-image”. Increased commitment to blood donation and corresponding changes in self-image are thus produced in small incremental steps as donation continues, individuals begin to see themselves as “the kind of person who donates”.  We need to think creatively about how similar processed of engagement can be provided to registry members so that we can enhance their perceptions of themselves as donors and increase their commitment to donate.

GE Switzer, MA Dew, VA Butterworth, RG Simmons, M Schimmel (1997). Understanding donors’ motivations: a study of unrelated bone marrow donors. Soc Sci Med. July; 45(1): 137-47.

Callero, P. L., Howard, J. A. and Piliavin, J. A. (1987) Helping behavior as role behavior: disclosing social structure and history in the analysis of prosocial action. Social Psychology Quarterly 50, 247-256.

 Piliavin, J. A. and Callero, P. L. (1991) Giving Blood.” The Development of an Altruistic Identity. The Johns Hopkins University Press, Baltimore, MD.

Callero, P. L. (1985) Role-identity salience. Social Psychology Quarterly 48, 203-215.

Charng, H. W., Piliavin, J. A. and Callero, P. L. (1988) Role identity and reasoned action in the prediction of repeated behavior. Social Psychology Quarterly 51, 303-317.

Gardner, W. E. and Cacioppo, J. T. (1995) Multi-gallon blood donors: why do they give? Transfusion 35, 795-798.

Royse, D. and Doochin, K. E. (1995) Multi-gallon blood donors: who are they? Transfusion 35, 826-831.

We do think that for any type of research for which the goal is to publish in top-tier journals, it is critical to engage trained researchers and follow rigorous research methods – that includes both qualitative and quantitative research.  That said, there are many highly valuable projects that can be conducted with minimal resources and training that can be useful for local program improvement.  For example, focus groups and individual interviews involving potential/actual HSC donors can yield information about cultural/religious beliefs, misconceptions, and key concerns that may be barriers to donation.  Recording these conversations – either via audio-recording or intensive note-taking – is important so that they can be reviewed for key themes.  There are multiple low-cost software programs that can assist with extracting themes from written text (e.g., NVivo and ATLAS.ti).  It is even possible to use Excel spreadsheets or Word for entering and code responses when resources to purchase specialized software are limited.  Information from these focus groups or interviews can then be used to tailor information and recruitment strategies to directly address donation-related concerns/barriers.

It is true that some information – particularly for qualitative research – may be lost in an audio-only telephone interview.  Even if the interview is conducted using an audio-visual platform (e.g., zoom), it is difficult to know how to code and interpret anything other than the spoken words (e.g., facial expressions and gestures).  Social psychologists have been working on ways to code facial expressions for many years but still have not settled on a systematic, cost-effective, and accurate way to do that except for the most general of emotional reactions.  At this time, the best strategy is to rely heavily on the verbal responses of research participants.

As noted in the presentation, we know that younger potential HSC donors are the most clinically desirable and least available to donate after having preliminarily matched a patient.  Younger donors are less likely to have health issues that preclude donation and using this donor group leads to better transplant outcomes.  However, younger potential donors also have the highest rates of unavailability (>50%) when contacted as a potential match for a patient.  We believe that trying to identify reasons for these high rates of unavailability is critically important and we have focused much of our recent research on this issue.  Here in the US, we also know that members of racial/ethnic minority groups are less likely to join the registry and more likely to opt-out after matching a patient.  We are highly engaged in trying to determine what barriers to donation might be specific to these groups.  If we were able to improve availability rates among younger donors and race/ethnic minorities by even a modest amount (e.g., 5%) it would have a substantial impact on the ability to find matched donors for patients in need.

The short answer is “yes”.  In the early days of most registries, potential registry members had to pay for their own typing and endure a blood draw at registration.  In combination, these things likely meant that only the most committed individuals ended up on the registry.  Lowering the threshold to join (i.e., making it easier) likely allows individuals who are less committed to join the registry.  However, in the US, a high threshold for joining also meant that there was a lack of diversity in the first few years of the registry.  There is no doubt that the cheek swab is here to stay as a typing method and that suggests that we need to find other ways to enhance/ensure commitment.  One of the most promising avenues seems to be online registration.  We know that individuals who join online are more likely to be available after matching a patient.  This is likely because joining online often means that the individual (a) has sought out the registry, (b) is likely to be better informed before making a decision, (c) is not subject to immediate social pressure to join, and (d) has had time to process the decision.  Our own research has found that individuals who joined with others, joined at a drive for a specific patient, joined at a college or university or reported that their ethnic group mattered in their decision of whether to join the registry are all more likely to discontinue registry participation.  Some registries have tried using a combination of recruitment strategies that involve live recruitment drives followed by a requirement that individuals enter/re-enter information online to confirm their decision to join.  We think that these are promising strategies that deserve additional attention and research.  Ultimately, finding ways to balance ease of joining with requirements that demonstrate commitment to donation are critical.

This is both a critical issue and a difficult one.  This is partly because many registries have grown so large that the cost of any engagement effort or intervention is often prohibitive.  That said, we have encouraged the registries we work with to try to find ways to actively engage registry members in behaviors that are consistent with HSC donation.  For example, registries could partner more closely with blood donation centers to encourage HSC donors to become regular blood donors – we know that blood donors are more likely to be available after matching a patient.  There are also often local volunteer opportunities centered around donor recruitment and management that can engage registry members and enhance commitment.   Finally, encouraging financial donation to registry-affiliated foundations is another way of fostering commitment.  Beyond that, any way that a registry can engage in active communication with donors is likely to enhance engagement/commitment.  This is a difficult issue and we recognize that additional creative solutions are needed.

Our research has found that there are several potential barriers to donation that may be unique to, or more prevalent in, this younger group.  These include fewer financial resources, childcare issues, work commitments, school commitments, and a sense that parents/family might worry about donation-related consequences.  These are all important issues to address to try to enhance availability among this group and creative solutions are needed.  Things like sending nurses directly to potential donors to administer pre-donation medications, assisting with provisions for childcare, contacting employers directly to explain the importance of donation and paying for workdays missed, and scheduling donation (if possible) around required school activities are some possibilities.


The second part of the question is about recruitment contexts.  We know that in the US, the two main contexts in which younger individuals join the registry are at college events and online.  Joining at a college/university is associated with less availability and joining online is associated with greater availability for reasons discussed in previous responses.  College campuses are a fertile recruitment setting and recruiting on campuses also enhances diversity of the registry – we would not want to eliminate this as a potential recruitment setting.  An interesting finding from our research is that on-campus recruitment is often targeted to or in proximity of athletic teams/athletes. Our qualitative research findings suggest that this group may also may have elevated concerns about how donation could impact their ability to perform their sport (recovery, long-term effects, timing of donation would coincide with their sport’s season/event). These college student athletes have been working on their sport for a long time and college athletics may be the culmination of their career and their way for paying for part of their education.  Finding ways to address concerns among this group is important.  Ultimately, we may need to take extra care that individuals recruited on campus are committed to donation.  A possible strategy that I mentioned above is to have a two-step process that requires an online activation and commitment affirmation after the live-drive campus recruitment.

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