In the cold of last December, the 506th donor to be matched up by the Tzu Chi Bone Marrow Donor Registry went to Tzu Chi Hospital in Hualien for the marrow extraction procedure. The mother of the donor, a 25-year-old man, accompanied him to Hualien, carrying on a "live broadcast" by cell phone for the benefit of family and friends unable to make the trip.

"Since my son has agreed, then let him do it," his mother says. "Anyway, the pain will only last awhile, and it happens that it's a good chance for him to catch up on his sleep, since he is normally so busy that he doesn't get enough rest." Through him, friends and family also get a chance to see the Registry motto "it never hurts to save a life" in action, helping to dispel the traditional view that extraction of bone marrow is unhealthy, and encouraging others to join the ranks of marrow donors.

Lee Jui-hua, a senior administrator at the Tzu Chi Foundation, says that for any given bone marrow transplant operation they normally have a few potential matches for donors. Even after weeding out those candidates with whom they have lost contact and those who can't make it for personal reasons, having one individual who is willing to donate is considered a success. People are gradually coming around to accept that marrow donation surgery causes no lasting harm, and the number of people willing to join the data bank has been increasing by a steady 20,000 per year.

The focus of hope

Tzu Chi is a world famous charitable institution. Ten years ago when people in Taiwan were figuring out how to set up a bone marrow data center, the Tzu Chi Hospital (TCH) became the "focus of hope" for all concerned.

Yeh Ching-chung, now director of the Donor Registry, was ten years ago a vice director of the Department of Health, in charge of coordinating the establishment of a bone marrow data center. He recalls that at that time National Taiwan University Hospital had begun the creation of a database, but after getting 4000-5000 candidates, could not continue because of a lack of funds. The Department of Health then got together with National Taiwan University Hospital, Veterans General Hospital, and other major domestic medical institutions to discuss the problem. Everyone agreed that TCH would be the optimum choice for the creation of the data center. TCH, which did not even participate in the discussions but was handed this heavy responsibility, did an evaluation, then declared itself happy to accept.

"The two biggest problems for any bone marrow data center are funding and persuading people to donate," says Yeh. "Tzu Chi has an extremely persuasive fund-raising network and huge number of volunteers. These factors provided an excellent foundation." Simply doing the analysis of HLA for a single potential donor costs more than NT$4000. The Tzu Chi center has already spent more than NT$500 million, of which it has reclaimed less than one-fifth through the medical system. This is a genuine charitable enterprise.

A lottery

Bone marrow transplants are usually used to treat blood diseases, such as leukemia or aplastic anemia. If treatment with traditional methods like chemotherapy and regular blood transfusions cannot improve a patient's condition, then a bone marrow transplant becomes the only therapeutic option. In the case of leukemia, for example, only about 20% of patients survive three years using traditional therapies. But the survival rate goes over 50% for those who have received bone marrow transplants. For aplastic anemia, 80-90% of patients can make a full recovery.

But bone marrow transplants are limited by the degree of matching of HLA, a critical defense mechanism in the immune system that helps the body distinguish between friend and foe. Unless the donor and the recipient have a complete match, the result will be rejection of the transplant. Compared to Japan, for example, where the population is relatively genetically homogeneous, in Taiwan the population composition is more complex, so the rate of matching is lower. However, because of this genetic diversity, Chinese from all over the world can try their luck in Taiwan, and there have even been more than a few cases of people of European ancestry finding a match here. Statistics indicate that if you have a database of 10,000 donors, the chance of an HLA match is 15%, rising to 45% for a list of 100,000 and to 75% if you have a pool of one million potential donors.

The larger the database, the higher the rate of finding a match. Encouraged by the Venerable Cheng Yen, founder of Tzu Chi, the tens of thousands of Tzu Chi volunteers became the core of the donor registry. But because it is popularly believed in Taiwan that one should not extract the so-called "dragon bone water" from the body, early on there was considerable resistance to the idea of bone marrow donation.

"In fact, the marrow still in the bone is in something of a state of hibernation and has no function. It has to become mature, divide, and enter the bloodstream before it becomes functional," explains Huang Hai-hsiang, a lab supervisor at the registry. Marrow donation requires taking only 5% of the hibernating marrow cells and transferring them to the person who needs them. Because marrow consists of cells that can divide and reproduce, the extracted amount can be replaced within about ten days, so there is no real loss to the donor. "The marrow is extracted from the ilium, and not, as many people believe, from the spine, so there can be no damage to the central nervous system," says Huang.

Fated matches

Thanks to educational efforts by Tzu Chi, accurate information about bone marrow donation has steadily spread among the general public, and the number of donors has continually increased. A group set up under the donor registry holds activities each week at different places in Taiwan to encourage marrow donation, and the number of potential donors on the list increases by about 20,000 per year. And this is not just in Taiwan. The overseas branches of Tzu Chi are also putting considerable effort into promoting marrow donation. For example, the Singapore branch cooperates with the bone marrow registry in that country, and from time to time holds blood testing activities for potential donors.

One result is countless moving stories.

Last year, one donor was right in the middle of arranging her father's funeral when she received the notification call from Tzu Chi. Still, she prepared some simple luggage, and headed to Hualien for the marrow extraction. Two days later, she left the hospital and returned home, just in time for her father's burial.

Another donor said to a Tzu Chi volunteer after the marrow extraction was complete: "So it's that simple to save someone's life. You go back and find some more for me, and I'll donate a few more times."

Mainland China, the US, Canada, Australia, Singapore, Hong Kong, Malaysia, Japan, Korea... Around the world there are more than 300 people who have felt the love from Taiwan right down to their bones.

The first "lucky lottery winner" from overseas following the establishment of the Tzu Chi Donor Registry was a 16-year-old girl from Singapore. Chen Nai-yu, a Tzu Chi volunteer who helped deliver the marrow, says that in order to ensure that the marrow did not coagulate while in its cold storage box, he had to shake it all the way to Singapore. When he got through the airport, the family members of the ill girl were already waiting at the door, and all their eyes were fixed on the container in his hands. He says, obviously touched, that the anxiety felt by the patient's family was deeply etched on their faces.

Tzu Chi is a charitable organization that grew out of Buddhist belief. While not all of the people who participate in its marrow donation activities are Buddhists, in the eyes of the recipients, each and every donor is like a bodhisattva, bringing blessed compassion from a realm that recognizes no religious or national boundaries.

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It costs more than NT$4000 for each HLA analysis, so the costs add up fast.

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The more people there are in a bone marrow donor registry, the higher the chances of finding a match. In order to help even more patients, the Tzu Chi Donor Registry has held many activities to promote bone marrow donation.

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Before a bone marrow transplant, the recipient must undergo chemotherapy to completely eradicate the original bone marrow cells. Only then can the patient's body start over with the marrow from the donor. The process is painful and risky, so the rules governing visits to transplant patients are especially strict.