THE BUCHAREST ACADEMY OF ECONOMIC STUDIES

THE FACULTY OF BUSINESS ADMINISTRATION IN

FOREIGN LANGUAGES
(ENGLISH DEPARTMENT)
GRADUATION PAPER
QUANTITATIVE EVALUATION OF STEM CELL
DONATION IN ROMANIA
Scientific coordinator: Graduate:
Prof. univ. dr. Daniela erban Maria Bolboac
Bucharest
2010
II
Abstract
The aim of the present paper is to examine the stem cell donation procedure in Romania and
to determine the main factors that contribute to the development of the national volunteer stem cell
donor registry.
The methods of research and data collection used for realizing this paper are the study and
critical analysis of scientific literature and mass media materials on the topic, case study, personal
interviews and internet surveys.
The paper is structured in three chapters. Firstly, it introduces the concepts of stem cell
donation and stem cell donor registry. It also gives an insight into the current situation of Romania
regarding stem cell donations. Then, it presents the statistical methods used for doing the research
and for reaching a conclusion. Finally, it describes the case study, which analyzes the factors that
determine Romanians willingness to donate stem cells and to register as volunteer donors.
As a result of the research, the author studied and summarized the most important
influencing factors of the development of the national volunteer stem cell donor registry and made
up recommendations for the already established national registry but also highlighted the window of
opportunity for the creation by a non-governmental organization of a more complex registry.
The paper contains 40 pages, 4 tables, 2 figures and 9 appendixes. It was realized by using
22 bibliography sources and 37 references.
III
TABLE OF CONTENTS
Index of Abbreviations....IV
Index of Tables and Figures .....V
Introduction1
1. Blood Stem Cell Donation and Donor Registries..3
1.1 Blood Stem Cell Donation......3
1.2 Stem Cell Donor Registries ....6
1.3 Current Situation in Romania..7
1.4 Similar Researches on Blood Stem Cell Donation..8
2. Quantitative Methods Used for Research..10
2.1 Basic Concepts of Statistics...10
2.2 Data Collection and Presentation...11
2.3 Data Analysis and Interpretation...13
2.3.1 Descriptive Statistics...13
2.3.2 Inferential Statistics....14
3. Case Study Research on Stem Cell Donation in Romania....20
3.1 Purpose of the Research.20
3.2 Sample Profile....22
3.3 Data Analysis.23
3.4 Relationship between Variables....26
3.4.1 Influencing Factors of Romanians Willingness to Donate Stem Cells..26
3.4.2 Influencing Factors of Romanians Willingness to Register as Donors..29
3.4.3 Effects of Publicity Campaigns..31
3.5 Hypothesis Testing. Confidence Intervals.....32
Conclusions and Recommendations..35
Bibliography..41
Appendix...45
IV
Index of Abbreviations
NGO non-governmental organization
HSCs hematopoietic stem cells
HLA human leukocyte antigens
BM bone marrow
PB peripheral blood
PBSC peripheral blood stem cell
BMDW Bone Marrow Donors Worldwide
V
Index of Tables and Figures
Table 2.1 Types of errors
Table 3.1 Distribution of ages
Figure 3.1 Distribution of responses according to the understanding of the expression
blood stem cell donation
Table 3.2 Coefficients of regression
Table 3.3 Chi-Square Tests
Figure 3.2 The organizational chart of Romanian Stem Cell Foundation
1
Introduction
Act as if what you do makes a difference. I t does.
William James, American philosopher, 1842-1910
The theme of the present graduation paper is Romanias current situation regarding the stem
cell donations. The theme will be further introduced in the present-day global context.
First of all, it must be presented the fact that, each year, thousands of persons worldwide are
diagnosed with diseases treatable by a blood stem cell transplant. These blood stem cells needed for
transplant can come from bone marrow, peripheral blood or cord blood donation. The donor can be
a tissue type matched relative or an unrelated volunteer donor. Although some patients can find a
related donor, 60-70% of them have no relative that matches their tissue type. For this reason,
millions of volunteer donors are listed within the registries around the world in case they can help by
providing blood stem cells to patients who do not have a matched relative.
One of the diseases which can be treated by a blood cell transplant is leukemia. In Romania,
the number of people suffering of leukemia is unknown since there are no complete national
statistics, but this number is approximated to the value of 8,000 patients for the beginning of 2010.
The most recent estimates of the leukemia incidence, mortality and prevalence, for all the countries
of the world, are offered by the IARC
1
(International Agency on Research on Cancer) for the year
2002. In that year, in Romania were registered 1,331 incidence cases of leukemia.
Most of these patients need a blood stem cell transplant, but only a few have the chance to
find a related donor. The others are under the necessity of finding an unrelated volunteer donor
which can be searched for in registries. The chances of finding a tissue type matched donor in the
patients country are big since people having the same ethnicity are more similar regarding their
tissue type. However, in Romania, until the beginning of September 2009 did not function such a
registry. For this reason, those who needed a transplant had to search in international registries, a
lengthy and costly procedure which did not even assure their success of finding a donor.
Moreover, if an unrelated donor were to be found in Romania, the costs of a transplant would
be around 50,000 euros. However, if the donor is found abroad, the transplant could cost about
150,000 euros
2
.
2
The initiative of founding the National Registry of Volunteer Hematopoetic Stem Cell
Donors belonged to PRO TV News, which conducted in the spring of 2009 a social campaign,
named We have life in our blood, for determining the Health Ministry to create this registry.
There were many advertisements on television in that period meant to inform people about the
usefulness of this registry for our nation and asked them to sign a petition which could show to the
state representatives Romanians will. Through this campaign 39,029 Romanians expressed their
interest for the creation of the national registry
3
.
Although the campaign was successful and the registry was created at the beginning of
September 2009, having about 700 donors registered, until now this national registry has not been
properly functioning. A proof of the fact that the registry is not functioning as it should is that it is
not registered in the Bone Marrow Donors Worldwide Organization, which gathers the registries
from all over the world, even those which have been created but have not started their activity yet.
The second proof is that it has been impossible to access the registrys website from its beginnings
until recently, although more than ten months have passed from its creation. Moreover, some
persons who wanted to become volunteer donors complained on different online forums that they
could not make the required steps because the registry was not professionally administered.
Therefore, the aim of this paper is to determine the main factors that contribute to
Romanians willingness to donate stem cells and become volunteer donors in the national registry,
and decide who should administer a national registry in order to attract the most potential donors. Its
objective is to provide some recommendations for the already established national stem cell donor
registry or highlight the existence of a window of opportunity for the creation of such a registry by a
non-governmental organization.
The research method used in order to reach conclusions concerning Romanias current
situation of stem cell donations is the survey research. The subject of the research consists of the
adult male and female citizens of Romania from the territory of our country. In the investigation
process, since there were no secondary data sources, primary data was collected. The methods of
data collection used were personal interview and webpage survey. There were collected the
responses of 325 persons in January February 2010.
3
I. Blood Stem Cell Donation and Donor Registries
Chapter 1 provides basic information about stem cells. The first subchapter explains what
stem cells are, the second introduces the several types of blood stem cell donation and the third
presents the evolution and activity of donor registries worldwide. In the last subchapter it is made
a short presentation of Romanias situation concerning this subject.
1.1. Blood Stem Cell Donation
A stem cell is an unspecialized cell that gives rise to a specific specialized cell, such as a
blood cell
4
. On the Swiss Blood Stem Cell Foundation website
5
it is presented a classification of
stem cells. The term stem cells is used both for embryonic stem cells (the original cells of an
unborn child) and for adult stem cells which are found in each of us. On the one hand, embryonic
stem cells have the outstanding ability to develop into a whole range of different cells (more than
200 different tissue types), depending on what the body needs. On the other hand, adult stem cells
no longer have this specific ability, but they are still extremely important since they typically
generate the cell types of the tissue in which they reside
6
. For example, blood-forming cells, also
known as hematopoietic stem cells (HSCs) are capable of developing into different blood cells and
into the cells of the immune system. Considering the purpose of this paper, there will be further
described only the blood (hematopoietic) stem cells.
Blood stem cells are mostly located in the bone marrow. This is where they produce the
actual blood cells: red blood cells, B lymphocytes, T lymphocytes, natural killer cells, neutrophils,
basophils, eosinophils, monocytes, and macrophages. To a small extent, blood stem cells can also be
found in the blood stream itself. A significant number of stem cells is also found in the umbilical
cord (the cord blood) of newborn babies
7
.
Adult stem cells, such as HSCs, are currently the only type of stem cell commonly used to
treat human diseases. Doctors have been transferring HSCs in bone marrow transplants for over 40
years, and advances in techniques of collecting have been made. HSCs collected from a healthy
person are transplanted in order to reconstitute the immune system after leukemia, lymphoma or
various blood or autoimmune disorders which have been treated with chemotherapy
8
. Compared to
adult stem cells from other tissues, HSCs are easy to obtain, as they can be either aspirated directly
out of the bone marrow or stimulated to move into the peripheral blood stream, where they can be
easily collected
9
.
4
There are two types of HSCs transplants: autologous transplant in which the patient receives
his own previously harvested stock of stem cells or bone marrow and allogeneic transplant in which
the patient receives someone elses stem cells or bone marrow
10
. Since only the allogeneic transplant
is of interest for the present paper, any further reference to a blood stem cell transplant will
automatically be considered an allogeneic transplant.
Nearly 50 years ago Dr. E. Donnall Thomas first published an attempt to transplant blood-
forming tissue (bone marrow) from one person to another. This was the first bone marrow
transplant, a treatment now known to be efficient because blood stem cells are contained within the
transplanted marrow. Today, specialists are able to collect highly-enriched populations of blood
stem cells from the bone marrow, peripheral blood, and also cord blood
11
.
Before enlarging upon these three types of blood stem cells donation (bone marrow donation,
peripheral blood stem cell donation and cord blood donation), it is important to understand the
conditions that must be respected in order to make a successful transplant.
The principle underlying blood stem cell donation is similar to blood transfusion in that the
donor and the recipient must be compatible. While in a blood transfusion the blood groups are
important, in a blood stem cell donation it is the compatibility of the tissue markers (HLA markers)
that is essential for the success of the blood stem cell transplant
12
.
The HLA system (Human Leukocyte Antigens) is extremely complex. The HLA antigens are
important tissue markers for distinguishing between own and foreign and are inherited half from
a person's father and half from the mother. They are located on the surface of the immune cells, e.g.
on the white blood cells. Today the structure of these antigens is known to be the result of a billion
possible combinations. For a blood stem cell transplant, the donors and the recipients most
important HLA antigens and their subgroups must be identical. If this is not the case, the recipients
body will reject the cells
13
. After tests of tissue type are made and it is proven that a potential donor
and a patient are compatible, the donation process takes place.
The source of HSCs for transplantation has diversified over the years. Traditionally, the cells
were harvested from the bone marrow (BM) under general anesthesia. More recently, peripheral
blood hematopoietic stem cells have been increasingly used in stem cell transplants. Unmanipulated
cord blood cells collected and cryopreserved at birth have been used in related and unrelated HLA-
matched and HLA-mismatched allogeneic transplants in children and more recently in adults. It has
become evident that there are many quantitative and qualitative differences between these cell
sources (Gluckman&Rocha, 2004:144-145).
5
Historically, HSCs for transplantation to treat hematologic malignancies have been obtained
by BM harvest (Pidala et al., 2009:1415). Donating bone marrow is a surgical procedure done under
general or regional anesthesia in a hospital. While a donor receives anesthesia, doctors use needles
to withdraw liquid marrow from the back of the pelvic bone.
14
However, HSCs are increasingly obtained through mobilization and collection from the
peripheral blood (PB). A review of current trends indicates that most allogeneic stem cell
transplantations are performed using PB stem cells (Pidala et al., 2009:1415). PB stem cells (PBSC)
donation is a non-surgical procedure done in an outpatient clinic. Prior to the donation, PBSC
donors receive daily injections of a drug called filgrastim for five days, to increase the number of
blood-forming cells in the bloodstream. Then, through a process called apheresis, a donor's blood is
removed through a needle in one arm and passed through a specialized machine that separates out
the stem cells. The remaining blood is returned to the donor through the other arm
15
.
By comparing these two procedures it can be observed that the collection of PBSCs rather
than BM offers several advantages to the donor, including avoidance of anesthesia, hospitalization,
and potential exposure to blood products, although controlled comparisons of PBSC and BM
donation do not indicate substantial differences in serious adverse effects (Eapen, 2007:1461).
The third type of transplant is the unrelated cord blood transplantation. It has been used to
treat patients with malignant and non-malignant hematopoietic disorders for whom an HLA-
compatible hematopoietic stem cell donor is not available (Gluckman&Rocha, 2004:143). Cord
blood is collected from the umbilical cord and placenta after a baby is born. This blood is rich in
blood-forming cells. The donated cord blood is tested, frozen and stored at a cord blood bank for
future use. The use of cord blood transplants has grown for both children and adults. Cord blood is
used more often in children because a cord blood unit has a limited amount of blood-forming cells
16
.
The option of performing cord blood transplants should be based on urgency of the transplant, cord
blood cell dose and number of HLA disparities which makes it difficult to find a PBSC or BM donor
(Gluckman&Rocha, 2004:143).
These three types of procedures make it possible to transfer HSCs from a healthy person to
one that went through chemotherapy. However, the most important step in making a transplant is not
the procedure itself but finding a matching donor. Although it might seem that there is a great
chance of tissue type compatibility between siblings due to the fact that they have a certain number
of genes in common, in reality only 20-30% of patients find a suitable donor within the family,
while all the other must rely on a suitable unrelated donor being found
17
. The easiest way to find an
unrelated donor is through donor registries.
6
1.2 Stem Cell Donor Registries
A stem cell donor registry is a national organization whose responsibility is to process
requests for HSCs from donors originating within a country and from abroad. The registry is where
the HLA typing information on donors is stored and made available in an anonymous fashion for
patient searches, through computer-based matching programs. The registry acts as the intermediary
between the donor centers of a country and transplant centers within the same country. For
international activity, the registry links with similar registries in other countries and becomes a hub
as its interactions radiate out to donor centers and transplant centers within its own country and to
those in other countries via the foreign hub. The hub concept has been developed by the World
Marrow Donor Association (Treleaven & Barrett, 2008:221-222).
The first bone marrow donor registry was created in 1970 by Prof. Dr. JJ van Rood who
proposed to set up a file of HLA typed volunteer blood transfusion donors to be used for HLA
matched platelet transfusions and bone marrow transplantation.
18
It was followed in 1974 by the
Anthony Nolan Trust, United Kingdom, which established a tradition of making unrelated bone
marrow donors available not only locally but all over the world. In 1987 the National Marrow Donor
Program (NMDP) of the United States also started recruiting donors and, in 1988, JJ von Rood
created collaboration between the existing bone marrow donor registries worldwide by producing
the global search engine for donors, the Bone Marrow Donors Worlwide (Atkinson et al.,
2004:369). In February 1989 the first edition of Bone Marrow Donors Worldwide was published,
which contained the donor files of eight registries with a total of 155,000 volunteer stem cell donors.
Today, Bone Marrow Donors Worldwide (BMDW) is a web based search engine which is about
to reach fifteen million donors worldwide, being a successful collaboration of 63 stem cell donor
registries from 44 countries
19
. In 1988 it was shown that cells from cord blood could be used for
transplantation and in 1992 the first cord blood registry was set up by Dr. Pablo Rubinstein at the
New York Blood Center. Since then the number of cord blood registries has gradually increased to
the present number of 44 cord blood banks in 26 countries (Atkinson et al., 2004:369 and BMDW
website).
According to the BMDW Annual Report for 2008, almost half of the donors (45%) reside in
North America, 42% in Europe, 11% in Asia and the remaining 2% originate from other continents.
The distribution of donors in 2008 was identical to 2007 (see Appendix 1 and Appendix 2).
7
With the current size of the pool of volunteer donors, approximately 75% of Caucasian
patients can locate a suitable matched volunteer donor. Patients belonging to minority ethnic groups
have lower rates of success in locating a fully matched donor. This is only partly due to the smaller
number of donors from racial minorities, and mainly a result of their greater prevalence of
uncommon HLA types. This means that a substantial increase is needed in the recruitment of
minority racial groups for stem cells donors to alleviate the problem of access to HLA matches for
patients belonging to racial minority groups (Ezzone & Schmit-Pokorny, 2007:68-69).
1.3 Current Situation in Romania
Although there are almost fifty years since the first bone marrow transplant was made, in
Romania only recently this type of procedure was made. In 2001, Prof. Dr. Margit erban made the
first autologous HSCs transplant in Timisoara, being followed by the Fundeni Hospital team (Prof.
Dr. Dan Colita, Prof. Dr. Constantin Arion) who made a similar intervention
20
. In 2003, at Fundeni
Hospital, it was made the first allogeneic transplant in order to cure a 13 years old boy who suffered
from leukemia
21
. The annual report for 2008 of the National Agency of Transplant informs that
during that year were made 116 HSCs transplants (92 autologous transplants, 24 allogeneic
transplants from related donors and 0 allogeneic transplants from unrelated donors).
At national level, the Health Ministry imposed a fixed number of financed transplants: 100
autologous and 30 allogeneic (with HSCs form related donors)
22
. Thus, Romania continues to be far
from the European average of HSCs transplants which varies between 200 and 400 procedures for
each 10 million habitants
23
.
Although a patient could have a HSCs transplant in Romania, not finding a related donor
obliges him to search for an unrelated donor. Since in Romania, until recently did not exist a donor
registry, the patient had to search for a donor in the international registries and have the transplant
done in a foreign country, thus paying for the same intervention at least twice the amount he would
have paid in Romania.
In September 2009, the Health Ministry announced that this national HBCs volunteer donor
registry was created. However, the website of this registry has not been, until now, functional.
At the beginning of 2010, Daniel Coriu, medical director of Fundeni Hospital said that the
lack of a functional HSCs donor national registry diminishes considerably the chances of survival of
those persons without a related donor. They are sent abroad just because in our country the national
8
registry does not work. The money paid by the Health Ministry for treatment abroad could be
invested in the Romanian centers.
24
Having this problem with finding a donor who is not family, more Romanians choose to
preserve cord blood of their newborn in order to ensure that in the future the child or another
member of the family will have the chance to use it in order to cure certain illnesses. There are
about 70 illnesses which can be treated with stem cells. For instance, 1,700 individuals are
diagnosed with leukemia in Romania every year, one of the highest rates in Europe. In Spain, where
the practice of samplings taken at birth is widespread, and part of a program covered by the national
insurance system, leukemia has been taken off the list of terminal illnesses, said Bogdan Ivnescu,
General Manager of Stem Sure Solutions. There are already six companies operating on the
Romanian stem cell market, and most of them process and preserve samples abroad. The players on
the stem cell market are Cord Blood Center, Biogenis, Criosave, Stem Sure Solutions, and CMU
25
.
1.4 Similar Researches on Blood Stem Cell Donation
Since blood stem cell transplants are a novelty in medicine, there havent been made many
studies on the blood stem cell donation. In most countries in which these procedures are common,
the only studies published are concerned with statistics of those people who already donated and
with the adverse reactions or other symptoms that occurred after donations. However, there is shown
little interest at national and international level for the factors that influence people willingness to
donate and to register in a donors registry, which are essential for the future development of the
blood stem cell transplants worldwide.
Nevertheless, there are some non-governmental organizations (NGOs) which administer
local or national blood stem cells donor registries and which are interested in the results of such
studies. For this reason they order surveys for their own purposes and few make them available to
the public.
A NGO, Swiss Blood Stem Cells
26
, which has been running since 1988 the national donor
database and recruiting compatible donors in Switzerland and abroad, conducts periodically surveys
in Switzerland in order to improve their recruitment methods and reach more people with their
publicity campaigns, this way increasing the chances of saving lives. Moreover, the Swiss Blood
Stem Cells Foundation also publishes the results of the surveys in its Annual Reports
27
which are
available online on its website, thus making people aware of the current situation and of the steps
that must be done for a future development.
9
In Romania there havent been made any studies concerning this subject. Like it was
mentioned previously, in the spring of 2009, with the campaign We have life in our blood, PRO
TV News gathered signatures of people sustaining the creation of the national donors registry, but
there was no mention about these peoples willingness to donate or to become members of the
registry. Since the national registry has, at the moment, 754 members, which is a small number if we
consider the fact that Romania has about 22 million citizens and that the registry exists for more
than 10 months, we, as Romanians, must know which are the factors which influence our
willingness to donate blood stem cells and to become registered volunteer donors in order to find
solutions for increasing the numbers of donors and save lives.
The answers to the problems discussed previously will be further introduced and interpreted in
the present paper.
10
Quantitative Methods Used for Research
Chapter 2 presents the methods used in the research described in Chapter 3. Firstly, it
introduces the role of Statistics and survey in Business and Economics. Furthermore, in the first
section, it defines some key statistical terms and in the following sections it illustrates the steps of
data processing (collection, analysis, presentation, interpretation).
In todays global business and economic environment, anyone can access vast amounts of
statistical information (Anderson et al., 2007:4) and, by using it effectively, can transform this
information into a competitive advantage. According to professor Thai Hoang, Statistics is a
science that helps us make better decisions in Business and Economics as well as in other fields
28
.
This is the reason why todays business managers and professionals are, as professor
Arsham
29
sustains, increasingly required to justify decisions on the basis of data. Statistical concepts
and statistical thinking, being a useful management tool, enable managers to solve problems in a
diversity of contexts, add substance to decisions and reduce guesswork.
2.1 Basic Concepts of Statistics
In everyday usage, the term Statistics refers to numerical facts. However, the field of
Statistics is more complex. In a broad sense, Statistics is the art and science of collecting, analyzing,
presenting and interpreting data. Particularly, the information acquired through this process gives
managers and decision-makers a better understanding of the business and economic environment
(Anderson et al., 2007:2-5) and, by assessing all available information, both quantitative
(measurable) and qualitative (observable), and on the basis of their skills, knowledge and
experience, they make their final decisions (Waters, 2001:6).
Statistics, as a science, can be divided into two main categories, Descriptive Statistics and
Inferential Statistics. Descriptive Statistics is the process of obtaining meaningful information from
sets of numbers that are often too large to deal with directly. Inferential Statistics is the process of
using observations from a sample to estimate the properties of a large population (Downing &
Clark, 2003:2). Before enlarging upon this subject, there are some basic concepts of Statistics that
should be firstly understood.
11
First of all, it must be made the distinction between population and sample. The term
population refers to all the people or things that you are interested in, while a sample is a group
chosen from the population, with the same characteristics as the population. In order to avoid
inaccurate predictions, it is essential that the sample be representative of the population it is chosen
(Downing & Clark, 2003:2-4).
Furthermore, it is also important to know the meaning of some notions like the unit, the
variable and the indicator. The unit represents the basic element of the population. The variable is
the distinctive trait of the statistical unit - common feature to all the population units describing
each unit in a distinguished. The statistics (indicator) is the representative measure concerning a
statistical distribution for a sample, obtained using numerical calculus from a well and clear defined
formula (Mitrut & Serban, 2003:5).
In the following subchapters it will be presented each of the steps of statistical data
processing: collecting, analyzing, presenting and interpreting.
2.2 Data Collection and Presentation
Data collection procedure represents a necessary condition for a statistical research to
accomplish its goal and needs to be done previously to summarizing and analysis data. After
defining the statistical population, the units and variables, data collection principle is to reveal and
record the values and categories characterizing all the population units, called statistical data (Mitrut
& Serban, 2003:10).
Data of different types are collected in different ways. For this reason, before discussing the
methods of data collection, it is compulsory to start by describing the different types of data. Data
can be classified in several ways. The first classification defines data as qualitative and quantitative.
According to Wikipedia definitions, quantitative
30
data is a numerical measurement and can be
expressed in numbers, while qualitative
31
data cannot be measured and can be expressed by means
of natural language description.
An extension of this basic classification of data describes how well they can be measured.
This classifies data as nominal, ordinal and cardinal. Nominal data cannot be quantified with any
meaningful units. Ordinal data are one step more quantitative in that the categories into which
observations are divided can be ranked in some order. Cardinal data have some attributes which can
be directly measured and are generally the easiest to analyze and the most relevant to quantitative
12
methods. Cardinal data can be divided into two types on whether they are discrete or continuous
(Waters, 2001:64-66).
There is one more classification of data which is directly related to the method of collection:
primary data data that is obtained through statistical observation and it is used for the first time
and secondary data data from other sources (including banks of statistical data), data that are used
for the second time, at least (Mitrut & Serban, 2003:13).
There are several ways of collecting primary data, but mostly used is sampling. The purpose
of sampling is to get reliable results using a sample of the whole population. The main types of
samples are: simple random sampling, systematic sample, stratified sample, cluster sampling and
convenience sample. Once the researcher has decided on the sample, the next step is to collect data
(Mitrut & Serban, 2003:18-25; Waters, 2001:74). Methods to gather primary data can be personal
interviews, telephone interviews, mail surveys, computer direct surveys, e-mail surveys, web page
surveys and scanning questionnaires.
The first activity of a researcher, after collection, is to summarize the collected data. The
activity is redundant for the secondary data taking into account that secondary data is already
summarized and accessed as tables, distributions, and graphical displays. The purpose of the data
grouping and classification is to put in order massive sets of data in order to extract the pertinent
information describing numerically the data set. There are several useful techniques used for data
summarizing and classification. Among these techniques, the most commonly used are the
frequency distributions which can be obtained according to one or two variables. The frequency
distributions can be of various types: absolute frequency, relative frequency, cumulated frequency
(Mitrut & Serban, 2003:49-50).
After data collection and classification, the next step for statistical analysis is data
presentation. Good statistical presentations can provide a convincing means of communicating to
others the underlying message that is present in data. Graphical statistical methods have four
objectives: exploring the content of a data set, finding structure in data, checking assumptions in
statistical models and communicating the results of an analysis (Jacoby, 1997:2-4).
Forms of graphical data representation are pictograms, pie charts, histograms, bar charts,
time series plots and scatter plots. Pictograms are charts, which represent different magnitudes by
repeating or varying the size of symbols/pictures, which are easily identifiable by a non-expert
audience. The pie chart is an easy to understand diagram that is typically used to represent how a
total (the pie) has been divided into slices. A histogram is a graphical picture of a frequency
distribution where the relative differences in the areas of the rectangles correspond to relative
13
differences in the number of observations between different classes. The bar charts are variations of
histograms and are often used to illustrate data on the form of classes or categories of interest, the
time series plot is a graph of data that has been gathered over a period of time while the scatter plot
represent a two-dimensional graph of the ordered pairs of two variables. (Groebner et al, 1987:38-
45; Mitrut & Serban, 2003:58).
2.3 Data Analysis and Interpretation
2.3.1 Descriptive Statistics
Although frequency distributions and graphs are used in order to summarize data, sometimes
it is desirable to summarize further by using numbers to describe other properties of data.
Descriptive Statistics consists of data summarizing, presentation, tabulation, and displaying
followed by computation of the central tendency measures, analysis of data uniformity, consistency,
and symmetry interpretation (Mitrut & Serban, 2003:2-3).
The most important property of data is usually its central tendency, the score value on which
a distribution centers. In referring to the central tendency of a distribution, statisticians use the terms
of Mode, Mean and Median. The Mode is the score or qualitative category that occurs with the
greatest frequency. The most widely used and familiar measure of central tendency is the Arithmetic
Mean the sum of scores divided by the number of scores. The Median is that value splitting a
ranked data set in two equal parts, thus compared to the Median we will have half of the population
possessing the characteristic with a smaller value and the other half possessing the characteristic
larger than the Median value (Mitrut & Serban, 2003:106; Kirk, 2008:62-67).
Close behind central tendency importance is the phenomenon of dispersion, which is the
extent to which scores differ from one another. The measures of dispersion can be simple or
synthetic. The simple measures of dispersion are: the range, the inter-fractile range, the inter-quartile
range and the individual deviation.
The synthetic dispersion measures are evaluating the spread of the individual observations
around their Arithmetic Mean. The system of measures comprises: Mean Absolute Deviation,
variance, Standard Deviation and the coefficient of variation. The Mean Absolute Deviation shows
the average variation, both positive and negative variation, from the Arithmetic Mean. The variance
is computed as an Arithmetic Mean of the squared deviations from the Mean. The Standard
Deviation is the average difference of recorded data from the Mean. There are also other important
14
properties of data such as Skewness which tells whether a distribution is symmetrical or not.
Different categories of Skewness are: positive Skewness, which means that the frequencies are
concentrated around the small values of the recorded variable; and negative Skewness which
suggests that the frequencies are concentrated around the large values of the recorded variable
(Mitrut & Serban, 2003:108-121; Kirk, 2008:98-107).
2.3.2 Inferential Statistics
Inferential Statistics is a set of procedures used to make predictions about the whole
population by studying the properties of a population sample. Statistical inference is gathering the
set of methods allowing to: draw conclusions on a population based on the information
characterizing the sample, forecast the evolution of a phenomenon and characterize statistical
relations between variables (Mitrut & Serban, 2003:3).
Correlation and Regression Analysis
Researchers are not interested only in analyzing variables independently, but they also focus
on the relationship between them. There are, broadly speaking, two main types of relationships. In
the first one, which usually gives rise to a regression analysis, one of the variables is thought of as
being dependent on the other, the independent variable. In the second type of relationship, which
usually leads to the calculation of a correlation coefficient, neither of the variables can be singled
out as of prior importance to the other and one is interested in their interdependence rather than in
the dependence of one of them on the other.
The theory of regression has many points in common with that of correlation, although they
answer different questions. It is now recognized that regression techniques are more flexible and can
answer a wider range of questions than correlation techniques which are used less frequently than
they once were (Bulmer, 1979:209). Nevertheless, both of them will be further presented.
Regression is concerned with obtaining a mathematical function describing the statistical
relation between variables. If the relation is between one dependent and one independent variable
then we are in the case of a simple regression; if the statistical relation is between one dependent and
two or more independent variables then we are in the case of a multiple regression (Mitrut &
Serban, 2003:175).
According to the mathematical function modeling the relation between the variables can be
classified as linear or non-linear equations. However, in this paper, it will only be presented the
simple linear regression model, which is described by the following formula:
15
0 1

Y X = + - + , where: (1)
-

Y = the value of the dependent variable

- X = the value of the independent variable
-
0
= Y-intercept, indicates the mean value of Y when X is 0 (when the population could have
X values of 0)
-
1
= slope of the regression line, gives the average change in the dependant variable, Y, for
each unit change in X; the slope can be either positive or negative depending on the
relationship between X and Y
- = error variable (i.e., the difference between the actual Y value and the predicted value of
Y)
In order for the regression model to provide best estimators of the intercept and slope, the
assumptions on the model must be checked. These assumptions are: the mean value of y, given x, is
given by the linear regression, the regression model chosen is the best function providing the
smallest errors, the independent variables are not stochastic variables, for each value of x the
values of y are distributed around their mean with a constant variance:
2
var( ) y = , the value of y
are uncorrelated having zero covariance and thus no linear relationship: cov( , ) 0
i j
y y = , the
variable x must take at least two different values, so that x c = (where c is a constant) and the values
of the y are normally distributed about their mean for each value of x, so the dependent variable y is
normally distributed (Serban & Mitrut, 2007:108).
The estimators for the parameters of the regression line are obtained usually by using the
least square method. The properties of these estimators are: unbiased (the sample mean = the
population parameter), consistent and convergent, efficient (from two unbiased estimators, the most
efficient is the one with the smallest variance) and normally distributed if the random variable, error,
is normally distributed (Serban & Mitrut, 2007:109-111).
Researchers in the social sciences, business, policy studies and other areas rely heavily on
the use of linear regression analysis. This research tool is so common because it adds considerable
understanding of economic, political and social phenomena (Schroeder et al., 1986:7). In order to
evaluate the interdependence of two variables one must measure the degree of correlation between
this two. This can be made using the following indicators: covariance, coefficient of correlation and
coefficient of determination.
16
The particular descriptive statistic that measures the degree of linear association between two
variables is called correlation coefficient and is denoted by r. This coefficient, r, can range from -1,
meaning perfect negative correlation, to +1 which represents a perfect positive correlation. A low
correlation coefficient, somewhere near zero, does not always mean that there is no relationship between
the variables, but it suggests that there is no linear relationship between the variables while there could
be a non-linear one. The coefficient of determination expresses how much of total variation of the
dependent variable is explained by the independent variable. This coefficient is the square of the
correlation coefficient (Schroeder et al., 1986:25-26; Mitrut & Serban, 2003:198-200). It is
important to note that the linear regression, the correlation coefficient and the coefficient of
determination are all related but that they provide different amounts of information and are based on
different assumptions (Schroeder et al., 1986:28).
Estimation
The object of this branch of Inferential Statistics is to estimate population values or
parameters from Statistics computed from samples. There are two kinds of estimation procedures
point estimation and interval estimation. Estimates may take the form of a single number, called
point estimate, or an interval of values, called interval estimate (Healey, 2005:165). First, a point
estimate of a parameter is a statistic, a single value computed from the observations in a sample that
is used to estimate the value of the target parameter
32
. Secondly, an interval estimate is an interval
that provides an upper and lower boundary for a specific population parameter whose value is
unknown. This interval estimate has an associated degree of confidence of containing the population
parameter possible values within a class. Such interval estimates are called confidence intervals and
are calculated for random sample parameters (Serban & Mitrut, 2007:39).
Both point and interval estimation procedures are based on sample Statistics and in order to
decide which of them should be used two criteria must be considered: bias and variance. Estimators
should be based on sample Statistics that are unbiased and relatively efficient. An estimator is
unbiased if and only if the Mean of its sampling distribution is equal to the population value of
interest. Sample proportions are also unbiased. All statistics other than sample means and
proportions are biased. Knowing that sample means and proportions are unbiased allows
determining the probability that they lie within a given distance of the population values that are
being estimated (Healey, 2005:166). The best estimator tends closest to the population parameter
that is estimated. Since closeness is often evaluated using measures of Standard Deviation, or
variance, the best estimator is often considered to be the estimator that has the smallest variance
17
associated with its sampling distribution. Such estimators are called minimum variance unbiased
estimators (Serban & Mitrut, 2007:44).
The procedures for constructing these two estimates are different. The procedure for
constructing a point estimate is straightforward. After computing either the proportion or the Mean,
it is made the estimation of the population parameter as being the same as the sample statistic.
Compared to point estimates, interval estimates are more complicated but safer. The first step in
constructing an interval estimate is to decide on the risk of being wrong assumed. An interval
estimate is wrong if it does not include the population parameter. This probability error is called
alpha (symbolized ). The exact value of alpha will depend on the nature of the research situation,
but a 0.05 probability is commonly used. Setting alpha equal to 0.05, also called using the 95%
confidence level, means that over the long run the researcher is willing to be wrong only 5%of the
time. The second step is to picture the sampling distribution, divide the probability of error equally
into the upper and lower tails of the distribution, and then find the corresponding Z score (Healey,
2005:169-171). The third step is to actually construct the confidence interval. The formula for
constructing a confidence interval based on sample means is:
. . c i X Z
N
,
= :


(2)
where c.i.= confidence interval
X = the sample Mean
Z= the Z score as determined by the alpha level
N

= the Standard Deviation of the sampling distribution (the standard error of the Mean)
Point estimates are useful, but interval estimates supply the researcher with more
information. A point estimate does not indicate how much uncertainty might be associated with the
estimate. An interval estimator provides the upper and lower boundary for the population parameter
based on sample statistics. The resulting interval is referred to as a confidence interval because of
the existence of an associated level of confidence that accompanies the interval. Therefore, when a
90% confidence interval is computed from sample data, one can never be certain that the interval
actually contains the population Mean and must express this uncertainty as follows: You can be
90% confident that the confidence interval contains
0
X (Serban & Mitrut, 2007:42-49).
18
Hypothesis Testing
A foremost statistical mechanism for decision making is the hypothesis test. The concept of
hypothesis testing lies at the heart of Inferential Statistics, and the use of Statistics to prove or
disprove claims hinges to it. With hypothesis testing, business researches are able to structure
problems in such a way that they can use statistical evidence to test various theories about business
phenomena. In searching for answers to questions and in attempting to find explanations for
business phenomena, business researchers often develop hypotheses that can be studied and
explored (Black, 2010:290).
Hypothesis testing is useful in situations in which researchers are interested in making a
decision about a parameter value, rather than obtaining an estimate of its value
33
. All statistical
hypotheses consist of two parts, a null hypothesis and an alternative hypothesis. These two parts are
constructed to contain all possible outcomes of the experiment or study. First, the investigator forms
the alternative hypothesis (
1
H in notation) that states an expectation to be tested. Then he derives
the null hypothesis (
0
H in notation) that is the opposite of the alternative hypothesis. It is the null
hypothesis that is actually tested, not the alternative one. If the null hypothesis can be rejected, than
it is taken as evidence in favor of the alternative hypothesis. Because individual tests are rarely
conclusive, it is usually not said that research hypothesis has been proved, but only that it has been
supported (Voelker et al., 2001:62; Black, 2010:292).
Statistical hypotheses are written so that they will produce either a one-tailed or a two-tailed
test. Two-tailed tests always use = and in the statistical hypotheses and are directionless in that the
alternative hypothesis allows for either the greater than (>) or less than (<) possibility. One-tailed
tests are always directional, and the alternative hypothesis uses either the greater than (>) or the less
than (<) sign (Black, 2010:293). The decision of whether to use a one-tailed or a two-tailed test is
important because a test statistic that falls in the region of rejection in a one-tailed test may not do so
in a two-tailed test, even though both test use the same probability level (Voelker et al., 2001:67).
The hypothesis can be verified through a statistical test which will help take the decision of
accepting or rejecting the hypothesis. Only two outcomes of a hypothesis test are possible: either the
null hypothesis is rejected, or it is not.
However, because hypothesis test are based on sample information, it exists the possibility of
errors. Table 2.1 illustrates the two kinds of errors that can be made in hypothesis testing.
19
Table 2.1. Types of errors
Type of decision
0
H true
0
H false
Reject
0
H Type I error ( ) Correct decision (1- )
Accept
0
H Correct decision (1- ) Type II error ( )
If on the basis of the data survey the null hypothesis is rejected even though in reality this is
true, then we say that it was an error of first level (type I error), and when the null hypothesis is
accepted although in reality is false, an error of second level (type II error) is made (Serban &
Mitrut, 2007:66). The probability of committing a type I error is denoted by while the probability
of committing a type II error is denoted by .
According to professors Quang and Hong
34
, in order to arrive at a decision in a hypothesis
testing situation there are some steps that must be followed. The first step is to obtain a random
sample from the population of interest. The second step is to determine a test statistic that is
reasonable in the context of a given hypothesis test. The standard test static can be computed using
the formula:
Standard test statistic = sample statistic- hypothesized parameter value (3)
standard error of the statistic
The third is to specify the rejection region, the range of possible computed values of the test
statistic for which the null hypothesis will be rejected. The location of the rejection region depends
on whether the test is one-tailed or two-tailed, and on the pre-specified significance level, . The
forth is to use the data in the sample to compute the value of the statistic. The fifth is to observe
whether the computed value of the test statistic lies or not within the rejection region.
There are two approaches for testing hypotheses, p-value approach and critical approach. In
the present paper, it will only be used the p-value approach. The p-value is a probability, computed
using the test of statistic, that measures the support (or lack of support) provided by the sample for
the null hypothesis, and is the basis to determine whether the null hypothesis should be rejected
given the level of significance. A small p-value indicates a sample result that is unusual given the
assumption that
0
H is true. Small p-values lead to the rejection of
0
H whereas large p-values
indicate the null hypothesis should not be rejected (Anderson, 2007:298).
20
III. Case Study Research on Stem Cell Donation in Romania
Chapter 3 presents the case study research, the analysis of the blood stem cell donation in
Romania, which will be done by following the next steps: define the research questions, determine
data gathering and analysis techniques, collect and prepare data in the field, evaluate and analyze
the data, present the results.
3.1 Purpose of the Research
The main purpose of the research is to determine the factors that influence Romanians
willingness to donate blood stem cells and to register in a volunteer donor registry in order to
develop some recommendations for the already established registry of the Health Ministry or to
highlight the existence of a window of opportunity for creating a NGO to administer such a registry.
Thus, the objectives of this research are: to discover the most important factors which
determine Romanians to donate stem cells, to compare these results with those offered by the Swiss
Blood Stem Cells Foundation in their Annual Report for 2008, to determine the marketing mix
which will increase Romanians awareness of this type of procedure and its benefits, and to provide
recommendations for a good management of a national blood stem cells volunteer donors registry.
The research question that focuses on the most important aspect of the topic is: What are the
factors that make the development of the volunteer stem cell donor registry most favorable?.
The hypothesis, the possible answer to the research question, is: The factors most favorable
for the development of the donor registry are Romanians awareness of the donation procedure and
its significance at international level, and their willingness to donate.
The object of the research is the current situation of stem cell donations in Romania. In the
investigation process, since there were few secondary data sources, primary data was collected. The
methods of data collection used were personal interview and online survey in order to get data for
the analysis from respondents who reside in different parts of the country. The subject of the
research consists of the adult male and female citizens of Romania who live on the territory of our
country, both in urban and rural areas. The statistical unit for the research is the individual. The
survey was conducted on a sample of 325 persons in the period January February 2010.
Concerning the recording method, the information collection was done through a
questionnaire because it is one of the fundamental techniques used in a research, being easy to
21
compile and answer. The annexed questionnaire (Appendix 3) was delivered to the respondent in
two different ways. Firstly it was used the personal interview because the interviewer has the
possibility to check that the respondent fills correctly the questionnaire and give explanations in case
of misunderstandings. However, because through the personal interview it is difficult to reach
people from the entire country and since one of the purposes of the survey was to get answers from
many parts of Romania in order to see if there is a correlation between the area of living and the
tendency of the respondent towards a certain answer, it was also used the online survey, which
helped the interviewer to reach all the target respondents.
The questionnaire contains twenty questions, all of them being compulsory except the first
one, the name of the respondent. This question was included because it showed the commitment of
the respondent to his answers, meaning that if, for example, he sustains that it is willing to donate or
become a volunteer donor, by giving his name or a contact address or telephone number instead, he
can further be invited to register.
The other questions can be classified in four categories. Firstly, there are the demographic
questions as, for example, age, sex, profession, studies and place of living. The next questions are
related to respondents knowledge of notions such as blood stem cells and the availability of
procedures of blood stem cells donation and conservation in Romania. Then, the respondent is asked
to state if he donated blood, if he is willing to donate blood stem cells or bone marrow and which are
the motivators that would determine him to donate. Finally, he is asked to indicate if he is aware of
the existence of the national volunteer stem cell donor registry in Romania, if he wishes to register
as a donor and who should, in his opinion, administer such a registry.
All the variables from the questionnaire are important, because, by processing and
interpreting them, it helps reach the objectives of the research.
The answers were centralized in a database and were analyzed using a statistical computer
program.
In order to get a complete understanding of the results of the survey, the variables were
analyzed individually, one by one, being firstly classified and presented. Then, the relationships that
appeared between them were interpreted and in the end the hypothesis were tested. All these steps
are presented in the following sections.
22
3.2 Sample Profile
Demographic inquiries offer a clear image of the respondent and help making the profile of
the potential volunteer blood stem cell donor. The set of variables used for defining the sample were
age, sex, education, profession and place of residence.
The average age of the typical person interviewed is 34.92 years, the ages varying from 18 to
59 years (see Table 3.1) with a coefficient of variation of 0.34 and a Standard Deviation of 12.02
years. This shows a medium homogeneity of ages and the fact that the arithmetic Mean is
representative for the set of respondents. The median age is 32 years, thus half of the persons
interviewed are less than 32 years old, while the most frequent age is 21 years. The Skewness
coefficient is 0.38, a positive Skewness of the frequency distribution, meaning that there are mostly
small ages in the sample.
Table 3.1. Distribution of ages
Age
N Valid 325
Missing 0
Mean 34,92
Median 32,00
Mode 21
Std. Deviation 12,021
Variance 144,500
Skewness ,429
Std. Error of Skewness ,135
Minimum 18
Maximum 59
Out of the 325 respondents, there are 55.7% females and 44.3% males (see Appendix 4.
Figure 1). This information is useful in order to see the choices of respondents according to their
gender, which will be further analyzed in the next section.
The level of education can be also an important and significant influencing factor of the
respondents willingness to donate. It is essential to observe how strong this relationship is. Most
respondents have graduate studies (41.2%), being followed by those who graduated high school
(34.2%) and those who have also a postgraduate degree (24.3%). One person has only graduated
secondary school and represents 0.3% of the sample (Appendix 4. Table 1).
23
With respect to the profession of the persons interviewed, although the respondents gave
their precise jobs, in order to better classify the information, their answers were grouped in four
categories: student, employed, unemployed and pensioner. Therefore, in the sample, the majority
(74.8%) are employed, 20.3% are students, while less than 5% are unemployed or pensioners
(Appendix 4. Figure 2).
For the place of residence, even though the respondents named the town in which they live,
the places were grouped, depending on the region of Romania in which they were found, in west,
south, east and center. According to this classification, most respondents (74.2%) reside in the south
of Romania, being followed by those who live in the east (13.5%), in the center (8%) and in the west
(4.3%) (see Appendix 4. Table 2). Studies made by stem cell donor registries administrators from
abroad show that there are differences in people willingness to donate blood stem cells according to
the place where they live, a fact which will be also discussed in the present paper.
3.3 Data Analysis
After answering to the demographic questions, the respondents had to prove their knowledge
about stem cell donation. To the question if they know the meaning of blood stem cell donation or
if they have ever heard this expression, 84% of the respondents gave positive answers and 9.8%
answered negatively. Only 6.2% said that they are not sure if they know or not the meaning of this
expression (see Appendix 5. Figure 1). In a study conducted by Swiss Blood Stem Cells Foundation
in 2008 (see Appendix 5. Figure 2), only about 70% of the respondents were confident about
knowing the meaning of blood stem cell donation, which shows that, in comparison with the
Swiss, Romanians have a better understanding of what this expression stands for.
The next requirement for the respondents was to relate the term blood stem cell donation
with one of the following blood donation, leukemia patients, cloning embryos or sperm donation.
53.5% of the respondents were sure that this term can be related to leukemia patients, 37.8% thought
that it is similar to blood donation, while 8.3% sustained that it relates to cloning embryos and 0.3%
correlated it to sperm donation (see Appendix 5. Table 1). In comparison with the results of the
Swiss Blood Stem Cells Foundation study of 2008, Romanians are more aware of the relationship
between leukemia patients and the treatment to their illness, blood stem cell donation, since less than
40% of the Swiss respondents gave this answer (see Appendix 5. Figure 3).
Furthermore, the respondents had to state if they noticed any publicity for donating blood
stem cells or bone marrow. This question was created to see if the publicity campaigns conducted by
24
PROTV News and other organizations or individuals to determine Romanian people to donate and
register as volunteer donors were successful. The answers were 53.2% positive, 37.8% negative and
8.9% preferred to say that they do not know (see Appendix 5. Figure 4). It must be pointed out that
this survey was done few months after the launching of the national volunteer stem cell donor
registry in Romania so the promotion of the registry and of the procedure in general should have
been very strong in the previous months. The same question was addressed to the Swiss people in
2008, when less than 20% of the respondents said that they noticed such publicity campaigns.
Therefore, it can be concluded that either the Romanians are more receptive to advertisements or the
publicity campaigns were very well conducted in Romania (Appendix 5. Figure 5).
Regarding the previous question, those who answered positively were further required to
mention through which channel of distribution they received this information. 69.5% of the
respondents who noticed publicity campaigns said that they were delivered through television. This
shows the great effect of the social campaign We have life in our blood of PROTV News because
it was the only campaign of this procedure conducted on television. Moreover, 20.7% of the
respondents observed such campaigns on the internet, equally 3.4% noticed promotions in specialty
magazines or received flyers with this information, while 2.9% read about it in newspapers (see
Appendix 5. Table 2).
Although most of the respondents knew what blood stem cell donation is and what it is used
for, they did not know if such transplants can be done in Romania. 44.9% of the persons interviewed
expressed their uncertainty concerning the possibility of doing this procedure in our country and
18.5% were sure that this type of transplant cannot be done in Romania. Only 36.6% of the
respondents were sure that blood stem cell transplants are done here (see Appendix 5. Figure 6).
These results are unsatisfactory if it is considered the fact that these procedures are done in Romania
for almost 10 years in hospitals from different regions of the country and helped saving hundreds of
lives in this period.
Moreover, the Romanians proved to be skeptical also about the existence of stem cell banks
on the territory of the country, the percentages of the answers being similar to those expressed for
the previous question (see Appendix 5. Table 3). This way they seem to ignore the stem cell market
which has developed in the last years in Romania, even though the six big players on the market
conduct impressive advertising campaigns for umbilical cord blood harvesting.
Studies show that few Romanians donate blood
35
. It is approximated that less than 2%
Romanians are donating blood, a percentage below that of many European countries. In the present
survey, 34.2% of the respondents said that they have donated blood thus far, a value which is much
25
grater than the statistics at national level (see Appendix 5. Table 4). This difference can be explained
by the fact that most respondents are young, educated, and live in urban areas, thus they are more
aware of the need of blood in Romanian hospitals and are more willing to donate.
Furthermore, the respondents expressed their readiness to donate blood stem cells with a
majority of 53.2%. Some (31.7%) expressed their indecision whether to donate or not and 15.1%
were sure that they do not wish to donate stem cells from peripheral blood (see Appendix 5. Figure
7). The percentages were not the same for bone marrow donation since few respondents (22.8%)
were willing to donate bone marrow, while most of them (48.6%) were unsure. The rest (28.6%)
expressed their decision of not to donate bone marrow (see Appendix 5. Figure 8). It is easy to
understand that the difference between the willingness to donate blood stem cells and bone marrow
is made by the risks and side effects related to each procedure.
Another important issue associated with blood stem cell donation is represented by the
factors which may determine individuals to donate. When the respondents were asked about the
purposes for which they would donate, they oscillated between two answers, the need of transplant
of someone beloved and saving lives (see Appendix 5. Table 5). Therefore, 47.7% of the persons
interviewed expressed their willingness to donate in order to save lives in general, while 46.2% said
that they will donate only for saving the life of a relative, the difference between these options being
made by only 5 persons. The rest chose to answer that they need material rewards (2.8% - 9 persons)
for donating blood stem cells or that they have other motivators (3.4% - 11 persons). This shows that
there are many caring Romanians who think about the well-being of those around them and who
would do everything that is in their power to help them fight against such a terrible disease as
leukemia.
Before asking the respondents to express their willingness to register into a national
volunteer stem cell donor registry, they were questioned if they are aware of the existence of an
international and of a national donor registry. For both questions, the persons interviewed preferred
to say that they do not know if these registries exist or not (50.8% do not know answers for the
international registry and 69.8% for the national registry). Almost half, 46.5%, of the respondents
were sure that an international registry exists, while only 15.7% considered that there is a national
registry in Romania. The others thought that there are not such registries either in Romania or in the
rest of the world (see Appendix 5. Figure 9). The answers for these two questions are in accordance
with the overall tendency of the respondents to ignore the realization of blood stem donations and all
the other procedures related to them in Romania. Even though they seemed more confident about
26
the existence of the international registry than of the national one, this was not due to their
knowledge but to the fact that they were expecting it to exist.
Nevertheless, to the question If in Romania there were such a registry, would you register
as a volunteer donor?, most respondents (45.8% - 149 persons) expressed their willingness to
register as volunteer donors and many (41.8% - 136 persons) were not sure of their choice (see
Appendix 5. Table 6). There were 40 persons (12.3%) in the sample who stated their preference of
not to register in a national donor registry. The results can be seen as positive considering the fact
that the respondents do not know much about what such a registry does and what being a volunteer
donor would imply.
Finally, the persons interviewed chose the institution which, in their opinion, should
administer a national volunteer stem cell donor registry. The majority (58.2%) voted in favor of the
Health Ministry, being followed by those (30.8%) who sustained a non-governmental organization.
Few considered that a public hospital (2.5% of the votes) or a private clinic (8.6%) should
administer this registry (Appendix 5. Figure 10). Thus, it can be observed that the Romanians still
confide in the national agencies for entrusting them the administration of the registry, yet consider
appropriate also the establishment of a NGO to take over this responsibility.
3.4 Relationship between Variables
Although many relationships can be established among the variables of this survey, for the
purpose of the current paper, there will be laid great emphasis on the effects of publicity campaigns
on the overall development of blood stem cell donation in Romania and on the factors which
influence Romanians willingness to donate and register as volunteer donors.
3.4.1 Influencing Factors of Romanians Willingness to Donate Stem Cells
External and internal factors have been identified to influence Romanians willingness to
donate stem cells. The first to be presented are the external factors.
Being very similar to the procedure of donating blood, it is expected that a person who has
already donated blood to be more willing to donate blood stem cells. However, according to their
responses, only 2.2% Romanians wish to donate blood stem cells because they have donated blood
before (see Appendix 6. Table 1). Since, for the moment, few Romanians donate blood and fewer
donate stem cells, it is difficult to observe a connection between these two procedures.
27
Romanians decision to donate is determined firstly by their knowledge about what this
procedure means, a fact shown in Figure 3.1:
Figure 3.1 Distribution of responses according to the understanding of the expression blood stem
cell donation
Since any human being is afraid of the unknown, it is normal that the respondents express their
unwillingness to donate when they do not know what this procedure means. While they become aware
of what blood stem cell donation implies, their interest for donating increases.
A similar trend can be observed in the relationship between knowledge about the stem cell
market in Romania and the respondents willingness to donate (see Appendix 6. Figure 1). Those who
know about the realization of stem cell transplants in this country and that there are several stem cell
banks here, are surer that they wish to donate blood stem cells.
Having more information about the stem cell industry worldwide and about its evolution in
Romania, makes the respondents confide in the procedure of blood stem donation and determines
them to express their willingness to donate. This is the effect of the publicity campaigns, their
influence following the same trend with the information they provide (see Appendix 6. Figure 2).
The factors presented above are influencing not only the blood stem cell donations but also the
bone marrow donations. Having more information about the way this transplant is done, its usefulness
and implications increases the number of those who express their readiness to donate bone marrow.
28
In the present context, 6.5% of Romanians willingness to donate bone marrow is explained by
their knowledge about the realization of stem cell transplants on the territory of the country (see
Appendix 6. Table 1). However, in comparison with the influence they have on blood stem cell
donations, publicity campaigns have a less powerful influence upon bone marrow donations. This is
due to the fact that the advertisements made recently were focusing mostly on determining people to
donate peripheral blood stem cells and encouraged the establishment of the national volunteer donor
registry.
Regarding the internal factors, the first to be discussed is the age. The most willing to donate
blood stem cells are the respondents with ages varying from 18 to 35 years old (see Appendix 6.
Figure 3). This can be attributed to the fact that they have more access to information, spending a lot
of time on the internet, or that they are more adventurous and dont think about the risks of such a
procedure, putting great emphasis on the value of their deed.
Secondly, more women than men are ready to donate blood stem cells (see Appendix 6.
Figure 4). Women are known to be emotive and sensitive to the problems of others and this is why,
when it comes to saving lives, they are more inclined to offer their help.
Another internal factor can be considered the level of education. According to the
distribution of their answers, the respondents who have graduated higher levels of education are
more willing to donate blood stem cells (see Appendix 6. Figure 5). They are more aware of the
developments made in medicine and technology and trust these new procedures of transplant.
Moreover, most of the respondents who are willing to donate are employed (see Appendix 6.
Table 2), this fact sustaining their affirmation that their readiness to donate has nothing to do with
receiving material rewards.
The last internal factor, which many stem cell donor registries administrators consider to be
important is the region in which the potential donor resides. The place of residence is believed to be
an influencing factor because there is a similar trend in the responses of people who live in the same
area. In the present survey, the percentage of those willing to donate blood stem cells was greater
than of those unwilling to donate in the western and in the eastern regions of Romania. In the south
dominated those who did not wish to donate and in the central region of the country, most
respondents preferred to say that they are not sure whether to donate or not (see Appendix 6. Figure
6). These results can be attributed to the fact that people from the western region are more familiar
with the occidental ideas, while those from the eastern region are more religious and the Christian
will of helping those in need is greater than their fear of risking their on health.
29
The internal influencing factors of Romanians willingness to donate bone marrow are not the
same with those to donate blood stem cells. First of all, the age of those most willing to donate bone
marrow is between 36 and 55 years old (see Appendix 6. Figure 7). The change appeared because
this procedure is more complicated than that of donating blood stem cells and implies more
commitment from the part of the donor, a fact that a mature person is more willing to do than a
younger one.
However, the distribution of answers concerning respondents willingness to donate bone
marrow remains the same as for donating blood stem cell according to the gender of the person
interviewed (see Appendix 6. Table 3), the reasons being similar.
Nevertheless, when considering education as an influencing factor, in the case of donating
bone marrow, only those who have post-graduate studies are more willing to donate (see Appendix
6. Figure 8). As for the age, having a post-graduate degree implies a higher level of knowledge and
maturity which is proven by the acceptance of donating while ignoring the possible side effects for
a noble cause.
A similarity in the responses concerning the willingness to donate blood stem cells and bone
marrow of the persons interviewed can be also observed while considering the profession as an
influencing factor. Those employed, are, by far, more interested in donating bone marrow, proving
again that the reasons for donating are honorable (see Appendix 6. Figure 9).
Finally, in what concerns the regions in which the respondents reside, those more willing to
donate bone marrow live in the western and central regions of Romania (see Appendix 6. Table 4).
Their choices are explained, like for blood stem cell donation, by the occidental influences of
mentality, people from these regions being more opened to experiment new technologies, mostly
when it comes to saving people lives.
3.4.2 Influencing Factors of Romanians Willingness to Register as Donors
Wanting to donate stem cells does not automatically mean registering as a volunteer donor.
For this reason, it will be further analyzed the factors which determine people to become members
of a national volunteer stem cell donor registry.
Although it is not the only, the willingness to donate blood stem cells is one of the most
influencing factors when it comes to the respondents readiness to register as volunteer donors.
Taking into account the value of the coefficient of correlation, r = 0.646 (significant at the 0.01
level), there is a medium to high linear correlation between these two variables, having enough
evidence that this is a true relationship (see Appendix 7. Table 1). Moreover, the coefficient of
30
determination being 0.417, it means that 41.7% of variance in respondents willingness to register as
donors can be explained by the variance in their wish to donate blood stem cells (see Appendix 7.
Table 2).
Table 3.2. Coefficients of regression
Model
Unstandardized Coefficients
Standardized
Coefficients
T Sig. B Std. Error Beta
1 (Constant) ,105 ,033 3,207 ,001
Are you willing to donate
blood stem cells?
,603 ,040 ,646 15,208 ,000
Dependent Variable: If in Romania there were such a registry, would you register as a volunteer donor?
According to the data provided in Table 2, the stochastic relation between the willingness to
donate blood stem cells and to register as a volunteer donor can be defined as y=0.105 + 0.603*x
(Formula 1). The intercept 0.105 shows the disposition to register of a person if not dependent on her
wish to donate blood stem cells. Being close to 0 it means that, regardless of the readiness to donate
blood stem cells, a person is not sure whether to register or not in a volunteer donor registry. The
slope 0.603 expresses the average change in willingness to register for a change in willingness to
donate. Being positive, it shows a direct relation between these two variables. Thus, for every unit
increase in disposition to donate blood stem cells, there will be a 0.603 increase in readiness to
register as volunteer donor.
Another important influencing factor is people willingness to donate bone marrow. This fact
is proven by the value of the coefficient of correlation, r = 0.424 (significant at the 0.01 level),
which means that there is a medium correlation between these two variables (see Appendix 7. Table
3). Furthermore, the coefficient of determination equals 0.179 which means that 17.9% of variation
in respondents willingness to register as donors can be explained by the variation in their
disposition to donate bone marrow (see Appendix 7. Table 4). For sampling data, the linear
stochastic relation between the willingness to donate bone marrow and the wish to register as a
volunteer stem cell donor is y=0.359 + 0.406*x (see Appendix 7. Table 5). The intercept 0.359
shows the willingness to register of a person as donor if not depending on her disposition to donate
bone marrow. Being close to 0 it means that, regardless of the readiness to donate bone marrow, a
person does not know whether to register or not in a volunteer stem cell donor registry. The slope
31
being 0.406 shows the average change in willingness to register for a change in disposition to donate
bone marrow. Since it is a positive value, it defines a direct relationship between these two
variables. Therefore, for every unit increase in willingness to donate bone marrow, there will be a
0.406 increase in readiness to register as volunteer stem cell donor.
Having a good motivator can be also considered an influencing factor. From the distribution
of responses regarding the respondents willingness to become volunteer stem cell donors according
to their motivators, it can easily be seen that 66.5% of the persons interviewed who considered that
saving lives would be their motivator are willing to become volunteer donors (see Appendix 7.
Table 6). Those motivated by the need of transplant of someone beloved expressed their uncertainty
of whether to register or not, which is logical considering the fact that if you want to save the life of
a relative you do not have to be a volunteer donor. Being a member of such a registry implies your
availability to donate for curing anyone who matches your HLA type, this is why a good motivator
for registering in a volunteer donor registry is saving lives in general.
Other influencing factors, but not so valuable as those already presented, are the knowledge
about the existence of an international volunteer donor registry and of a national registry. The
correlation is stronger in the case of the international volunteer stem cell donor registry. The
coefficient of correlation is 0.24 which means that there is a weak positive linear correlation,
therefore those who know about the existence of such an international registry have a greater
tendency to register in a national one (see Appendix 7. Table 7). In what concerns the relationship
between the knowledge about the existence of the Romanian volunteer stem cell donor registry and
the respondents willingness to register, the coefficient of correlation (r = .177) shows also a weak
positive linear correlation, which means that having this information could have a small influence on
the respondents readiness to register in the national registry.
3.4.3 Effects of Publicity Campaigns
The results of the publicity campaigns which were conducted prior to the realization of the
survey can be interpreted as the difference in knowledge about stem cell donation of those who have
and those who have not noticed these promotions.
First of all, there is a weak positive linear correlation (r = 0.225, significant at 0.01 level)
between the observation of publicity campaigns and understanding the meaning of blood stem cell
donation (see Appendix 8. Table 1). The same level of weak positive correlation is kept for the
relationship between noticing these advertisements and both knowing if stem cells transplants are
done in Romania and if there are stem cell banks in this country (see Appendix 8. Table 2 and Table
32
3). Therefore, it can be concluded that, even though, most Romanians did not acknowledge the
existence of blood stem cell donations in this country through publicity campaigns, their awareness
increased because of them.
Moreover, similar values of correlation are also determined between peoples observation of
these promotions and their knowledge about the existence of an international and a national
volunteer stem cell donor registry (see Appendix 8. Table 4). This is due to the fact that the purpose
of the most aggressive publicity campaign made so far was the establishment of the national donor
registry, this being the reason why it mostly publicized the utility of donor registries at national and
international level.
Furthermore, the effect of these publicity campaigns is seen in the influence they have upon
the respondents willingness to donate blood stem cells and to register in the national volunteer
donor registry. The first relationship is described by a coefficient of correlation of 0.169, while the
second by a coefficient of correlation of 0.187, both showing weak positive linear correlations,
meaning that peoples decisions to donate or to register are slightly influenced by these publicity
campaigns (see Appendix 8. Table 5).
Another important effect, which can be attributed mostly to the publicity campaign
conducted by ProTV News, was to determine Romanians to sustain the Health Ministry as
administrator of the national volunteer stem cell donor registry. 86 respondents out of the 121 who
declared that they have watched promotions for blood stem cell donation on television stated that
they prefer the Health Ministry to be the administrator (see Appendix 8. Table 6).
It can be concluded that these positive relations prove the effectiveness of the publicity
campaigns conducted lately in Romania and may be considered an encouragement to continue this
activity on the long term.
3.5 Hypothesis Testing. Confidence Intervals
In order to draw conclusions about the factors which influence Romanians willingness to
register in a national volunteer stem cell donor registry, several hypotheses have been tested by
using statistical tests.
The first hypothesis is that there is no relationship between Romanians willingness to register
in the national volunteer stem cell donor registry and their knowledge about the meaning of blood
stem cell donation. The statements are:
0
H : = 0 (There is no actual correlation)
33
1
: 0 H = (There is a correlation)
For testing this hypothesis, it is used the p-value method. Since p equals 0.000 ( 0.01 p s ), it
means that the null hypothesis is rejected and that you can be 99% confident that there is a
correlation between these two variables (see Appendix 9. Table 1). It can be concluded that the
research hypothesis was supported and that Romanians willingness to register as volunteer stem cell
donors can be related to their knowledge about the meaning of blood stem cell
donation, (325) .268, 0.01 r p = s . This relationship proves the fact that increasing people awareness
of what the blood stem cell donation procedure implies could determine more Romanians to express
their willingness to donate and to register as volunteer donors.
Since the information that Romanians have about stem cell donations could have been
acquired because of their eager to know more about the subject or because this subject was
publicized in such a way that they received it whether they wanted or not, it is important to know if
the publicity campaigns conducted so far had any influence on people willingness to register.
Therefore, the second hypothesis tested is that there is no relationship between Romanians readiness
to register in the national registry and the publicity campaigns that were conducted prior to the
established of this registry. The assumptions are:
0
H : = 0 (There is no actual correlation)
1
: 0 H = (There is a correlation)
The p-value method is also used for this test. The p-value is 0.001 ( 0.01 p s ), thus the null
hypothesis is rejected and you can be 99% confident that there is a significant correlation between
these two variables (see Appendix 48). The conclusion is that the research hypothesis was supported
and that Romanians willingness to register as volunteer stem cell donors can be related to publicity
campaigns, (325) .187, 0.01 r p = s .
This relationship highlights the fact that publicity campaigns are an influencing factor of
Romanians willingness to register as volunteer donors, therefore a public information campaign
conducted at national level can have great results on the future development of the national
volunteer stem cell donor registry.
Another hypothesis to be tested claims that there is no relationship between the willingness
to donate blood stem cells and the readiness to register as volunteer donor. The suppositions are:
0
H : = 0 (There is no actual relationship)
1
: 0 H = (There is a relationship)
34
As it can be seen in Figure 3.2, the chi-square test shows that there is a connection between
these two variables because the significance level is below 0.01, meaning that the initial assumption
is rejected.
Table 3.3. Chi-Square Tests
Value Df Asymp. Sig. (2-sided)
Pearson Chi-Square 180,322
a
4 ,000
Likelihood Ratio 172,815 4 ,000
Linear-by-Linear Association 135,193 1 ,000
N of Valid Cases 325
a. 0 cells (,0%) have expected count less than 5. The minimum expected count is 6,03.
Thus, you can be 99% confident that a person who wishes to donate blood stem cells has a
greater tendency to accept to register in the national donor registry than one who does not want to
donate. It is normal for a person who is willing to donate blood stem cells to agree also to be a
member of such a registry because this means a more fruitful use of his disposition through offering
more chances to those in need to find a matched donor.
The same assumption can be made for the relationship between the respondents willingness
to donate bone marrow and their readiness to register as volunteer donors. However, the statistical
tests prove that there is a significant correlation between these two variables, this way rejecting the
null hypothesis. Having a p-value of .000 which is a very low significance value, it is possible to
conclude that there is a highly significant relationship between the willingness to donate bone
marrow and the disposition to become a volunteer donor (see Appendix 39). The explanation is, like
in the previous case, the donors wish to make the process of finding a HLA typed matched
unrelated donor more effective in Romania.
Therefore, by testing the above hypotheses, the following conclusion was reached. There is
enough evidence to state that there is a highly significant relationship between registering as a
volunteer donor and such influencing factors as knowledge about the meaning of the donation
procedure, publicity campaigns, willingness to donate blood stem cells and readiness to donate bone
marrow.
It must be understood that in order to develop the national volunteer stem cell donor registry,
considerable emphasis must be placed on these influencing factors since their change to better or
worse has effects upon people willingness to register as volunteer donors.
35
Conclusions and Recommendations
The purpose of this paper is to perform an analysis of the factors which determine the
development of the national volunteer stem cell donor registry in Romania. Through this research
several influencing factors were identified, among which the most important can be considered
knowledge about the stem cell donation procedure, publicity campaigns and willingness to donate
stem cells in order to save lives, in general.
Most respondents declared to have knowledge about the meaning of stem cell donation and
the majority was also able to link this procedure with the most common illness which these
transplants can cure, leukemia. These answers, in comparison with the results of a similar survey
done in Switzerland by the Swiss Blood Stem Cell Foundation in 2008, are more optimistic,
showing that Romanians are aware of this new medical procedure and understand its usefulness
better than the Swiss. This suggests that in the future publicity campaigns which will be conducted,
there should not be put too much emphasis on defining the procedure of donation, but on more
relevant information for attaining the purpose of convincing Romanians to donate.
In order to develop a fruitful publicity campaign, it must be taken into account the pluses and
minuses of the previous one. The results of these campaigns are reflected in peoples responses for
the survey. Romanians noticed the publicity made prior to the establishment of the National
Registry of Volunteer Hematopoetic Stem Cell Donors and were mostly responsive to the
advertisements delivered through television. Although the campaign of PROTV News lasted for few
months, the results of the survey prove that Romanians are more receptive than the Swiss, who had
more difficulties in observing promotions which were delivered in a longer period. Moreover, those
Romanians who saw the advertisements are more willing to register in a national registry, thus is can
be inferred that the publicity campaigns are an important influencing factor for the development of
the national registry.
Since the aim of the publicity campaign mentioned above was the creation of the national
registry, the information delivered did not include references to the current situation of stem cell
donations in Romania. This fact is shown by the low level of positive responses concerning the
knowledge about the realization of stem cell transplants in Romania and about the existence of the
stem cell banks in the country. Therefore, public information campaigns should be performed at the
36
level of the entire country in order to increase people awareness not only of the registration and
donation procedures but also of the stem cell industry and its evolution in Romania.
Furthermore, the success of the PROTV News campaign is proven by the fact that the
national registry was founded. However, Romanians are not aware of this achievement since less
than 20% of the respondents were sure that this registry exists. They seem to be more confident in
the existence of the international registry, not necessarily because they know it but because they
expect it to exist. Hence, the future publicity campaigns must also deliver this information essential
for the development of the national registry.
Even the willingness to donate either blood stem cells or bone marrow can be influenced by
a good publicity campaign. Delivering more information to the people, thus having them more
aware of the great help they will offer to those in need by registering in a volunteer donor registry,
can increase the chances to life of thousands Romanians who are, for the moment, sentenced to
death.
As a recommendation, one of the first steps that must be done in order to develop the
national volunteer stem cell donor registry is to promote the necessity of donation and of registering
at the level of the entire country through a publicity and public information campaign. In order to
summarize all the conclusions drawn previously, their implementation will be presented in the
description of this campaign.
The first feature of this publicity campaign is that it should be done by using the usual ATL
(above the line) channels of advertising in Romania, these being television, print, radio and web
search engines. A good advertisement for television should be created mostly since, as it can be seen
by analyzing the results of the survey, most Romanians notice the publicity on television. Moreover,
a radio ad can target the large number of Romanians who listen to the radio while driving or while
being at work and who spend little time in from of the television. The print media should include
mostly advertisements in the most preferred newspapers or magazines. Flyers and brochures must
not be made in large quantities because Romanians are not very responsive to this type of
promotion, a fact shown by their lack of knowledge of the existence of stem cell banks in Romania
although many of these banks advertise their businesses with flyers. Flyers and brochures can be
made only to target small but of high interest groups as students, young people being the most
important target since they can be members for a longer period. Also web search engines can be
used to deliver the advertisements mostly to the youth because they are those who spend much time
on the internet. Nevertheless, the most important channel of advertising in Romania is television and
should be the most utilized for conducting the publicity campaign.
37
Another feature is the message to be delivered through this campaign. This message must
contain information about the registry, the registration and donation procedures, their significance
and future implications at national and international level.
The last feature but also the most important is the concept of the commercial and the visual.
After seeing this advertisement, people should have clear in mind their value as potential donors
since in their hands stands the power to save another persons life. Slogans such as Its up to you to
make the difference, You can make the world a better place, Donating is the easiest way to
become a hero or Be the one to help save a life have been used in other countries to convince
people of their value. Moreover, the visual is also important. In the case of Romania, two different
approaches can be successful. First of all, funny ads and even cartoons can have a great result since
Romanians are more responsive to humorous commercials and mostly if it is considered that
younger people are the main target. The second approach would be to show different cases of people
in need of a stem cell transplant who personally ask for the potential donors help. This type of ad
would be emotional and would touch a deep chord in Romanians hearts.
Having decided that a publicity campaign is the best solution for the development of the
national volunteer stem cell donor registry, the question that arises is who should conduct this
campaign. Normally, the department of the Health Ministry which is in charge with the
administration of the national registry should also have this responsibility. However, from the first
day of existence of this registry, there has been no publicity made in order to make it popular among
the Romanian citizens. This fact is proven by the low level of people recognition of the registrys
existence at national level and of the insignificant number of volunteer donors registered. Therefore,
it can be deduced that there is a lack of disposition of those responsible with the registrys
administration to really make it function at international standards. This is also the explanation why
the registrys website has started to function recently although it was created along with the registry
in September 2009 and why it is not yet a member of the Bone Marrow Donors Worldwide, the
organization that administers the online database which gathers all the registries in the world.
Considering the defective administration of the registry during almost one year, it can be
stated that the Health Ministry finds it difficult to manage innovation or it is unwilling to manage it.
They have established this registry at people request, but are not creating the conditions to make it
function as it should. The barrier in the real implementation of the stem cell donor registry in
Romania is, from those four barriers identified by professor Bratianu, the bureaucracy barrier
which kills any incentive for innovation in the public administration
36
. Thus, all the steps and the
paper work that should be done in order to develop the publicity campaign make it almost
38
impossible to have it done in the near future. Moreover, taking into account the present financial
crisis and the problems the state institutions are facing, it is even more improbable the realization of
such a publicity campaign.
In these conditions, it is useless to formulate any recommendations for the Health Ministry
in order to favor the development of the national volunteer stem cell donor registry in Romania.
Therefore, as any market in which the demand is high and the offer is low, it can be seen that there
is a window of opportunity for the establishment of another national volunteer stem cell donor
registry by a non-governmental organization.
The present paper can be considered the market research which shows the potential of
putting in practice this idea. With a weak competitor and having a positive feedback from 31% of
the respondents, considering the fact that, apart from the Health Ministry, the other two options (a
public hospital or a private clinic) were almost ignored by the persons interviewed, you can be sure
that there is enough space for this organization on the stem cell market.
The new registry should not be the substitute of the one administered by the Health Ministry,
but its complement. The already established registry, as its name National Registry of Volunteer
Hematopoetic Stem Cell Donors states, has the purpose of creating a database with the information
of potential donors of blood stem cells, while the new one should have a more extensive database
which comprises information not only of volunteer donors of blood stem cells but also of bone
marrow or cord blood.
In what concerns cord blood donation, this can be done only in collaboration with the
national stem cell banks which could preserve the cord blood donated at birth by donor families in
order to be available for general use, but only for transplants and not for research, thus being in
accordance with the Romanian law.
This new registry should have a short and representative name as, for example, Romanian
Stem Cell Foundation, which is similar to those from many countries and which is easier to be
memorized and spelled than that of the already established registry.
With a vision to cure and a mission to care, the same as for all registries worldwide, the role
of the foundation is to improve the quality of live of patients with leukemia and other blood related
illnesses.
The main activities of this foundation are searching for a compatible donor on request of an
institution within the country or abroad, high-level negotiations with national or international
authorities, organizing the actual procedure in the event of stem cell harvest or transplantation and
preparing general information material like statistics and other reports. In order to be sure of the
39
quality of the services rendered, the foundation must be well organized in specialized departments,
as it can be seen in Figure 3.2:
Figure 3.2: Organizational Chart of Romanian Stem Cell Foundation
The President, being also the General Manager, is mainly responsible with representing the
foundation at national and international level. The Executive Manager has to organize, coordinate
and supervise the activity of all the departments.
The Finance Manager is not only responsible with the financial activity of the organization
but also with fundraising. This foundation should finance itself from donations and sponsorships
which will be made in exchange for promoting the sponsors in its advertising campaigns. The
companies most willing to collaborate should be the stem cell banks. They are almost unknown on
the Romanian market, a fact proven by the low level of knowledge Romanians have about their
existence. Since through these publicity campaigns more people will get to know the big number of
illnesses that can be cured with stem cells and the small chances there are to find an unrelated HLA
typed matched donor, they will be more willing to have their children cold blood preserved in order
to avoid, if it will ever be the case, such desperate situations. Nevertheless, the foundation can reach
a funding agreement with the health insurance companies so that it can charge for its work. This is a
common practice of other national registries from abroad, having the services that they carry out for
the patients from that country paid for by the insurance companies. This procedure can also be
applied in Romania since working people are obliged to have private health insurances.
President
General Manager
Executive Manager
Finance Manager Partnership
Development Manager
Database
Administrator
Marketing and
Communications
Manager
Medical Services
Manager
40
In order to develop this registry, the foundation must start with a public information
campaign in which to present the new created registry and the implications of registering as a
volunteer donor, this being the responsibility of the Marketing and Communications Manager.
Then the Database Administrator will start to register the volunteer donors in the database,
always update the information and search for compatible donors when it is requested.
Another activity of the foundation is to conduct high-level negotiations with national or
international authorities, meaning to be always willing to collaborate with different organizations
and national bodies, having as main purpose delivering more value to its nationals. Thus, the
responsibility of the Partnership Development Management is to create and maintain a close
relationship not only with the stem cell banks, but also with all the hospitals and clinics which
harvest stem cells so that they will assure a good functioning of the system. In addition, it seems that
there is a high probability of making another relation, this one being with the first center for
treatment with stem cells from Romania, whose creation was announced as a joint venture of the
Concorde Gruppe GmbH and Healthcare of Today
37
at the beginning of June 2010. Furthermore, in
order to administer the registry according to the international standards, the foundation must
participate in the Bone Marrow Donors Worldwide (BMDW). Being a member of this organization,
the foundation offers to Romanian citizens access to a worldwide database while also giving the
possibility to foreign people to access the Romanian database of stem cells volunteer donors. Even
though this foundation will be accepted as a participating registry in BMDW, the other national
registry still has its chances to be accepted since there is always place for new entrants, no matter if
they are many from the same country. Therefore, the membership in BMDW will make possible the
search for a compatible donor not only in the country but also abroad, this way increasing the
chances of survival of many Romanians.
Moreover, one important activity, of which the Medical Services Manager is in charge,
would be to organize the actual procedure in the event of stem cell harvest or transplantation which
is, in any conditions, a major responsibility. The foundation must keep the anonymity of both the
donor and the recipient, settle with the hospital or the clinic chosen for doing the transplant all the
steps that must be followed and supervise that everything is done as required.
The last duty of the foundation, also the responsibility of the Marketing Manager, would be
to prepare reports concerning the activity of the company and also conduct periodical surveys so that
they can see which are the measures that should be taken in the future for a better development of
the national industry. As it has been observed in the present paper, using a survey research is a
useful tool for analyzing the present situation in the domain but it also helps to make decisions.
41
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Sons
Waters, D., 2001. Quantitative Methods for Business 3
rd
ed. England: Pearson Education Limited
William, G. J., 1997. Statistical Graphics for Univariate and Bivariate Data: Statistical Graphics.
USA: Sage Publications
43
Endnotes
1
IARC (International Agency on Research on Cancer) website - http://www-dep.iarc.fr/ accessed on March 10, 2010
2
Reda speranta website, http://www.redasperanta.ro/despre/donare accessed on March 12, 2010
3
Stirile ProTV website, http://formular.stirileprotv.ro/ accessed on March,12, 2010
4
American Psychological Association (APA): stem cell. (n.d.). The American Heritage Stedman's Medical Dictionary.
Retrieved March 23, 2010, from Dictionary.com website: http://dictionary.reference.com/browse/stem cell
5
Swiss Blood Stem Cell Foundation website- http://www.bloodstemcells.ch/blood-stem-cells/significance accessed
March 10, 2010
6
Stem Cell Information The National Institutes of Health resource for stem cell research
http://stemcells.nih.gov/info/basics/basics2.asp retrieved March 10, 2010
7
Swiss Blood Stem Cell Foundation website - http://www.bloodstemcells.ch/blood-stem-cells/where-are-they-found
8
Stem Cell Information The National Institutes of Health resource for stem cell research
http://stemcells.nih.gov/info/health.asp, accessed March 26, 2010
9
PhD Suzanne Kadereit, Adult Stem Cells, International Society for Stem Cell Research -
http://www.isscr.org/public/adultstemcells.htm#hema, accessed March 26, 2010
10
UK Department for Work and Pension website - http://www.dwp.gov.uk/publications/specialist-guides/medical-
conditions/a-z-of-medical-conditions/bone-marrow-transplant/ , accessed 26 march 2010
11
PhD M. William Lensch, Stem Cells in the Blood, International Society for Stem Cell Research -
http://www.isscr.org/public/blood.htm , accessed March 26, 2010
12
Swiss Blood Stem Cell Foundation website - http://www.bloodstemcells.ch/blood-stem-cells/tissue-compatibility
accessed March 26, 2010
13
Swiss Blood Stem Cell Foundation website - http://www.bloodstemcells.ch/blood-stem-cells/tissue-compatibility/hla-
system accessed March 26, 2010
14
National Marrow Donor Program, retrieved April 9, 2010
http://www.marrow.org/DONOR/When_You_re_Asked_to_Donate_fo/Donation_FAQs/index.html#what_pbsc
15
idem
16
National Marrow Donor Program, retrieved April 9, 2010
http://www.marrow.org/PATIENT/Undrstnd_Disease_Treat/Undrstnd_Treat_Opt/Lrn_BMT_Cord/Cord_Blood_Tx/
17
Swiss Blood Stem Cell Foundation website - http://www.bloodstemcells.ch/blood-stem-cells/related-unrelated,
accessed March 26, 2010
18
Unrelated Bone Marrow and Cord Blood Stem Cell A Fact Sheet, http://www.docstoc.com/docs/27476675/A-fact-
sheet-UNRELATED-BONE-MARROW-AND-CORD-BLOOD-STEM-CELL/ accessed April 9, 2010
19
Bone Marrow Donors Worldwide Organization website, http://www.bmdw.org/ accessed April 9, 2010
20
ROmedic.Treizeci de ani de la primul transplant, available at http://www.romedic.ro/treizeci-de-ani-de-la-primul-
transplant-in-romania-0N17189 accessed on April 10, 2010
44
21
Stirile de acasa. Primul transplant de maduva realizat in Romania, available at
http://stiri.acasa.ro/articole/social/primul-transplant-de-maduva-realizat-in-romania , accessed April 10, 2010
22
Evenimentul zilei. Bolnavii de leucemie ingraditi la tratament in prorpia tara, available at
http://www.evz.ro/articole/detalii-articol/888751/Bolnavii-de-leucemie-ingraditi-la-tratament-in-propria-tara/ accessed
March 23, 2010
23
ROmedic. Insitutul Fundeti 200 de transplanturi de cellule stem, available at http://www.romedic.ro/institutul-
fundeni-200-de-transplanturi-de-celule-stem-0N16769 accessed April 10, 2010
24
Evenimentul zilei. Bolnavii de leucemie ingraditi la tratament in prorpia tara, available at
http://www.evz.ro/articole/detalii-articol/888751/Bolnavii-de-leucemie-ingraditi-la-tratament-in-propria-tara/ accessed
March 23, 2010
25
Money.ro. Romanias first stem cell compatibility case, available at http://www.money.ro/english-brief/romania-s-
first-stem-cell-compatibility-case.html , accessed April 10, 2010
26
Swiss Blood Stem Cell Foundation website- http://www.bloodstemcells.ch accessed March 12, 2010
27
Swiss Blood Stem Cell Foundation website - http://www.bloodstemcells.ch/blood-stem-cells/news-
service/news/annual-report-sbsc-2008 accessed March 10
28
PhD DINH THAI HOANG, Lecture Notes page 7 - http://www.scribd.com/doc/7675895/Statistics-for-business-1
accessed April 12, 2010
29
PhD Hossein Arsham, Lecture notes Statistical Thinking for Managerial Decisions (Subchapter 1.5 What is Business
Statistics?) - http://www.mirrorservice.org/sites/home.ubalt.edu/ntsbarsh/Business-stat/opre504.htm#rInferCond
accessed April 23, 2010
30
Definition of quantitative data on Wikipedia website, http://en.wikipedia.org/wiki/Quantitative_data, accessed April
23, 2010
31
Definition of qualitative data on Wikipedia website, http://en.wikipedia.org/wiki/Qualitative_data, accessed April 23,
2010
32
Dr. DANG QUANG A. And Dr. BUI THE HONG, Lecture Notes Statistical Data Analysis, page 87 -
http://www.scribd.com/doc/6910841/Statistics accessed May 3, 2010
33
Idem, page 116
34
Idem, page 121
35
Realitatea. Mai putin de 2 procente dintre romani doneaza sange, accessed at http://www.realitatea.net/mai-putin-de-
2prc--dintre-romani-doneaza-sange_537002.html 24 June 2010 , accessed June 10, 2010
36
Management and marketing. Implementing Innovation and Knowledge Management in the Romanian Economy,
available at http://www.managementmarketing.ro/pdf/articole/159.pdf , accessed June 10, 2010
37
Mediafax. Primul centru de tratament cu celule stem din Romania, available at http://www.mediafax.ro/social/primul-
centru-de-tratament-cu-celule-stem-din-romania-6131625/ accessed June 1, 2010
45

APPENDIX
Appendix 1
Total number of stem cell donors per continent according to Bone Marrow Donors Worldwide Annual Report 2008

Appendix 2
(A) Distribution of stem cell donors in the world from Bone Marrow Donors Worldwide Annual Report 2008



46

Appendix 2
(B) Distribution of stem cell donors in Europe from Bone Marrow Donors Worldwide Annual Report 2008.

Appendix 3
Questionnaire concerning stem cell donation

1. Name:
2. Age:
3. Gender (M/F):
4. Last school graduated:
o Secondary school
o High school
o Graduate studies
o Postgraduate studies
5. Profession:
6. Town:
7. Do you know the meaning of <<blood stem cell donation>> or have you heard this expression?
o Yes
o No
o Dont know
8. What comes to your mind spontaneously when you hear the term <<blood stem cell donation>>?
o Blood donation
o Leukemia patients
o Cloning embryos
o Sperm donation
9. Have you noticed any publicity for donating blood stem cells or bone marrow?
o Yes
47

o No
o Dont know
10. Answer question 10 if the answer to question 9 is Yes. Where?
o Specialty magazine
o Newspaper
o Television
o Internet
o Flyer
11. Do you know if stem cell transplants can be done in Romania?
o Yes
o No
o Dont know
12. Do you know if there are stem cell banks in Romania?
o Yes
o No
o Dont know
13. Have you ever donated blood?
o Yes
o No
14. Are you willing to donate blood stem cells?
o Yes
o No
o Dont know
15. Are you willing to donate bone marrow?
o Yes
o No
o Dont know
16. What could motivate you to donate blood stem cells?
o Need of transplant of someone beloved
o Saving lives
o Material rewards
o Other motivators
17. Do you know if there is a volunteer stem cell donor registry at international level?
o Yes, it is
o No, it is not
o Dont know
18. Do you know if there is such a registry in Romania?
o Yes, it is
o No, it is not
o Dont know
19. If in Romania there were such a registry, would you register as a volunteer donor?
o Yes
o No
o Dont know
20. Who should administer this registry?
o The Health Ministry
o A public hospital
o A private clinic
o A non-governmental organization




48

Appendix 4
Demographic variables

Figure 1. Responses to question number 3 Gender:
44%
56%
Female
Male

Table 1. Results of question number 4 Last School Graduated:
Frequency Percent Valid Percent Cumulative Percent
Valid secondary school 1 ,3 ,3 ,3
high school 111 34,2 34,2 34,5
graduate studies 134 41,2 41,2 75,7
postgraduate studies 79 24,3 24,3 100,0
Total 325 100,0 100,0

Figure 2. Results of question number 5 Profession:










where 1-student, 2-employed, 3-unemployed, 4-
pensioner
49

Table 2. Responses to question number 6 Place of residence:

Frequency Percent Valid Percent
Cumulative
Percent
Valid Center 26 8,0 8,0 8,0
East 44 13,5 13,5 21,5
South 241 74,2 74,2 95,7
West 14 4,3 4,3 100,0
Total 325 100,0 100,0

Appendix 5
Distribution of answers

Figure 1. Responses to question number 7 Do you know the meaning of <<blood stem cell donation>> or have you heard
this expression?

Figure 1. Results of question number 1 of the Swiss Blood Stem Cells Foundation Survey



50

Table 1. Responses for question number 8 What comes to your mind spontaneously when you hear the term <<blood stem
cell donation>>?
Frequency Percent Valid Percent Cumulative Percent
Valid blood donation 123 37,8 37,8 37,8
leukemia patients 174 53,5 53,5 91,4
Cloning embryos 27 8,3 8,3 99,7
sperm donation 1 ,3 ,3 100,0
Total 325 100,0 100,0

Figure 3. Results of question number 1 of the Swiss Blood Stem Cells Foundation Survey


Figure 4. Responses to question number 9 Have you noticed any publicity for donating blood stem cells or bone marrow?







51

Figure 5. Results of question number 3 of the Swiss Blood Stem Cells Foundation Survey


Table 2. Responses to question number 10 Where?
Frequency Percent Valid Percent Cumulative Percent
Valid specialty magazine 6 1,8 3,4 3,4
newspaper 5 1,5 2,9 6,3
Television 121 37,2 69,5 75,9
Internet 36 11,1 20,7 96,6
Flyer 6 1,8 3,4 100,0
Total 174 53,5 100,0
Missing System 151 46,5
Total 325 100,0

Figure 6. Answers to question number 11 Do you know if stem cell transplants can be done in Romania?

Table 3. Responses to question number 12 - Do you know if there are stem cell banks in Romania?

Frequency Percent Valid Percent Cumulative Percent
Valid No 68 20,9 20,9 20,9
don't know 145 44,6 44,6 65,5
52

Yes 112 34,5 34,5 100,0
Total 325 100,0 100,0


Table 4. Answers to question number 13 Have you ever donated blood?
Frequency Percent Valid Percent Cumulative Percent
Valid No 214 65,8 65,8 65,8
Yes 111 34,2 34,2 100,0
Total 325 100,0 100,0

Figure 7. Responses to question number 14 Are you
willing to donate blood stem cells?


Figure 8. Results of question number 15 Are you willing
to donate bone marrow?
Table 5. Answers to question number 16 What could motivate you to donate blood stem cells?
Frequency Percent Valid Percent Cumulative Percent
Valid need of transplant of someone beloved 150 46,2 46,2 46,2
saving lives 155 47,7 47,7 93,8
material rewards 9 2,8 2,8 96,6
other motivators 11 3,4 3,4 100,0
Total 325 100,0 100,0



53

Figure 9. Comparison between the answers of questions number 17 Do you know if there is a volunteer stem cell
donor registry at international level? and number 18 Do you know if there is such a registry in Romania?

Table 6. Responses to question number 19 If in Romania there were such a registry, would you register as a
volunteer donor?
Frequency Percent Valid Percent Cumulative Percent
Valid No 40 12,3 12,3 12,3
don't know 136 41,8 41,8 54,2
Yes 149 45,8 45,8 100,0
Total 325 100,0 100,0

Figure 10. Distribution of answers to question number 20 Who should administer this registry?

54

Appendix 6
Influencing Factors of Romanians Willingness to Donate Blood Stem Cells

Table 1. Romanians willingness to donate blood stem cells if they have donated or not blood
Model R R Square Adjusted R Square Std. Error of the Estimate
1 ,147
a
,022 ,019 ,727
a. Predictors: (Constant), Have you ever donated blood?

Figure 1. Romanians willingness to donate blood stem cells according to their knowledge about the stem cell market

Figure 2. The effect of publicity campaigns on Romanians willingness to donate blood stem cells

Table 1. Influence of knowledge about stem cell transplants in Romania upon the willingness to donate bone marrow

Model R R Square Adjusted R Square Std. Error of the Estimate
1 ,254
a
,065 ,062 ,693
a. Predictors: (Constant), Do you know if stem cell transplants can be done in Romania?
55

Figure 3. Distribution of answers concerning the willingness to donate blood stem cells according to age

Figure 4. Distribution of answers concerning the willingness to donate blood stem cells according to gender

Figure 5. Distribution of answers concerning the willingness to donate blood stem cells depending on education

56

Table 2. Distribution of answers concerning the willingness to donate blood stem cells according to profession

Are you willing to donate blood stem cells?
Total

no don't know yes
Profession student 11 27 28 66
employed 35 71 137 243
unemployed 0 1 5 6
pensioner 3 4 3 10
Total 49 103 173 325

Figure 6. Distribution of answers concerning the willingness to donate blood stem cells according to place of residence

Figure 7. Distribution of answers concerning people willingness to donate bone marrow according to their age

57

Table 3. Distribution of answers concerning people willingness to donate bone marrow according to their gender

Are you willing to donate bone marrow?
Total

no don't know yes
Gender female 49 84 48 181
male 44 74 26 144
Total 93 158 74 325

Figure 8. Distribution of answers concerning people willingness to donate bone marrow according to their education

Figure 9. Distribution of answers concerning people willingness to donate bone marrow according to their profession

58

Table 4. Distribution of answers concerning people willingness to donate bone marrow according to the place of
residence

Are you willing to donate bone marrow?
Total

no don't know yes
Town center Count 6 14 6 26
% within Town 23,1% 53,8% 23,1% 100,0%
east Count 17 19 8 44
% within Town 38,6% 43,2% 18,2% 100,0%
south Count 66 120 55 241
% within Town 27,4% 49,8% 22,8% 100,0%
west Count 4 5 5 14
% within Town 28,6% 35,7% 35,7% 100,0%
Total Count 93 158 74 325
% within Town 28,6% 48,6% 22,8% 100,0%

Appendix 7
Influencing Factors of Romanians Willingness to Register as Donors

Table 1. Correlation between willingness to donate blood stem cells and readiness to register as volunteer donor

Are you willing to donate
blood stem cells?
If in Romania there were such a registry,
would you register as a volunteer donor?
Are you willing to donate
blood stem cells?
Pearson Correlation 1 ,646
**

Sig. (2-tailed)

,000
N 325 325
If in Romania there were
such a registry, would you
register as a volunteer
donor?
Pearson Correlation ,646
**
1
Sig. (2-tailed) ,000

N 325 325
**. Correlation is significant at the 0.01 level (2-tailed).

Table 2. Correlation between willingness to donate blood stem cells and readiness to register as volunteer donor
Model R R Square Adjusted R Square Std. Error of the Estimate
1 ,646
a
,417 ,415 ,524

59

Table 3. Correlation between willingness to register as volunteer donor and readiness to donate bone marrow

If in Romania there were such a
registry, would you register as a
volunteer donor?
Are you willing to donate
bone marrow?
If in Romania there were such a
registry, would you register as a
volunteer donor?
Pearson Correlation 1 ,424
**

Sig. (2-tailed)

,000
N 325 325
Are you willing to donate bone
marrow?
Pearson Correlation ,424
**
1
Sig. (2-tailed) ,000

N 325 325
**. Correlation is significant at the 0.01 level (2-tailed).

Table 4. Correlation between willingness to donate bone marrow and readiness to register as volunteer stem cell donor
Model R R Square Adjusted R Square Std. Error of the Estimate
1 ,424
a
,179 ,177 ,622

Table 5. Regression between willingness to donate bone marrow and readiness to register as volunteer stem cell donor
Model
Unstandardized Coefficients Standardized Coefficients
t Sig. B Std. Error Beta
1 (Constant) ,359 ,035

10,369 ,000
Are you willing to donate bone
marrow?
,406 ,048 ,424 8,406 ,000
a. Dependent Variable: If in Romania there were such a registry, would you register as a volunteer donor?

Table 6. Distribution of responses concerning the willingness to become a volunteer donor according to motivators

If in Romania there were such a registry, would you register as a
volunteer donor?
Total

no don't know Yes
What could motivate you to
donate blood stem cells?
need of transplant of
someone beloved
27 84 39 150
saving lives 10 42 103 155
material rewards 1 5 3 9
other motivators 2 5 4 11
Total 40 136 149 325
60


Table 7. Correlations

If in Romania there
were such a registry,
would you register as
a volunteer donor?
Do you know if
there is a volunteer
stem cell donor
registry at
international level?
Do you know if there is
such a registry in
Romania?
If in Romania there were such a
registry, would you register as a
volunteer donor?
Pearson Correlation 1 ,240
**
,177
**

Sig. (2-tailed)

,000 ,001
N 325 325 325
Do you know if there is a
volunteer stem cell donor
registry at international level?
Pearson Correlation ,240
**
1 ,268
**

Sig. (2-tailed) ,000

,000
N 325 325 325
Do you know if there is such a
registry in Romania?
Pearson Correlation ,177
**
,268
**
1
Sig. (2-tailed) ,001 ,000

N 325 325 325
**. Correlation is significant at the 0.01 level (2-tailed).

Appendix 8
Effects of publicity campaigns

Table 1. Correlation knowledge of the meaning of <<blood stem cell donation>> and observation of promotions

Do you know the meaning of
<<blood stem cell donation>> or
have you heard this expression?
Have you noticed any publicity for
donating blood stem cells or bone
marrow?
Do you know the meaning of
<<blood stem cell donation>>
or have you heard this
expression?
Pearson
Correlation
1 ,225
**

Sig. (2-tailed)

,000
N 325 325
Have you noticed any
publicity for donating blood
stem cells or bone marrow?
Pearson
Correlation
,225
**
1
Sig. (2-tailed) ,000

N 325 325
61

Table 1. Correlation knowledge of the meaning of <<blood stem cell donation>> and observation of promotions

Do you know the meaning of
<<blood stem cell donation>> or
have you heard this expression?
Have you noticed any publicity for
donating blood stem cells or bone
marrow?
Do you know the meaning of
<<blood stem cell donation>>
or have you heard this
expression?
Pearson
Correlation
1 ,225
**

Sig. (2-tailed)

,000
N 325 325
Have you noticed any
publicity for donating blood
stem cells or bone marrow?
Pearson
Correlation
,225
**
1
Sig. (2-tailed) ,000

N 325 325
**. Correlation is significant at the 0.01 level (2-tailed).

Table 2. Correlation between knowledge of the realization of stem cell transplants and observation of promotions

Have you noticed any
publicity for donating blood
stem cells or bone marrow?
Do you know if stem cell
transplants can be done in
Romania?
Have you noticed any publicity
for donating blood stem cells or
bone marrow?
Pearson Correlation 1 ,168
**

Sig. (2-tailed)

,002
N 325 325
Do you know if stem cell
transplants can be done in
Romania?
Pearson Correlation ,168
**
1
Sig. (2-tailed) ,002

N 325 325
**. Correlation is significant at the 0.01 level (2-tailed).

Table 3. Correlation between knowledge about the existence of stem cell banks and observation of promotions

Have you noticed any
publicity for donating blood
stem cells or bone marrow?
Do you know if there are stem
cell banks in Romania?
Have you noticed any publicity
for donating blood stem cells or
bone marrow?
Pearson Correlation 1 ,309
**

Sig. (2-tailed)

,000
N 325 325
62

Do you know if there are stem
cell banks in Romania?
Pearson Correlation ,309
**
1
Sig. (2-tailed) ,000

N 325 325
**. Correlation is significant at the 0.01 level (2-tailed).

Table 4. Correlations between publicity and knowledge about the national and international registries

Have you noticed any
publicity for donating
blood stem cells or bone
marrow?
Do you know if
there is such a
registry in
Romania?
Do you know if there is a
volunteer stem cell donor
registry at international
level?
Have you noticed any
publicity for donating blood
stem cells or bone marrow?
Pearson Correlation 1 ,234
**
,233
**

Sig. (2-tailed)

,000 ,000
N 325 325 325
Do you know if there is such a
registry in Romania?
Pearson Correlation ,234
**
1 ,268
**

Sig. (2-tailed) ,000

,000
N 325 325 325
Do you know if there is a
volunteer stem cell donor
registry at international level?
Pearson Correlation ,233
**
,268
**
1
Sig. (2-tailed) ,000 ,000

N 325 325 325
**. Correlation is significant at the 0.01 level (2-tailed).

Table 5. Correlations between observation of publicity and willingness to donate and register as volunteer donor

Have you noticed any
publicity for donating
blood stem cells or bone
marrow?
Are you willing to
donate blood stem
cells?
If in Romania there
were such a
registry, would you
register as a
volunteer donor?
Have you noticed any publicity
for donating blood stem cells or
bone marrow?
Pearson Correlation 1 ,169
**
,187
**

Sig. (2-tailed)

,002 ,001
N 325 325 325
Are you willing to donate blood
stem cells?
Pearson Correlation ,169
**
1 ,646
**

Sig. (2-tailed) ,002

,000
N 325 325 325
63

If in Romania there were such a
registry, would you register as a
volunteer donor?
Pearson Correlation ,187
**
,646
**
1
Sig. (2-tailed) ,001 ,000

N 325 325 325
**. Correlation is significant at the 0.01 level (2-tailed).


Table 6. Crosstabulation between the choice of who should administer the registry and type of advertising channel

Who should administer this registry?
Total

The Health
Ministry
A public
hospital A private clinic A NGO
Answer question 10 if the
answer to question 9 is Yes.
Where?
specialty magazine 6 0 0 0 6
newspaper 4 0 1 0 5
television 86 3 5 27 121
internet 21 0 7 8 36
flyer 3 0 0 3 6
Total 120 3 13 38 174

Appendix 9
Hypothesis Testing

Table 1. Correlation between knowledge about the meaning of <<blood stem cell donation>> and willingness to register as
volunteer donor

If in Romania there were such
a registry, would you register
as a volunteer donor?
Do you know the meaning of
<<blood stem cell donation>> or
have you heard this expression?
If in Romania there were such a
registry, would you register as a
volunteer donor?
Pearson Correlation 1 ,268
**

Sig. (2-tailed)

,000
N 325 325
Do you know the meaning of
<<blood stem cell donation>> or
have you heard this expression?
Pearson Correlation ,268
**
1
Sig. (2-tailed) ,000

N 325 325
**. Correlation is significant at the 0.01 level (2-tailed).