A tragic case of altruism turned deadly recently as a high school principal in New Jersey lost his life donating bone marrow to help a stranger in France. Derrick Nelson a high school principal and a man with a history of sleep apnea and sickle cell anemia carrier state, underwent harvesting of bone marrow under local anesthesia to help someone on the other side of the world. After the procedure, he was unable to speak and eventually lapsed into a coma. He ultimately died weeks later.

The press has no reports I am aware of that reveal the cause of his death. But I have my theories.

First understand that death from bone marrow donation is exceedingly rare, but not unheard of. Complications can include infection, bleeding and, in the most severe circumstances, embolization. Emboli are small particles or tissue entities, like fat, blood clots or even trapped gases like air, that can enter blood vessels and travel via the circulatory system to the heart, lungs and even the brain and other vital organs. Emboli due to blood elements often come in the form of clots and are, perhaps, the most common and well known. Deep vein thrombosis, often in the leg, can cause a clot to dislodge from the wall of a vein and travel to the heart and lungs, causing a serious pulmonary embolus. Amniotic fluid embolization during childbirth can similarly cause a serious clinical picture when amniotic tissue traverses from the uterus into the general circulation. Fat emboli can enter the circulation during orthopedic surgery and after injury to large bones of the body such as the femur. And some people have a genetic or acquired propensity to develop blood clots, requiring them to be anti-coagulated (blood-thinned) in order to prevent serious complications from clots.

In the case of Mr. Nelson, he unfortunately had a number of medical issues that might have contributed to his death. His sleep apnea did put him at risk for anesthesia, even though it was done under local with sedation and not under riskier general anesthesia. Also, he appeared to be overweight, which always places people at extra risk for anesthesia, as is the case with a person with sickle cell disease (although it is unclear whether he suffered any clinical manifestations of this disease). My pet theory, due to the clinical picture, is that he might have suffered an embolization of bone marrow fat or other cellular material during or shortly after the procedure, although I cannot say for sure. You can read this link to better understand the process and risks of the procedure he underwent.

What happened to this poor man who heroically lost his life in service to others serves is a rare but sad lesson. Although bone marrow donation is extremely safe, there are risks involved, just as there are risks in any medical intervention. The risks can be very small, but other health factors, like extra pounds, sleep apnea, sickle cell disease of unknown severity or risks that are unknown at the time of the procedure can contribute to complications. This is in no way a discouragement to bone marrow donation or any other medical procedure. It is, however, a warning to gather as much information as you can about your own health before medical interventions of any kind to help the people taking care of you do the safest job possible. And, whenever it is feasible, you can do things to protect yourself, like lose weight, get your sleep apnea under good control and do other smart things like quit smoking, mange your health problems with better habits and take your medication as prescribed to help mitigate risk. Although this case is a tragic example of the adage “no good deed ever goes unpunished,” it should not deter anyone from doing the right thing.

For more with Dr. Sherer, click here for his podcast and video interviews, or purchase his memoir, The House of Black and White: My Life with and Search for Louise Johnson Morris.