Heart-rending appeals for potential bone marrow donors to help named individuals can spark the public imagination, but they can obscure the bigger picture, says Lynne Greenwood

On the website dedicated to six-year-old Molly-Ann Barnett, two photographs say it all.

In one, she is a smiling, happy little girl, her long, shiny hair showing beneath a sunflower-trimmed straw hat. The second shows a sad, pale-faced child, hands covering her bald head, a hospital identity bracelet visible on her wrist.

Molly-Ann is suffering from acute myeloid leukaemia. Last month, doctors at St James's University Teaching Hospital, Leeds, told her parents she needed a bone marrow transplant - within six weeks. Because her tissue type is very rare, a consultant warned them not to raise their hopes.

After two days of anguish, Molly Ann's parents, from Hessle, near Hull, launched a publicity drive to persuade people to become bone marrow donors in a desperate attempt to find a match.

The campaign was 'run like a military operation' by family members, and championed by the local newspaper, The Hull Daily Mail .Hundreds of people who saw Molly-Ann's photographs queued to give a blood sample.

Thousands joined the British Bone Marrow Registry. Late last week the family heard that a donor has been identified - the transplant is due to take place next month.

Despite the risks ahead, it is the best result Molly-Ann and her family could have hoped for. Anonymity rules preventing any contact between donor and patient for two years mean her parents cannot know whether the match was a result of their campaign.

When one case is highlighted - and in particular, that involving a young child - the public reaction which follows can leave the organisations which control the UK's bone marrow services struggling to keep up.

The Anthony Nolan Bone Marrow Trust, the world's first organisation to establish a register, records 350 first time volunteers every week, the maximum possible within their annual resources of£10m a year.

HSJ understands that Molly-Ann's family were warned that the trust would not be able to cope with additional numbers.

The National Blood Service, whose primary aim is to collect 10,000 units of blood per day, operates its own bone marrow register. Nurses take an extra blood sample at some normal donor sessions staffed by counsellors trained to explain the consent arrangements and implications of involvement to potential donors.

But the system can break down.

When Molly-Ann's teenage brother Daniel persuaded 45 sixth-form colleagues to attend a donor session to try to help his sister, staff were unable to process the students.

'The staff on duty were unaware of the procedure and turned them away, ' explains their father Paul, who has written to prime minister Tony Blair and the Department of Health asking for improvements to the bone marrow registry system. 'But once the service heard about it, they provided a minibus to take some of the students to Leeds for the samples to be taken.'

He is angry at the seeming lack of coordination of services which provide tissue-typing of blood samples, and the lack of investment in those services.

'It is almost scandalous that lives are being lost because it is not properly organised, 'he says.

The service began its bone marrow tissue-typing in 1987, although many regular donors remain unaware that they can provide an extra sample for the bone marrow register.

'We are driven by the transplant services round the country who approach us to search for a match for a particular patient, ' says Jim Moir, its head of corporate communications.'In the past we have run local advertising campaigns around the bone marrow issue, often round the gene pool in an area where a particular patient was born or lives.'

Last year in England and Wales the service tissue-typed 5,000 samples and it is aiming to double that figure for the current year.

But when Molly-Ann's publicity campaign prompted over 200 people to arrive at donor sessions in Hull where no more than 140 were expected, the practicalities became almost impossible to manage.

Representatives of the service visited Molly-Ann's 'campaign managers' to discuss ways of managing the extra numbers.

'We organised extra sessions in the early morning and late evening, we deployed extra nurses, more meeters and greeters to explain and apologise for any delays, right down to ensuring there were enough teabags for extra drinks, ' says Mr Moir.

Now the service is in discussion with the DoH about the provision of extra staff and equipment necessary to increase the number of samples which can be tested.

Although there is some concern that donors responding emotionally to a campaign are not fully aware of the implications - a donation can involve an overnight stay in hospital and a few days away from work - all register services are adamant that the details are fully explained before a consent form is signed.

The Anthony Nolan Trust is asked to search for a match for upwards of 3,000 patients every week. It has strong views on the 'knee-jerk reaction' of the public to emotionally charged campaigns.

Anne Parish, corporate affairs manager, says: 'We cannot imagine what the families of children awaiting a transplant are going through. But becoming a donor is not about one person - every single patient is important.

'We understand why people focus on individuals but we would ask them to use those individuals as a catalyst for all those needing a transplant. In the counselling offered to potential donors, it is made clear that it may be 10 years before they receive a call to say they may be a match for a patient.

'That's when we want them to remember why they joined, how they joined and not to consider reneging on their offer.'

The Anthony Nolan Bone Marrow Trust www.anthonynolan.com