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The Ethics of Hematopoietic Stem Cell Donation by Minors

The Ethics of Hematopoietic Stem Cell Donation by Minors The article by Kesselheim et al1 regarding the ethics of hematopoietic stem cell (HSC) donation by biological siblings of adopted children points out the importance of intimacy in justifying minors participating as HSC donors. However, the article highlights one common error in this process. Because HLA testing is a simple blood test, parents and physicians believe that they can test children, and do so without considering its broader implications. While the physical risk is minimal, if the child is found to be HLA identical to the potential recipient, questions arise about whether the child is an appropriate HSC donor. This question, however, should be asked before HLA testing is done. In that vein, the case cited by Kesselheim et al was problematic despite the fact that the siblings were found to be non–HLA compatible: nonintimate siblings should not be evaluated to determine if they are eligible to serve as HSC donors.2 The importance of acknowledging that HLA testing is not a routine blood test that should be done on children without some sort of donor advocate is made clear by the conclusion that the authors reach. They suggest that some cases of HSC donation beyond the family may be permissible and include “in theory, intimate friends or nonbiological siblings who happen against all odds to be HLA matched.”1 The problem here is that these minors should not have had HLA testing in the first place, and so, the cases should never arise. This error, in an article offering ethical guidance for HSC donation by minors, confirms the need for a donor advocate for all potential pediatric HSC donors,3,4 a concept that already exists for all pediatric and adult solid organ donors.5 In all HSC donations in which the potential donor is a minor, a donor advocate or donor advocate team should be involved from the onset, and this includes participation in the discussion about whether HLA testing is appropriate. Correspondence: Dr Ross, University of Chicago, 5841 S Maryland Ave, MC 6082, Chicago, IL 60637 (lross@uchicago.edu). Financial Disclosure: None reported. Funding/Support: This work is supported by the National Library of Medicine of the National Institutes of Health. References 1. Kesselheim JCLehmann LEStyron NFJoffe S Is blood thicker than water? ethics of hematopoietic stem cell donation by biological siblings of adopted children. Arch Pediatr Adolesc Med 2009;163 (5) 413- 416PubMedGoogle ScholarCrossref 2. Ross LFGlannon W A compounding of errors: the case of bone marrow donation between non-intimate siblings. J Clin Ethics 2006;17 (3) 220- 226PubMedGoogle Scholar 3. Pentz RDChan KWNeumann JLChamplin REKorbling M Designing an ethical policy for bone marrow donation by minors and others lacking capacity. Camb Q Healthc Ethics 2004;13 (2) 149- 155PubMedGoogle ScholarCrossref 4. Ross LF Ethical and policy lessons to be learned from a family with inherited bone marrow failure. Am J Med Genet A 2008;146A (21) 2715- 2718PubMedGoogle ScholarCrossref 5. US Department of Health and Human Services, Advisory Committee on Organ Transplantation Recommendations 1–18. http://www.organdonor.gov/research/acotrecs1-18.htm. Accessed May 20, 2009 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

The Ethics of Hematopoietic Stem Cell Donation by Minors

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Publisher
American Medical Association
Copyright
Copyright © 2009 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpediatrics.2009.194
Publisher site
See Article on Publisher Site

Abstract

The article by Kesselheim et al1 regarding the ethics of hematopoietic stem cell (HSC) donation by biological siblings of adopted children points out the importance of intimacy in justifying minors participating as HSC donors. However, the article highlights one common error in this process. Because HLA testing is a simple blood test, parents and physicians believe that they can test children, and do so without considering its broader implications. While the physical risk is minimal, if the child is found to be HLA identical to the potential recipient, questions arise about whether the child is an appropriate HSC donor. This question, however, should be asked before HLA testing is done. In that vein, the case cited by Kesselheim et al was problematic despite the fact that the siblings were found to be non–HLA compatible: nonintimate siblings should not be evaluated to determine if they are eligible to serve as HSC donors.2 The importance of acknowledging that HLA testing is not a routine blood test that should be done on children without some sort of donor advocate is made clear by the conclusion that the authors reach. They suggest that some cases of HSC donation beyond the family may be permissible and include “in theory, intimate friends or nonbiological siblings who happen against all odds to be HLA matched.”1 The problem here is that these minors should not have had HLA testing in the first place, and so, the cases should never arise. This error, in an article offering ethical guidance for HSC donation by minors, confirms the need for a donor advocate for all potential pediatric HSC donors,3,4 a concept that already exists for all pediatric and adult solid organ donors.5 In all HSC donations in which the potential donor is a minor, a donor advocate or donor advocate team should be involved from the onset, and this includes participation in the discussion about whether HLA testing is appropriate. Correspondence: Dr Ross, University of Chicago, 5841 S Maryland Ave, MC 6082, Chicago, IL 60637 (lross@uchicago.edu). Financial Disclosure: None reported. Funding/Support: This work is supported by the National Library of Medicine of the National Institutes of Health. References 1. Kesselheim JCLehmann LEStyron NFJoffe S Is blood thicker than water? ethics of hematopoietic stem cell donation by biological siblings of adopted children. Arch Pediatr Adolesc Med 2009;163 (5) 413- 416PubMedGoogle ScholarCrossref 2. Ross LFGlannon W A compounding of errors: the case of bone marrow donation between non-intimate siblings. J Clin Ethics 2006;17 (3) 220- 226PubMedGoogle Scholar 3. Pentz RDChan KWNeumann JLChamplin REKorbling M Designing an ethical policy for bone marrow donation by minors and others lacking capacity. Camb Q Healthc Ethics 2004;13 (2) 149- 155PubMedGoogle ScholarCrossref 4. Ross LF Ethical and policy lessons to be learned from a family with inherited bone marrow failure. Am J Med Genet A 2008;146A (21) 2715- 2718PubMedGoogle ScholarCrossref 5. US Department of Health and Human Services, Advisory Committee on Organ Transplantation Recommendations 1–18. http://www.organdonor.gov/research/acotrecs1-18.htm. Accessed May 20, 2009

Journal

Archives of Pediatrics & Adolescent MedicineAmerican Medical Association

Published: Nov 2, 2009

Keywords: ethics,hematopoietic stem cells

References