The review also assesses the circumstances in which a minor may ethically be a hematopoietic stem cell donor, how to reduce risks to the donor and recipient,
While the ethical considerations spelled out below are important for all involved to think about when considering a minor as hematopoietic stem cell donor, one key question has been left out. “What does the child think?” Would you yourself donate stem cells to your sibling?
I can’t speak for all hematopoietic stem cell donors of course, but I can draw on my experiences as a long-term survivor of an autologous stem cell tranplant patient (my own stem cells) who may have had an allogeneic stem cell transplant if any of my siblings had been a match. See the study’s explanation below.
Had I been able to donate stem cells to one of my siblings or had one of my siblings been able to donate to me, we should share a bond for the rest of our lives.
Are you considering a BMT? Scroll down the page, post a question or comment to learn more about the complicated world of hematopoietic stem cell transplantation.
Thanks,
David Emerson
- Cancer Survivor
- Cancer Coach
- Director PeopleBeatingCancer
Recommended Reading:
” Minors may ethically serve as stem cell donors provided specific criteria are met…”In the past half-century, hematopoietic stem cell transplantation has become standard treatment for a variety of diseases in children and adults, including-
- selected hematologic malignancies,
- immunodeficiencies,
- hemoglobinopathies,
- bone marrow failure syndromes,
- and congenital metabolic disorders,
“There are 3 sources of allogeneic hematopoietic stem cells: bone marrow, peripheral blood, and umbilical cord blood; each has its own benefits and risks. Children often serve as hematopoietic stem cell donors, most commonly for their siblings.”
Compared with unrelated donors, human leukocyte antigen (HLA)–matched biological siblings are usually preferred as donors because risks for transplant-related complications are decreased.
The AAP statement reviews the ethical issues concerning minors being stem cell donors, considering traditional benefit/risk calculations for the donor as well as for the recipient. The review also assesses the circumstances in which a minor may ethically be a hematopoietic stem cell donor, how to reduce risks to the donor and recipient, details of the informed-consent process, the role for a donor advocate or other protective safeguard, and other ethical concerns.
Specific AAP recommendations regarding minors acting as hematopoietic stem cell donors include the following:
Five criteria must be fulfilled for children who are medically appropriate potential donors to ethically serve as hematopoietic stem cell donors:
- No medically equivalent histocompatible adult relative is available who is willing and able to donate;
- The potential donor and recipient have a strong, personal, and emotionally positive relationship;
- There is reasonable likelihood of benefit to the recipient;
- Compared with the benefits expected for the donor and the recipient, the clinical, emotional, and psychosocial risks to the donor are reasonable and are minimized to the extent possible…
- Parental permission is obtained, as well as consent of the child when appropriate.
- For all minors being considered as hematopoietic stem cell donors, a donor advocate with expertise in pediatric development should be appointed…
- To the degree that they are capable, children and adolescents being considered as hematopoietic stem cell donors should be included in all stages of decision making.
- The family may ask the pediatrician about in vitro fertilization with preimplantation genetic diagnosis to ensure conception of an HLA-matched sibling for cord blood donation. Obtaining umbilical cord blood poses no risk to the newborn infant, provided delivery is not modified. In those cases in which additional hematopoietic stem cells are required from this child, the other criteria listed above regarding pediatric donors must be met.
- Research is needed on donors and recipients to advance the effectiveness of various hematopoietic stem cell transplants.
