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Open Access Debate

The policy statement of the American academy of pediatrics – children as hematopoietic stem cell donors – a proposal of modifications for application in the UK

Tak Kwong Chan1* and George Lim Tipoe2

Author Affiliations

1 Anatomy, University of Hong Kong, L1-59, Laboratory Block, 21 Sassoon Road, Hong Kong, Hong Kong

2 Department of Anatomy, University of Hong Kong, L1-59, Laboratory Block, 21 Sassoon Road, Hong Kong, Hong Kong

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BMC Medical Ethics 2013, 14:43  doi:10.1186/1472-6939-14-43

Published: 31 October 2013

Abstract

Background

With a view to addressing the moral concerns about the use of donor siblings, the Policy Statement of the American Academy of Pediatrics - Children as Hematopoietic Stem Cell Donors (the Policy) has laid out the criteria upon which tissue harvest from a minor would be permissible.

Discussion

Although tissue harvest serves the best interests of recipient siblings, parents are also obliged to act in the best interests of the donor sibling in the UK. Tissue harvest should proceed if and only if it serves the best interests of both the donor and recipient. Parents should be forbidden, and they are by UK law, to consent to tissue harvest unless there are substantial benefits for an incompetent minor that can outweigh the potential harm. There is no basis to subject a minor to the medical risks of tissue harvest if the recipient sibling can wait without significant risks of complications until the donor becomes Gillick competent. We also argue that the Policy fails to take into account recent advances in haematopoietic transplantation from haploidentical donors or related tissue-matched donors.

Summary

Unless a recipient sibling will suffer from serious complications or die without the transplantation and no other medically equivalent donors are available, there is no moral or legal basis to violate the donor sibling’s right to bodily integrity. Accordingly, we propose that the Policy should be modified in order to fully satisfy the legal requirements for application in the UK and other commonwealth jurisdictions with similar statute laws protecting minors.

Keywords:
Policy; Haematopoietic stem cell transplant; Ethical concerns; Donor siblings