Bone Marrow Donation Between Siblings Living in Different Families

Minor siblings are often considered as potential bone marrow donors when a child needs a bone marrow transplant. The practice of using minors as bone marrow donors is ethically controversial, because there is some risk to the donor—and some pain and suffering—but no medical benefit. Nevertheless, most courts and most ethics committees have sanctioned bone marrow donation procedures as long as the donor and the recipient are in the same family and have an emotional tie. Presented here is a case that pushes the limits of those criteria; we asked Drs Doug Diekema, Steve Joffe, and Andrea Vandeven to comment on the ethical issues raised by this unusual case. Dr Diekema is immediate past-chair of the American Academy of Pediatrics Committee on Bioethics; Dr Joffe is a pediatric oncologist at Boston Children's Hospital; and Dr Vandeven is a member of the child-protective-services (CPS) team at Children's Mercy Hospital in Kansas City, Missouri.

K. B. was a 7-week-old girl who was brought to the emergency department for poor weight gain. She was 3 oz over her birth weight. Her parents reported that she had been taking 2 oz of formula every 2 to 3 hours. However, doctors in the emergency department noted that the parents did not know how to feed her and fell asleep while she was crying. CPS was called. They were familiar with the family, because a 17-month-old sister had been previously removed from the home for neglect and placed with a foster family.

After an extensive medical workup, K. B. was diagnosed with infantile osteopetrosis. The only treatment for this disease is a bone marrow transplant. Children who do not receive a transplant usually die in the first decade of life.

The foster family that had taken the 17-month-old sibling were planning to adopt her but were …

Address correspondence to John D. Lantos, MD, Department of Pediatrics, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108. E-mail: jlantos{at}cmh.edu