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Ethical considerations of using a single minor donor for three bone marrow harvests for three HLA‐matched siblings with primary immunodeficiency
Author(s) -
Parikh Suhag H.,
Pentz Rebecca D.,
Haight Ann,
Adeli Mehdi,
Martin Paul L.,
Driscoll Timothy A.,
Page Kristin,
Kurtzberg Joanne,
Prasad Vinod K.,
Barfield Raymond C.
Publication year - 2019
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.27602
Subject(s) - medicine , sibling , human leukocyte antigen , bone marrow , bone marrow transplantation , primary immunodeficiency , immunodeficiency , transplantation , hematopoietic stem cell transplantation , immunology , haematopoiesis , bone marrow transplant , stem cell , pediatrics , antigen , immune system , genetics , psychology , developmental psychology , biology
Allogeneic hematopoietic stem cell transplantation is curative for primary immunodeficiencies. Bone marrow from an unaffected human leukocyte antigen (HLA)‐identical sibling donor is the ideal graft source. For minor donors, meaningful consent or assent may not be feasible, and permission from parents or legal guardians is considered acceptable. Adverse events, albeit extremely small, can be associated with bone marrow harvest in pediatric donors. Donor safety concerns potentially increase with multiple bone marrow harvests. Very little is known about multiple bone marrow harvests from pediatric donors. We describe the ethical considerations and clinical decision‐making in an unusual clinical situation where three patients with the same primary immunodeficiency were HLA identical to one another and their younger sibling, who underwent bone marrow harvests three times between 1.3 and 4 years of age, resulting in successful transplantation for all three patients. We hope that this experience will provide guidance to providers and families in a similar situation.