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Medical Ethics

The Ethical Justification for Minor Sibling Bone Marrow Donation: A Case Study

^aWinship Cancer Institute, Emory University, Atlanta, Georgia, USA; ^bAflac Cancer Center and Blood Disorders Center, Emory University School of Medicine, Atlanta, Georgia, USA; ^cChildren's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; ^dSt. Jude Children's Research Hospital, Memphis, Tennessee, USA; ^eAlberta Children's Hospital, Calgary, Alberta, Canada; ^fCincinnati Children's Hospital, Cincinnati, Ohio, USA; ^gThe Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

Correspondence: Rebecca D. Pentz, Ph.D., Winship Cancer Institute, Emory University, 1365 Clifton Rd. NE, C3008, Atlanta, Georgia 30322, USA. Telephone: 404-778-5694; Fax: 404-778-5520; e-mail: rpentz{at}emory.edu

Disclosure: No potential conflicts of interest were reported by the authors, planners, reviewers, or staff managers of this article.

Using a case study of a mentally delayed minor sibling donating bone marrow for his older sister, we discuss an alternative ethical justification for minor donation. The accepted justification for permitting minor siblings to donate bone marrow or peripheral blood stem cells is that the donor will benefit because of the greater likelihood of survival and less suffering of the sibling. Based on the limited data from four small retrospective studies of the risks and benefits for minor donors, we argue that there is a possibility, illustrated by this case, that the donor may not benefit, particularly if the transplant is unsuccessful. We, therefore, encourage the oncology community to increase support for minor donors, particularly mentally delayed ones. We also argue that the donation can be ethically justified based on the donor's familial duty to his sister. The basis of familial duties is complex, including such factors as the nature, intimacy, and history of the relationship and the specific risks and benefits to all involved. We examine each of these factors for our case study.