Minor siblings routinely donate hematopoietic stem cells (HSC) for transplantation. However, the ethical justification for using minors as donors is controversial. Prompted by a recent case involving a biological sibling who, because of adoption, had no intimate relationship to the potential transplant recipient, we review systematically the ethical foundation for using minors as HSC donors. Analysis of the various potential justifications for using minor siblings as donors suggests that HSC donation in this case is ethically impermissible. Looking beyond this particular example, we contend that optimal patient advocacy requires that generalist and specialist pediatricians be familiar with the ethical framework that guides decisions about accepting minors as HSC donors.
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