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The article by Kesselheim et al1 regarding the ethics of hematopoietic stem cell (HSC) donation by biological siblings of adopted children points out the importance of intimacy in justifying minors participating as HSC donors. However, the article highlights one common error in this process. Because HLA testing is a simple blood test, parents and physicians believe that they can test children, and do so without considering its broader implications. While the physical risk is minimal, if the child is found to be HLA identical to the potential recipient, questions arise about whether the child is an appropriate HSC donor. This question, however, should be asked before HLA testing is done. In that vein, the case cited by Kesselheim et al was problematic despite the fact that the siblings were found to be non–HLA compatible: nonintimate siblings should not be evaluated to determine if they are eligible to serve as HSC donors.2
The importance of acknowledging that HLA testing is not a routine blood test that should be done on children without some sort of donor advocate is made clear by the conclusion that the authors reach. They suggest that some cases of HSC donation beyond the family may be permissible and include “in theory, intimate friends or nonbiological siblings who happen against all odds to be HLA matched.”1 The problem here is that these minors should not have had HLA testing in the first place, and so, the cases should never arise. This error, in an article offering ethical guidance for HSC donation by minors, confirms the need for a donor advocate for all potential pediatric HSC donors,3 - 4 a concept that already exists for all pediatric and adult solid organ donors.5 In all HSC donations in which the potential donor is a minor, a donor advocate or donor advocate team should be involved from the onset, and this includes participation in the discussion about whether HLA testing is appropriate.
Correspondence: Dr Ross, University of Chicago, 5841 S Maryland Ave, MC 6082, Chicago, IL 60637 (lross@uchicago.edu).
Financial Disclosure: None reported.
Funding/Support: This work is supported by the National Library of Medicine of the National Institutes of Health.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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