UNESCO Course on
Benefit and Harm
CASE STUDY:
TRANSPLANTATIONS – BONE MARROW DONATION FROM A
MINOR
AB is a 3-year-old girl with an incurable disease known as Gaucher’s
disease. This genetic disease results from an inborn enzyme
deficiency. The symptoms in this patient include severe anemia and
an enlarged liver and spleen, putting pressure on the lungs and
causing breathing difficulties and a tendency to develop pneumonia.
AB’s deteriorating medical condition was temporally relieved after a
splenectomy performed two months ago. Nevertheless, AB’s
condition continues to deteriorate day by day as her liver enlarges.
Currently AB’s disabilities are affecting her mobility, causing her
difficulty in standing and walking. Her condition is expected to
deteriorate rapidly in the next few weeks.
The only treatment likely to restore the missing enzyme and cure AB
is a bone marrow transplant from a matching donor. If AB does not
receive a bone marrow transplant, the disease will lead to her death
within a short time. AB’s brother died of this disease at the age of
one. CD, AB’s 8-year-old sister, was tested and found to be a tissue
match for AB. There does not appear to be any other matching donor
for AB. The risks to the donor are minimal. The only risk is from the
anesthesia. Removing the bone marrow from CD’s body is a simple
procedure, involving extracting an amount of bone marrow equal in
volume to a unit of blood.
Dr. S, a child psychiatrist, believes that extracting bone marrow from
CD might be traumatic. He also believes she will be more
traumatized if she must live with the feeling that she did not do
everything she could have to save her sister’s life. This trauma will
increase as she enters adolescence. Dr. S believes that it is in CD’s
best emotional interests to donate bone marrow and recommends
proceeding with the transplant.
Should a bone marrow transplant from CD to her sister be
allowed?