COMMENTARY

Is It Right to Ask a 4-Year-Old to Donate Bone Marrow?

Arthur L. Caplan, PhD

Disclosures

August 02, 2018

Hi. I'm Art Caplan, and I'm the director of the Division of Medical Ethics at the NYU School of Medicine.

Michael is a 4-year-old in Philadelphia. He has two twin brothers who suffer from a very rare immune disease, and the treatment for them is to get a bone marrow transplant.

Michael's parents [want their sons to receive bone marrow transplants], and they have been telling Michael that he can be a superhero. They bring up analogies to comic book heroes and things that you might see in a film that a 4-year-old would pay attention to, and say, "You can do the heroic thing, you can help your brothers." Michael says, "Yes. I want to donate the bone marrow."

Is this right? It's interesting because, in the past, we've seen families conceive a child in hopes that [the child would be] a match for another sibling who needed a bone marrow transplant. Parents can go quite a distance to find a matched bone marrow donor or bone marrow banks, and some patients may ask whether should they register or become a member of the National Marrow Donor Program. I think the answer is yes. I'm registered there and I helped found that organization—I was on the board. Sometimes you can find a donor and you might not have to use a child, but to be honest, the best matches are going to come from close biological relatives.

I think Michael's parents are doing what parents are going to do—try to help their children. And you know, it's a Sophie's choice. You don't want to say, "Well, Michael, if you say no, we're going to go along with that." I'm sure they're going to push as hard as they can to rescue the younger twins. But I think in these kinds of cases, no one would prohibit bone marrow donation from a 4-year-old.

A Person Who Will Protect the Child

I do think they [should have the case] looked at by an independent judge. I might say, "Let's have a judge take a look at the situation." [The judge will] make sure that the child who's being asked to be the bone marrow donor doesn't have health problems and that the parents aren't minimizing risks because they want so much to help their other children. [The judge can help] ensure that there's no other option, that they're not putting the child forward when one of the parents might be a donor to these twins. So, I think independent review is key.

Four-year-olds can't consent. Four-year-olds under a lot of pressure from their parents can't consent. A child who's been conceived so that they could be a bone marrow donor for a sibling, they're not going to be able to consent. In the absence of consent, ethically, what we have to do is request independent review.

Bone marrow donation isn't easy. It's painful. I don't think it is a high risk for death, but it certainly could be sore and achy. It might require a second bone marrow donation if the first one were to fail. So, there are risks and burdens that a child would face.

[I think the best way to handle these cases is to have] someone outside the family, someone outside the caregivers, ensure that it's a reasonably safe option and it's not going to put the child at too much risk. I'm Art Caplan from the NYU School of Medicine. Thanks for watching.

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