Learning Objective #1: Identify the ethical issues involved for the donor child in sibling-to-sibling transplants

Learning Objective #2: Develop and discuss ideas on ways to assure that the rights of the donor child are valued and protected during the donation process

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On December 23, 1954 the first human organ transplant occurred in the US. Presently throughout the world 400,000 transplants are done for children from birth to 18 years of age annually (Parmar, et al, 2003). Research has demonstrated that the most successful transplants are those that occur within families (MacLeod, et al. 2003). Due to close genetic links and increased likelihood of tissue matching siblings are a natural consideration as possible donors. The first successful bone marrow transplant between siblings was in 1958 when a 5 month old's bone marrow was used to save his sister's life. Since that time bone marrow transplantation (BMT) between siblings have continued to grow with 75% of BMT's presently occurring as sibling to sibling donations. (MacLeod, et al., 2003). It is important to recognize that risks associated with donations vary according to type of donation. BMT have relatively lower physical risks to the child then kidney transplants. The physical risks to the donor children are well known and easy to identify and discuss with parents as they make the decision to consent or not. What are not well known and difficult to predict for parents is the psychological outcomes for the donor child. These issues are rarely discussed or considered in the present consent processes in many sites. Little research has been done addressing the issues of the donor sibling's rights, emotional impact and ability to consent to these procedures. In order to be able to provide parents with enough information to make an informed decision there needs to be further research in the area which focuses on the donor children. This presentation will provide an overview of the ethical issues involved in sibling transplants and provide an evidenced based ethical protocol that could be implemented by advanced practice nurses working in transplant settings.