Tuesday, May 31, 2011

Ethics in Bone Marrow Transplant

There are many reasons for having children, but the most peculiar reason to have another baby is to save an already sick child. Before I start talking about the article, here is some background information about leukemia. Leukemia is a cancer of the blood and bone marrow. The identifying characteristic of the disease is the out of control accumulation of blood cells.



There are four types: acute myelogenous, acute lymphocytic, chronic myelogenous, and chronic lymphocytic. Acute means advance quickly and chronic means progress slowly. Myelogenous refers to marrow cells that are precursors to red blood cells, platelets, and some white blood cells. Lymphocytic refers to marrow cells that lead to lymphocytes. The broad overview of the disease mechanism is that the cancerous cells originate in the bone marrow, undergo a change, and divide until they overcrowd the healthy, normal cells.
These cancerous cells are more robust and survive better than healthy cells. Also the mechanism varies, depending on the specific type of leukemia. Some symptoms of leukemia are fatigue, shortness of breath, pale skin color, night sweats, slight fever, excessive bleeding, enlarged nodes, susceptibility to bruising, slow healing, small (pinhead) red spots on skin, aching joints and bones, and abnormal white blood cell counts. Five year survival rates: acute lymphocytic leukemia 66.4% and 90.8% for children under 5, chronic lymphocytic leukemia 79.7%, acute myelogenous leukemia 24.2% and 60.9% for children under 15, and chronic myelogenous leukemia 54.6%. Treatments for leukemia includes chemotherapy, biological therapy, target therapy, radiation therapy, and stem cell transplant.


The article is about a Californian couple who has a 17 year-old daughter with chronic myelogenous leukemia. They desperately searched for a bone marrow donor within their family and search systems, but no one matches their daughter. The father decides to reverse his vasectomy and the parents conceive a child in hopes of finding a donor that matches their daughter. The newborn baby, who is also a girl, is a full match and the parents go through with the bone marrow transplant without any further complications. From my research, I found out other parents in the United States have also conceived another child just to get a matching donor for their sick child. Search systems to find a bone marrow donor are very expensive and time consuming; time is very precious to someone who is sick. The age of the youngest donor known was only 6 weeks old. A successful transplant is determined by the number of cells transplanted per kilogram of the patient’s weight. So an adequate amount of cells must be given without harming the donor. There are some ethical issues involving these situations: is it fair for conceived children to “donate” bone marrow to their siblings? Should they even be called donors when they have no say? Are parents justified to conceive another child when their purpose is to heal their already sick child? Are child donors too young to participate in bone marrow transplants? Where the line should be drawn? These issues are problematic, but legally speaking parents can make children. Our legal system works by following previous case rulings. For laws to be implemented about bone marrow transplant there must be a case where the conceived child sues their parents for approving a bone marrow transplant to happen on them; a case like that would cause laws to be implemented about bone marrow transplant.