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Donor assessment and follow-up: not a minor issue

Bone Marrow Transplantation volume 54, pages 1728–1729 (2019)Cite this article

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Hematopoietic stem cell transplantation (HSCT) from family members still carries out significant advantages compared with unrelated donors, providing easier logistic and availability issues before transplant, better minor antigen match, and an option for further intervention such as donor lymphocyte infusion (DLI). When the recipient is a child—the chances are that a matched sibling donor will also be a minor. For many pediatric nonmalignant disorders, matched sibling donor transplant is encouraged over alternatives [1, 2]. Long-term data have confirmed that the donation procedure is safe [3], but substantial psychological and social stress is involved in the process of donation to a family member [4], especially when the donor is a minor [5, 6].

Hence, the transplant center deals with two pediatric patients: the recipient and the donor, a situation that may lead to conflicts of interests of treating physicians as well as parents. Previous work has shown a significant discrepancy between the perception of the donation process, the stress felt by the minor donor, and his or her quality-of-life impairment—which are generally positively overestimated by parents [7]. For example, pediatric donors perceive no choice in typing or donation [7, 8]. To address this, almost a decade ago, several guidelines emerged for related and unrelated donors, including a policy regarding the donation process for minors [9,10,11]. The American Association of Pediatrics (AAP) states five major criteria for family member minor donation [11] including:

  1. 1.

    Lack of a medical-equivalent adult relative able to donate.

  2. 2.

    Presence of a strong positive relationship between the donor and the recipient.

  3. 3.

    It is likely that the recipient will benefit from the transplantation.

  4. 4.

    Reducing donor risks (clinical and emotional) to a minimum.

  5. 5.

    Parental consent and child assent.

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Authors and Affiliations

  1. Division of Pediatric Hematology, Oncology and BMT, The Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Israel

    Elad Jacoby & Daphna Hutt

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Elad Jacoby

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  1. Elad Jacoby
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  2. Daphna Hutt
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Correspondence to Elad Jacoby.

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Jacoby, E., Hutt, D. Donor assessment and follow-up: not a minor issue. Bone Marrow Transplant 54, 1728–1729 (2019). https://doi.org/10.1038/s41409-019-0529-x

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