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The Ethics of Hematopoietic Stem Cell Transplantation for Sickle Cell Disease

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Sickle Cell Disease and Hematopoietic Stem Cell Transplantation

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Abstract

Hematopoietic stem cell transplant (HSCT) is a currently available cure for SCD, but its use raises ethical questions that often do not have definite answers. Five such important questions include: (1) Should HSCT be offered to children with less severe SCD? (2) Should assisted reproductive technology be used to conceive sibling donors? (3) Should HSCT be offered to children with significant social concerns? (4) Should children from low-income countries who plan to return to these countries be evaluated for HSCT differently? (5) What ethical considerations are relevant in HSCT for adults with SCD? Answers to these questions will be explored using the principles of nonmaleficence, beneficence, respect for autonomy, and justice.

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Authors and Affiliations

  1. Division of Hematology, Children’s National Medical Center, Washington, DC, USA

    Robert Sheppard Nickel

  2. Center for Cellular Therapies and Research, AABB, Bethesda, MD, USA

    Naynesh Kamani

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  1. Robert Sheppard Nickel
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  2. Naynesh Kamani
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Correspondence to Robert Sheppard Nickel .

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Editors and Affiliations

  1. Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA

    Emily Riehm Meier

  2. Division of Blood and Marrow Transplantation, Children’s National Medical Center, Washington, DC, USA

    Allistair Abraham

  3. Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA

    Ross M. Fasano

Glossary

Beneficence

Principle of biomedical ethics that refers to an obligation to act for the benefit of others

In vitro fertilization (IVF)

Assisted reproductive technology procedure in which eggs are first harvested, and these eggs are then combined with sperm in the laboratory to create embryos

Nonmaleficence

Principle of biomedical ethics that asserts an obligation not to inflict harm intentionally

Preimplantation genetic diagnosis (PGD)

Process used to identify genetic defects or traits in embryos created through in vitro fertilization (IVF) prior to their transfer to the uterus. Embryos to transfer and implant are selected based on the results of the genetic testing

Respect for autonomy

Principle of biomedical ethics that requires honoring a person’s right to make his or her own choices

Justice

Principle of biomedical ethics that ensures equals are treated equally and concerns the fair distribution of benefits and burdens

Rule of double effect

Ethical doctrine used to justify claims that a single act having both good and harmful foreseen effects is not always morally prohibited if the harmful effect is not intended

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Nickel, R.S., Kamani, N. (2018). The Ethics of Hematopoietic Stem Cell Transplantation for Sickle Cell Disease. In: Meier, E., Abraham, A., Fasano, R. (eds) Sickle Cell Disease and Hematopoietic Stem Cell Transplantation . Springer, Cham. https://doi.org/10.1007/978-3-319-62328-3_9

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