Bone marrow, a soft, spongy tissue inside bones, produces various blood components: red blood cells for oxygen transport, white blood cells for fighting infections, and platelets for clotting. When diseased or damaged, it fails to produce healthy blood cells, leading to severe conditions. Bone marrow transplantation replaces unhealthy marrow with healthy blood-forming stem cells. This procedure treats conditions like leukemias, lymphomas, aplastic anemia, and certain immune deficiencies.
When Child Donation is Considered
Bone marrow donation from a child is a rare and highly restricted occurrence. These donations are almost exclusively for family members, most often siblings, due to the need for a close genetic match, specifically in human leukocyte antigens (HLA). A full sibling has approximately a 25% chance of being an exact HLA match, making them the most likely related donor. Child donation is typically a last resort when no suitable adult donor, related or unrelated, can be identified.
Children generally cannot register as donors for public registries, like the National Marrow Donor Program (NMDP), until they reach adulthood, usually 18 years old. Public registries prioritize donors aged 18 to 40, as cells from younger donors often lead to more favorable outcomes for recipients. Despite these limitations, a child’s donation can be life-saving, offering a chance for recovery from severe illnesses.
Medical Procedures and Risks for Child Donors
Two primary methods exist for collecting stem cells for transplantation: bone marrow harvest and peripheral blood stem cell (PBSC) donation. Bone marrow harvest, the traditional approach, involves extracting marrow directly from the hip bone. This procedure requires general anesthesia, ensuring no pain during collection. Needles are inserted into the pelvic bone to draw out the liquid marrow.
Risks with general anesthesia, though uncommon, include potential breathing difficulties, allergic reactions, and in rare instances, brain damage or death, often linked to pre-existing health conditions. Minor side effects include nausea, drowsiness, and a sore throat. After a bone marrow harvest, children may experience pain and soreness at the donation site, along with bruising and fatigue, which typically resolve within days to a few weeks. There is also a small chance of infection or bleeding.
PBSC donation is a less common method for very young children. In this procedure, the child receives daily injections of filgrastim for several days before donation. This medication prompts stem cells to move from the bone marrow into the bloodstream. Stem cells are then collected through apheresis: blood is drawn from a vein, processed by a machine to separate the stem cells, and the remaining blood is returned to the donor.
Side effects from filgrastim can include bone pain, muscle aches, headaches, and fatigue, similar to flu-like symptoms. During apheresis, some donors may experience tingling sensations or lightheadedness. Medical teams diligently monitor the child’s health throughout both processes to minimize potential risks.
Ethical and Legal Safeguards
The decision for a child to donate bone marrow is governed by stringent ethical guidelines and legal frameworks protecting the child’s welfare. Parental consent is mandatory for any medical procedure involving a minor. For older children, their assent, meaning they understand and agree to the procedure, is also important to ensure they are not unduly pressured.
A key principle is the “best interest of the child” standard, dictating that the donation must genuinely serve the donor child’s well-being, not solely the recipient’s. Medical and ethics committees rigorously review each case to ensure these standards are met. If there is no direct familial relationship or parental disagreement, courts may become involved.
An independent advocate or guardian ad litem is sometimes appointed to represent the child’s interests. Psychological assessments of the child and family may also evaluate emotional readiness and potential emotional impact. While there is no direct medical benefit for the donor, helping a family member can offer substantial psychosocial benefits.
The Donation Process and Recovery
Once a child is deemed eligible and approved for bone marrow donation, a thorough pre-donation evaluation occurs. This involves detailed medical tests, physical examinations, and comprehensive consultations to ensure the child is healthy enough to donate. Families also receive information sessions explaining the process in detail.
For a bone marrow harvest, the child typically stays in the hospital for one to two days. The collection procedure usually lasts one to two hours under general anesthesia. PBSC donation is often an outpatient procedure, though it may require several sessions, each lasting four to six hours. After the procedure, the child is closely monitored in a recovery area.
At home, recovery includes soreness, fatigue, and bruising at the donation site. Most children return to regular activities, like school and play, within a few days to a couple of weeks. The body naturally regenerates the donated marrow within a few weeks. Follow-up appointments continuously monitor the child’s health and ensure a complete recovery.