Establishing the role of pre-implantation genetic diagnosis with human leucocyte antigen typing: what place do “saviour siblings” have in paediatric transplantation?
- 1Centre for Values, Ethics and the Law in Medicine, University of Sydney, New South Wales, Australia
- 2Centre for Clinical Research Excellence: Infection and Bioethics in Haematological Malignancies, Westmead Hospital, New South Wales, Australia
- 3Haematology Department, Westmead Hospital, Westmead, New South Wales, Australia
- 4BMT Services, Oncology Unit, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- 5Discipline of Paediatrics & Child Health, University of Sydney, Camperdown, New South Wales, Australia
- 6School of History and Politics, University of Adelaide, Adelaide, South Australia, Australia
- Gabrielle Samuel, Centre for Values, Ethics and the Law in Medicine, Level 1, Medical Foundation Building K25, University of Sydney, New South Wales 2006, Australia; gsamuel{at}med.usyd.edu.au
- Accepted 28 July 2008
- Published Online First 6 August 2008
Abstract
Background: Not all children in need of a haematopoietic stem cell transplant have a suitable relative or unrelated donor available. Recently, in vitro fertilisation (IVF) with pre-implantation genetic diagnosis (PGD) for human leucocyte antigen (HLA) tissue typing has been used to selectively transfer an IVF embryo in order to produce a child who may provide umbilical cord blood for transplantation to an ill sibling. Such children are sometimes called “saviour siblings”.
Objective: To examine the published clinical and epidemiological evidence relevant to the use of this technology, with the aim of clarifying those situations where IVF and PGD for HLA typing should be discussed with parents of an ill child.
Design: A critical analysis of published literature on comparative studies of umbilical cord blood versus other sources of stem cells for transplantation; comparative studies of matched unrelated donor versus matched related donor transplantation; and the likelihood of finding an unrelated stem cell donor.
Conclusion: IVF and PGD for HLA typing is only applicable when transplantation is non-urgent and parents are of reproductive age. Discussions regarding this technology may be appropriate where no suitable related or unrelated donor is available for a child requiring a transplant, or where no suitable related donor is available and transplantation is only likely to be entertained with a matched sibling donor. Discussion may also be considered in the management of any child lacking a matched related donor who requires a non-urgent transplant or may require a transplant in the future.
Footnotes
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Funding: This research is funded by the Cancer Council of New South Wales (RG 07–16). KAS is funded by a PhD scholarship from the Australian National Health and Medical Research Council (NHMRC) Centre for Clinical Research Excellence in Infection and Bioethics in Haematological Malignancies.
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Competing interests: None.
