Transplant of bone marrow and cord blood hematopoietic stem cells in pediatric practice, revisited according to the fundamental principles of bioethics.
The two most widely used sources of hematopoietic stem cells for allogeneic transplants in pediatric practice are bone marrow (BM) and cord blood (CB).
While bone marrow transplantation (BMT) is reaching its 30th year of application, human umbilical cord blood transplantation (HUCBT) is approaching its 10th.
Although these procedures have basically the same purpose, a number of biological differences distinguish them.
In particular, the intrinsically limited quantity of CB stem cells and their immunological naivete confer peculiar characteristics to these hematopoietic progenitors.
From a bioethical point of view, the problems which have repeatedly been raised when the BM donor is a child are well-known.
Different but no less important ethical problems are raised when one considers HUCBT ; in this regard the most important issues are the easier propensity of programming a CB donor in comparison with a BM donor (clearly due to the shorter time interval needed to collect the hematopoietic progenitors) ; the in utero HLA-typing ; the implication of employing'blood belonging to a neonate'for a third party ; the need to perform a number of investigations both on the CB of the donor and on the mother and the implications that the discovery of disease may have for them, but also the need to establish banks for storing CB, with the accompanying administration and management problems. (...)
Mots-clés Pascal : Greffe, Homogreffe, Cellule souche, Cellule hématopoïétique, Sang, Cordon ombilical, Moelle osseuse, Consentement éclairé, Ethique, Economie santé, Analyse avantage coût, Enfant, Homme, Transfusion
Mots-clés Pascal anglais : Graft, Homograft, Stem cell, Hematopoietic cell, Blood, Umbilical cord, Bone marrow, Informed consent, Ethics, Health economy, Cost benefit analysis, Child, Human, Transfusion
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0346106
Code Inist : 002B30A09. Création : 12/09/1997.