An 8-Year-Old Foster Child With Behavioral Problems Who Needs a Bone Marrow Transplant

Abstract

Patients who undergo bone marrow transplant (BMT) must adhere to a complex follow-up regimen. Nonadherence may lead to graft failure and death. Serious psychological disorders that interfere with the recovery process may be a contraindication to BMT. This issue’s “Ethics Rounds” raises issues about whether psychosocial issues should ever disqualify a child from receiving a transplant. Respondents are Maureen Kelley, PhD, a philosopher and bioethicist at the University of Washington School of Medicine and Seattle Children's Hospital; Yoram Unguru, MD, MS, MA, a pediatric hematologist/oncologist and bioethicist at the Herman & Walter Samuelson Children's Hospital at Sinai and Johns Hopkins Berman Institute of Bioethics; and G. Douglas Myers, MD, a hematopoietic stem cell transplant (HSCT) physician at Children's Mercy Hospital. ### Case Presentation B.K. is an 8-year-old boy with relapsed acute myelogenous leukemia (AML) and multiple social and psychiatric problems. B.K. has been a ward of the state since 3 years of age when his single mother lost parental rights due to substance abuse. The father is not known. B.K. has been in and out of 3 foster homes, including a medical group home during his first treatment of AML at age 5 years. He was diagnosed by a psychiatrist as having attachment disorder. He is currently in the inpatient psychiatry unit given behavioral difficulties exhibited when on the oncology ward, including aggression and temper fits. B.K. is very intelligent and often asks direct questions about his illness. He has become very close to 1 of the psychiatry nurses, who has considered offering temporary medical foster care for B.K. He has no relatives other than his mother. A court-appointed guardian ad litem and a state case worker are charged with making medical decisions on his behalf. They report that there is no immediate prospect for foster placement for B.K. given his medical and … Address correspondence to John D. Lantos, MD, Children’s Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64105. E-mail: jlantos{at}cmh.edu