Ethics and Apheresis: What Choice is There?

Abstract

By comparison with many other procedures in medicine, apheresis for collection of haematopoietic progenitor cells (HPC) is a relatively innocuous process. The procedure itself is straightforward, serious adverse effects are rare and many donors experience real benefits. But the apparent simplicity of HPC harvest is misleading as apheresis raises substantial issues of consent, risk assessment and conflict of interest. G-CSF primed apheresis is associated with a number of predictable shortterm risks and unpredictable long-term risks, particularly in those who submit to a second or third donation. Donors are often coerced by the very nature of their relationship to the recipient and by expectations of altruism and are infrequently offered a true choice between bone marrow harvest and peripheral HPC harvest. And, as is the case in solid organ donation, HPC donors may consent to HPC collection for a number of different reasons, some of which may negatively impact upon their experience of apheresis and may give rise to concerns regarding late withdrawal from donation. While these issues are complex enough where competent adults are the donors, they are more difficult again where the ‘donor’ in not competent, is mentally ill or is a child. In this paper I will review the ethics of apheresis, critique the concept of informed consent and the disproportionate concern with unrelated donors, and consider whether current practices are ethically justifiable.