Hematopoietic Stem Cell Transplantation: A Bioethical Lens

Abstract

Hematopoietic stem cell transplantation (HSCT) is one of a range of therapeutic options available to patients suffering from various diseases. HSCT procedure involves important ethical and legal aspects that can occur at every phase of the procedure: the clinical choice of whether to perform the procedure, pretransplantation preparation regimens, donor selection, stem cell harvest procedure, transplantation phase, and short-term and long-term follow-up care. In this discussion paper, we outline the ethical issue-facing physicians involved in HSCT. Currently, HSCT is a widely accepted treatment for many life-threatening diseases. It thus represents a real therapeutic hope for many patients. It does, however, carry a burden of possible morbidity and mortality. Consequently, there are substantial information and communication issues involved in the consent process for HSCT. In the final decision, the judgements of different parties, such as patients, family members, and healthcare professionals, intersect and overlap and this is particularly true when the patient is a minor. Finally, HSCT is a very expensive procedure. The social and economic concerns of HSCT are discussed within the actual contextual framework of the dramatic increase in healthcare costs and inequalities in healthcare in relation to socioeconomic status, educational status, and ethnicity.

Association of Outcomes and Socioeconomic Status in Mexican Patients Undergoing Allogeneic Stem Cell Transplantation

“…HSCT is an expensive procedure [12] and even though the cost is substantially lower in countries like Mexico [9], it still represents a financial challenge for most patients, especially when one-half of the population is vulnerable and lives in poverty. Numerous studies have suggested that SES influences health outcomes associated with cancer incidence and mortality [13].…”

Application of latent class analysis in diagnosis of graft-versus-host disease by serum markers after allogeneic haematopoietic stem cell transplantation

“…Hematopoietic stem cell transplantation (HSCT), either autologous or allogeneic, is an intensive therapy for patients who suffer from refractory or relapsing neoplastic disease and non-neoplastic genetic disorders 1,2 . Global, the rate of allogeneic HSCT continues to increase such that about 50,000-60,000 transplantation was performed annually.…”

Immigrants as donors and transplant recipients: specific considerations

“…Loss to follow-up and non-adherence to long treatments are common, frequently due to misconceptions about the disease course (i.e. remission perceived as a definitive cure) or inability to adhere to follow-up due to the fear of job loss [13,14]. Finally, nonfamiliarity with the medical model of the hosting countries may impede long-term maintenance of treatment [13,14].…”