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Médecine thérapeutique / Pédiatrie

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Ethical and regulatory aspects of collecting hematopoietic stem cells from children Volume 24, issue 1, January-February-March 2022

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Author
Agence de la biomédecine, Direction Générale Médicale et Scientifique, Direction Prélèvement Greffe organes –tissus, Service régional Auvergne Rhône-Alpes : réseau ARLO, Service régional Occitanie : réseau REPRELAR, 1 avenue du Stade de France, 93212 Saint-Denis La Plaine
* Correspondance : I. Pipien

Hematopoietic stem cells transplant (HSCT) remains, for hematologic malignancies and some non malignant hematologic diseases, the last therapeutic recourse for adult and paediatric patients. Probability to find a histocompatible donor is 1 for 1 million in international registers. In the family, this probability for a genoidentical donor is 33%. Haploidentical HCST is being increasingly used and allows appeal to intra family donor, from parent to child but also from child to parent. Access of blood/marrow gift by a minor donor is covered by law with a derogatory procedure. Child’s protection depends of a Living Donor Committee Experts (LDCE), depending of Biomedicine Agency, who receives and questions the child –alone if more than 7 years old and, after, with his parents, before giving official authorization. According to a recent law –August 2021 –a child can give HCSC to his father or mother. Every year, 90 children are presented to the LCDE for a possible donation. To approach ethical problems concerning HCST by children, a clinical case of an autistic child donation for his sister and the role of LCDE are presented. Despite law regulation and LCDE role are in place, some suggestions for possible improvement are suggested.