Addressing Ethical and Procedural Principles for Unrelated Allogeneic Haematopoietic Progenitor Cell Donation in a Changing Medical Environment.

Transplantation of allogeneic haematopoietic progenitor cells (HPC), as part of a potential life-saving treatment for haematological disorders, is a well-established medical procedure. Due to the efforts of the World Marrow Donor Association (WMDA) and other professional medical and scientific organisations, donation and collection of HPC from adult volunteer donors has become suitably regulated and standardized. Ongoing changes in the treatment of haematological disorders however, have led to a practice where organisations providing HPC from volunteer donors are confronted with requests for multiple or other than standard bone marrow or peripheral blood stem cell donations. These requests are sometimes a direct challenge to the donor's commitment. On the other hand, changing regulations requires adjustment of current treatment and collection standards and informed consent procedures. In this paper we discuss the potential impact and consequences for the donor's commitment and informed consent procedures and provide ethical guidance based on examples of daily practice of organisations providing HPC from volunteer donors.