PEDIATRICS Vol. 82 No. 5 November 1988, pp. 774-783
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Bone Marrow Transplantation: Economic, Ethical, and Social Issues

Meg Durbin MD1

1 From the Robert Wood Johnson Clinical Scholars Program, Stanford, California

Bone marrow transplantation is a useful model for the controversies surrounding medical technologies that involve high cost, mortality, and complications. This essay first delineates the economic circumstances of bone marrow transplantation, comparing it with other organ transplantations. Although children represent a significant proportion of bone marrow transplantation patients, little research has focused on the economic impact for this population. Next, the financial, social, and ethical motivations and controversies that surround bone marrow transplantation are explored, along with current allocation mechanisms. Finally, recommendations are offered for guiding discussions regarding the appropriate use of bone marrow transplantation. In making transplantation decisions, physicians must consider the costs and benefits of bone marrow transplantation for each patient. Such analyses, whether based on medical or socioeconomic criteria, are insufficient to resolve the fundamental cultural dilemmas posed by this procedure and other expensive medical technologies, however. The goal is to foster broader discussion of these issues to achieve more candid decisions in allocating resources among competing health priorities.

Key Words: bone marrow transplantation • ethics • organ transplantation • medical technology

Accepted on January 12, 1988




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