Lwin, Rebekah Bridget Ruth; (2002) Children as bone marrow donors: A longitudinal investigation into the psycho-social impact of paediatric bone marrow transplant on donor siblings. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Introduction: Paediatric bone marrow transplant is a high-risk treatment procedure for a number of life-threatening conditions. Siblings are frequently used as bone marrow donors but concerns have been raised about the ethics of this practice. There have been reports of anxiety, depression and post-traumatic stress in sibling donors. Despite this, no longitudinal assessment of bone marrow donor siblings has been published. Objective: To investigate the psychological impact of donating bone marrow in child donors, to explore the donor-recipient relationship and to identify child and family factors associated with psychological adjustment. Study design: A longitudinal investigation of 40 families comprising, 26 donors, 31 non-donors and 40 bone marrow recipients. Multi-method and multi-informant procedures were used. Assessment of outcome was by behavioural and emotional adjustment and change in adjustment a year after bone marrow transplant. Results: Donors' adjustment to the BMT process improved during the year following transplant. Measures of outcome indicated no evidence of gross psychopathology however analysis of the data identified child temperament, parental mental health, family communication and family support as particular risk factors. The role of donor does not appear to have afforded added risk or protection. Poor health outcome in the recipient increased the risk of adjustment problems in donors and non-donors and appeared also to influence pro-social behaviour. No significant change in the donor-recipient relationship was observed but a positive relationship appeared to be a protective factor for donors. Adequate preparation, open and honest family communication and good parental adjustment moderated the effects of the main risk factors, except those relating to poor recipient health outcome. Conclusions: Child donors of bone marrow are not necessarily at high risk of psychological adjustment problems. The results suggest that all siblings, donors and non-donors, may be vulnerable to certain risk factors. Some avenues for clinical intervention are discussed.

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