Essay--legal issues of stem cell transplantation and the family.

One sunny morning your best friend, and long time client, calls to inform you that her ten-year-old son has cancer. The only hope her child has for recovery is stem cell transplantation. Your friend is six months pregnant with her second child and she asks for your help in locating a biomedical company that can collect the umbilical cord blood stem cells from the forthcoming baby's delivery to use in her son's desperate fight against his terrible disease. As you interview your friend's obstetrician in an effort to coordinate this procedure, you learn that the son's disease is inheritable. The possibility of the newborn child also being affected with this disease is very likely, but no one will know until the unborn child is five years old. In five years, however, the tenyear-old son will be dead. As each umbilical cord blood stem cell donation only supplies enough cells to treat one recipient, what duty does the mother have to balance the needs of her two children? Who does she allow to receive the potentially life saving stem cell treatment? Can she legally balance her duty to both children without conflict? To whom do the stem cells belong, anyway? Are there alternative sources for acquiring stem cells that would ease this dilemma? Again, as is often the case, modern medicine confronts the family with an unanswerable legal issue. I. INTRODUCTION Medical research and practice throughout the latter part of the twentieth century brought society to the brink of curing many devastating diseases that have plagued mankind for centuries. As medical scientists have unraveled the mysteries of the human body's immune system, revolutionary advances in blood transfusions and organ transplantations have become almost commonplace.1 As we continue into the twenty-first century, stem cell technology appears to be able to provide additional hope in medicine's search for the cure of the previously incurable.2 Stem cells are self-renewing, immature cells that have the ability to divide for indefinite periods in laboratory cultures, thus giving rise to many types of specialized cells the body needs to survive.3 Additionally as these stem cells divide and mature, they may develop to perform specific functions in the body, such as muscle contraction or nerve cell communication. 4 This maturation process of the stem cell, known as differentiation, becomes fundamental to the development of a mature body organ. Differentiation is the scientific term used to describe a process by which an immature or unspecialized cell, such as a stem cell matures into one of the specialized cells that make up the body. Genes and proteins activated during the differentiation process signal the cell how to mature.6 Stem cell technology strives to manipulate this cellular differentiation to produce the specific cells needed for disease therapies.7 Of the most exciting and potentially advantageous uses of stem cell research includes the potential for developing "cell therapies," which could allow stem cells to replace dead or diseased cells in patients suffering from chronic diseases.8 There are two primary sources of human stem cells: (1) those of "fetal" origin (from either the embryo directly or from the germ cell layer that otherwise matures into sex organ tissue destined to become eggs and sperm), and (2) those of "adult" origin (from either the bone marrow tissue of children or adults or from the umbilical cord blood at birth).9 Currently, adult stem cells have a limited therapeutic capacity.10 Fetal origin stem cells, however, have the greatest potential for multi-organ use.11 Nevertheless, many of the practical legal issues regarding fetal origin stem cells must await advances in legislation, ethics, and technology. After a brief overview of both fetal and adult origin stem cells, this essay addresses the legal implications of umbilical cord blood stem cells, a subset of what is otherwise known as adult origin stem cells. …