Ethical and legal aspects of using an identical twin as a skin transplant donor for a severely burned minor.

On January 7, 2003, Sydney Cowan, a healthy six-year-old girl, underwent skin harvesting,' specifically to be used for her badly bumed identical twin sister, Jennifer.^ A day earlier, the Probate Court of Jefferson County, Alabama, after considering whether a healthy minor twin sibling could serve as a skin donor for her severely burned sister, authorized parental consent to the surgery.^ More accurately, the court addressed whether Sydney could undergo surgical procedures that provided her with no physical benefit, but, rather, resulted in harmful effects, such as acute postoperative pain, permanent residua, and potential long-term emotional and psychological dysfunction. Although the transplants were extraordinarily successful, and the newspaper article depicted Sydney's participation in heroic terms, the harvesting of Sydney's skin was ethically problematic. Specifically, I assert that the use of an incompetent minor as a skin transplant donor, even if an identical twin, is not justified unless the transplant will save the recipient's life. I develop this thesis in several foundational sections. In Part II, I present the facts of the girls' case. In Part III, I review the current treatment of bums and provide a general framework for ethical analysis of burn treatment via skin transplantation. In Part IV, I summarize the legal approach toward the use of incompetents as transplant donors. In Part V, I re-examine each of the previously discussed areas with reference to Jennifer and Sydney, specifically identifying weaknesses in the medical, ethical, and legal foundations supporting the decision to move forward with the skin harvesting procedures. Major deficiencies include the high likelihood that Jennifer would have survived her bum injuries