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pediatric sibling transplants, family privacy, fiduciary theory, children, equity jurisdiction, parent-child relationship, physical harms, emotional harms


A six-year-old girl suffers third-degree burns over eighty percent of her body. Her chance of survival with minimal scarring is said to depend on her identical twin sister’s availability as an organ source. There are other transplant options—including the parents—but because the twins’ skin is “equivalent,” a “sibling transplant” is likely to result in a better medical and aesthetic outcome for the burned twin. Her doctor thus proposes to harvest her healthy sister’s skin on “her backside from her bra line down to the bottom of her buttocks or possibly her thighs.” This procedure would be repeated up to three times in as many weeks. It would cause “‘permanent discoloration,’” and would feel like “‘a severe sunburn with blisters’” for “3–5 days with return to normality with[in] 10–12 days.”

Concerned about the legal implications of harvesting skin from a healthy minor child, the hospital consults with outside advisors, including at the local juvenile court, who suggest that the procedure might constitute child abuse. Anxious to proceed, the parents thus choose to bypass that forum and file an action in probate to establish their right to use their healthy daughter’s skin to benefit her injured sister. There, they argue that the grafts are in the healthy child’s best interests, presumably because of the sisters’ close relationship. Her guardian ad litem argues otherwise: “[U]nder no circumstances will this ‘well-child’ . . . escape these surgeries without immediate physical pain and trauma in addition to life-long physical skin damage appearance issues that create probable severe psychological and emotional damage.” The court, which goes to extraordinary lengths to establish its equitable jurisdiction, finds that, on balance, given the risks and benefits to both sisters, the parents have the right to authorize the surgeries.

Library of Congress Subject Headings

Finance, Right of privacy, Children, Danger (Law), Domestic relations, Jurisdiction, Equity