Bone Marrow Transplants: Neither Ethical nor Imperative?!

In the thoughtful essay by Durbin (Pediatrics. 1988;82:774-783) concerning bone marrow transplantation, she speaks of the "ethical imperative" for bone marrow transplantation. Yet, she notes that patients who undergo bone marrow transplantation have a high mortality rate and that survivors, especially children, suffer a "variety of long-term side effects." I would like to play devil's advocate and suggest that bone marrow transplantation in its current state may be neither ethical nor imperative as a therapy for dying children and that at the very least we need to take a long, hand look at when it is appropriate and how the technology is being developed.