Should young children with sickle cell disease and an available human leukocyte antigen identical sibling donor be offered hematopoietic cell transplantation?

Availability of an HLA-identical sibling donor raises the question, "should young children with SCD, and an available HLA identical sibling donor be considered for hematopoietic cell transplantation (HCT) even before they manifest severe clinical presentations of sickle cell disease (SCD)?" The overall survival (OS) and event free survival (EFS) following HCT from an HLA identical sibling is excellent in young children, and worsen with increasing age at HCT. SCD related complications, organ dysfunction, quality of life, and risk for premature mortality all worsen with age. The ethical principles of non-maleficence, beneficence, autonomy and justice all support the consideration of this life, quality of life, and organ saving therapy at a young age.