{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:28:20Z","timestamp":1792787300319,"version":"4.5.0"},"reference-count":20,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["no grant number"],"award-info":[{"award-number":["no grant number"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["C61296\/A27223"],"award-info":[{"award-number":["C61296\/A27223"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Institute for Health and Care Research Exeter Biomedical Research Centre","award":["NIHR203320"],"award-info":[{"award-number":["NIHR203320"]}],"id":[{"id":"https:\/\/ror.org\/0187kwz08","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Med Ethics"],"accepted":{"date-parts":[[2025,10,22]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>The increasing integration of genomic medicine into routine medical care brings to light issues of complexity and uncertainty in the interpretation of genetic variation.<\/jats:p>\n                  <jats:p>We describe a fictional case study based on our experiences in the haematological malignancy setting to illustrate the complexities in using genomic testing to evaluate the suitability of relatives to act as stem cell donors. In particular, we demonstrate the ethical issues arising following the identification of a germline variant of uncertain significance (VUS) in a gene associated with inherited cancer susceptibility in a potential recipient. We discuss the factors that need to be considered, such as how this might influence donor selection, the potential for donor-derived leukaemia and the issues of offering testing to other family members.<\/jats:p>\n                  <jats:p>Popular discourse suggests genomics can offer clarity and transformation in healthcare. This case highlights the ethically complex nature of decision-making in genetic medicine due to the familial aspects of genomic information, the uncertain nature of many genomic results and how changes in the use of genomic information in clinical practice can call for urgent decision-making. This highlights the need for increased interdisciplinary working which takes into account the factors driving decisions for each specialty and recommends access to independent ethics support for members of the multidisciplinary team.<\/jats:p>","DOI":"10.1136\/jme-2025-111111","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T18:20:19Z","timestamp":1763662819000},"page":"672-677","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Germline genomic testing to assess the suitability of stem cell donors in the treatment of haematological malignancy: clinical ethics commentary"],"prefix":"10.1136","volume":"52","author":[{"given":"Helena","family":"Carley","sequence":"first","affiliation":[{"name":"South East Thames Regional Genetics Service, Guy\u2019s Hospital, London, UK"},{"name":"University of Oxford Nuffield Department of Medicine, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5948-5581","authenticated-orcid":false,"given":"Kate","family":"Sahan","sequence":"additional","affiliation":[{"name":"The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Hanson","sequence":"additional","affiliation":[{"name":"Peninsula Regional Genetics Service, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK"},{"name":"Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Snape","sequence":"additional","affiliation":[{"name":"South West Thames Centre for Genomics, St George\u2019s University Hospitals NHS Foundation Trust, London, UK"},{"name":"City St George\u2019s, University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Westbury","sequence":"additional","affiliation":[{"name":"Translational Health Sciences, Bristol Medical School, Bristol, UK"},{"name":"Department of Haematology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7054-4711","authenticated-orcid":false,"given":"Michael J","family":"Parker","sequence":"additional","affiliation":[{"name":"The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3324-4338","authenticated-orcid":false,"given":"Anneke M","family":"Lucassen","sequence":"additional","affiliation":[{"name":"University of Oxford Nuffield Department of Medicine, Oxford, UK"},{"name":"Oxford Clinical Genetics service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"2026092202201056000_52.10.672.1","doi-asserted-by":"publisher","DOI":"10.1136\/jme-2023-109692"},{"key":"2026092202201056000_52.10.672.2","doi-asserted-by":"crossref","DOI":"10.1200\/EDBK_432218","article-title":"Germline Predisposition in Hematologic Malignancies: Testing, Management, and Implications","volume":"44","author":"Godley","year":"2024","journal-title":"Am Soc Clin Oncol Educ Book"},{"key":"2026092202201056000_52.10.672.3","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-022-01613-1"},{"key":"2026092202201056000_52.10.672.4","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-022-01620-2"},{"key":"2026092202201056000_52.10.672.5","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.18675"},{"key":"2026092202201056000_52.10.672.6","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.18682"},{"key":"2026092202201056000_52.10.672.7","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdz136"},{"key":"2026092202201056000_52.10.672.8","doi-asserted-by":"publisher","DOI":"10.1038\/gim.2015.30"},{"key":"2026092202201056000_52.10.672.9","unstructured":"Durkie MC , Taylor R , McMullan DJ . ACGS best practice guidelines for variant classification in rare disease 2024. Association for Clinical Genomic Science (ACGS); 2024. Available: https:\/\/www.acgs.uk.com\/media\/12533\/_media_12533_uk-practice-guidelines-for-variant-classification-v12-2024.pdf"},{"key":"2026092202201056000_52.10.672.10","doi-asserted-by":"crossref","unstructured":"Carreras E , Dufour C , Mohty M , eds. The EBMT handbook: hematopoietic stem cell transplantation and cellular therapies. 7th ed. Cham (CH), 2019.","DOI":"10.1007\/978-3-030-02278-5"},{"key":"2026092202201056000_52.10.672.11","unstructured":"GEP . The power of three: the importance of trios in diagnosing disease. Genomics education programme. 2023. Available: https:\/\/www.genomicseducation.hee.nhs.uk\/blog\/the-power-of-three-the-importance-of-trios-in-diagnosing-disease\/"},{"key":"2026092202201056000_52.10.672.12","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1136\/jmedgenet-2020-106876","article-title":"UKCGG Consensus Group guidelines for the management of patients with constitutional TP53 pathogenic variants","volume":"58","author":"Hanson","year":"2020","journal-title":"J Med Genet"},{"key":"2026092202201056000_52.10.672.13","doi-asserted-by":"crossref","DOI":"10.1186\/s12920-016-0219-0","article-title":"Known unknowns: building an ethics of uncertainty into genomic medicine","volume":"9","author":"Newson","year":"2016","journal-title":"BMC Med Genomics"},{"key":"2026092202201056000_52.10.672.14","doi-asserted-by":"publisher","DOI":"10.1038\/nature19057"},{"key":"2026092202201056000_52.10.672.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.gim.2022.05.002"},{"key":"2026092202201056000_52.10.672.16","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.13152"},{"key":"2026092202201056000_52.10.672.17","unstructured":"JCGM, Royal College of Physicians, Royal College of Pathologists and British Society for Genetic Medicine . Ethical issues in prenatal genetic diagnosis. guidance for clinical practice. report of the joint committee on genomics in medicine. London RCP, RCPath and BSGM; 2022."},{"key":"2026092202201056000_52.10.672.18","unstructured":"Carley H . How can we foster situated Ethical decision-making in clinical genetic practice? MSc Thesis. 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