Who Saves the Savior Siblings?

By Kemarah Thermidor '27

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The early 2000s saw the publication of My Sister’s Keeper, along with its film adaptation. The story follows Anna Fitzgerald as she seeks medical emancipation from her parents for a chance at a normal life after being treated as her ill older sister’s “organ bank” since being born. (1) Anna’s role as a “savior sister” may seem shocking, but as early as 2014, up to one percent of PGD, a type of in-vitro fertilization, was estimated to have been used for creating children that match tissues for their terminally ill siblings. (2) These savior siblings present a major bioethical dilemma, which requires addressing concepts like consent and legal precedents of similar cases. 

In My Sister’s Keeper, Anna seeks out the help of an attorney who constructs the foundation of her lawsuit: Anna’s right to bodily autonomy overrules her parents’ right to interfere with her medical decisions. (3) Anna’s case is a fictional one, but advanced reproductive technology makes it so that her case is not far from the scope of reality. 32 years prior to Anna’s story in My Sister’s Keeper, Hart v. Brown featured opposing views on whether or not parents had the right to consent for their underage children in the case of organ donations. (4) 

Seven-year-old identical twins, Kathleen and Margaret, found themselves in the midst of a legal dispute between their parents and Kathleen’s (who needed a kidney transplant) physician(s). (5) The Harts argued they could consent to the needed procedure for both of the girls, while the physicians and Yale-New Haven Hospital were unwilling to proceed until a court clarified that the parents had the right to consent for their twins. (6) Adhering to the “doctrine of substituted judgment” (a standard used to allow decision-making on behalf of incapacitated individuals), the court decided that the Hart parents did have the right to consent for their children. (7) 

Brown does not directly address the question of siblings born solely to provide needed organs for their siblings, but it brings up an important part of the conversation about the different considerations that are made. To fully understand the distinction and similarity between savior sibling cases and those that only address one aspect of the conversation, a savior sibling must be clearly defined.

According to the National Library of Medicine, a savior sibling is one created for the purpose of providing “an organ, bone marrow or cell transplant” to their fatally ill sibling. (8) Essentially, a savior sibling is someone who was born with the main purpose of keeping their sibling alive. While this reads as jarring, these situations feature various factors that may explain why the United States lacks any explicit legislation and regulation surrounding savior siblings. 

Real-life cases present conflicts of interest within families and pose difficulties in assessing psychosocial risks and benefits for children involved. (9) However, these complexities do not negate the glaring legal gap of specific regulations that should be incorporated in savior sibling cases. 

Other countries differ from the United States, with legal considerations regarding the practice implemented in parts of North America, Europe, and even Australia. (10) These regulations often consider the technology from an optimistic standpoint while trying to mitigate the potential ethical concerns. New Zealand’s legal framework captures the essence of these laws effectively. 

New Zealand’s use of reproductive technology is primarily regulated by the Human Assisted Reproductive Technology Act of 2004 (HART). (11) Several requirements have to be met to allow the use of reproductive technology for the purpose of creating a savior sibling. Notable restrictions in context to a child with a genetic disorder included the requirement that there were no other existing treatments for the ill child, and only the cord blood would be used. (12) 

HART has led to developments in savior sibling regulations, such as allowing the practice for children with non-genetic disorders. (13) Despite this added flexibility, any changes or dialogue to the savior sibling practice have been done with scrutiny of the existing legal framework, along with insight from specialized sources researching human genomes. (14) 

The argument here is not that New Zealand’s or another country’s legal regulations of the savior sibling practice are perfect, but rather that it is important that they exist. The U.S. has a legal obligation to address the practice because cases within the realm carry a high level of complexity that requires a general framework to resort to. The novelty of the procedure has left psychological and welfare impacts open to interpretation or dismissal, when a practice this serious cannot afford to be unregulated.

Endnotes

1. Nikita Sareen, Jodi Picoult, “My Sister’s Keeper” – The Banned Books Project, Cmu.edu (2019), https://bannedbooks.library.cmu.edu/jodi-picoult-my-sisters-keeper/.

2. Ibid ; Laurena Taylor, Savior Siblings in the United States - Petrie-Flom Center, Petrie-Flom Center - The blog of the Petrie-Flom Center at Harvard Law School (2014), https://petrieflom.law.harvard.edu/2014/10/23/savior-siblings-in-the-united-states/.  

3. Alex Fleming, My Sister’s Keeper: An Assessment of Living Organ Donation among Minors, 3 Voices in Bioethics (2017), https://journals.library.columbia.edu/index.php/bioethics/article/view/6036.

4. Hart v. Brown, 29 Conn.Supp 368, 289 A.2d 386 (1972): Case Brief Summary, Quimbee, https://www.quimbee.com/cases/hart-v-brown.

5. Ibid

6. HART v. BROWN | 29 Conn. Sup. 368 | Conn. Super. Ct. | Judgment | Law | CaseMine, www.casemine.com, https://www.casemine.com/judgement/us/591497abadd7b049345f771e.

7. Doctrine of Substituted Judgment: Legal Insights Explained | US Legal Forms, Uslegalforms.com (2025), https://legal-resources.uslegalforms.com/d/doctrine-of-substituted-judgment. ; Ibid

8. Alejandra Zúñiga-Fajuri, Born to donate: proposals for “savior sibling” regulation in Latin America, 49 Colombia medica (Cali, Colombia) 228 (2018), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220490/.

9. Ibid 

10. Ibid

11. Claire Graham, Spare Parts or Saviour Sibling? The Birth of an Ethical Dilemma, Wlu.edu (2025), https://www.wlu.edu/mudd-center/mudd-undergraduate-journal-of-ethics/volume-10-spring-2025/spare-parts-or-saviour-sibling-the-birth-of-an-ethical-dilemma. 

12. Ibid.

13. Ibid.

14. Ibid.