One year into researching the vulnerability of children who donate regenerative tissue, Angela Wyatt has no doubt: these children are substantially more vulnerable than others.
Ms Wyatt has embarked on a Philosophy PhD with a distinct bioethics direction at UTAS. There is no current concept of 'vulnerability' in these children who supply others, mostly family members, with organs or bone marrow.
Unable to interview these child donors for ethical reasons, Ms Wyatt is examining current research and comparing the different concepts of vulnerability.
"Are these children vulnerable to harm, family pressure or societal pressure? I believe they are certainly more vulnerable than the average group of children," she said.
The three main pressures on donor children are from parents, the legal system and society. All three influence whether or not children are donors.
"Often parents influence a child to feel obligated to help a family member, especially if it's a sibling needing the donation," Ms Wyatt said. "They may actively push the child to 'save your brother'.
"For example, a child might donate bone marrow so their sibling can survive cancer. But the real pressure comes if the child donates and their brother or sister still dies.
"They may feel their donation wasn't good enough."
Parents also have a role in that they need to give permission for a child under the age of 16 to donate.
Age is a factor in terms of vulnerability, in that the older the child the more likely he or she is to make an informed decision.
But for younger children parental permission can be a source of pressure, especially in cases where parents have conflicting opinions on whether to donate. The situation may be even worse where parents are not together any more.
The vulnerability of a child donating regenerative tissue can be even more pronounced when that child is born using in vitro fertilisation for the purpose of saving a sick child.
"It's not uncommon in Australia and the United Kingdom for parents who have a sick child, with leukaemia for example, to want a second child who is a biological match to be a bone marrow donor," Ms Wyatt said.
"Through IVF they choose an embryo which is a match to the sick child. So then the second child may seem to be born with a built-in obligation to be a donor.
"What are the ethical issues here? Did the parents have a baby to 'save' the first child or did they want a second child anyway?"
And how vulnerable is the donating child if the sick child dies, despite the donation?
Ms Wyatt asks: "What then is the parents' relationship to the 'designer' child?"
The legal system, in the form of courts, may also play a role – but the factor is cost and affordability.
"In a case where an older child wants to donate to an aunt, for example, and the parents refuse, the child can go to court to over-rule the parents or to prevent parents pressuring them to donate," Ms Wyatt said.
"But this is a First World solution only available to wealthier families."
In Third World countries donating children are far more vulnerable and much less likely to be rescued by a court system from financially struggling parents who see salvation in selling one of their child's kidneys.