Palliative care

Palliative care is an essential component of comprehensive care for children and adolescents undergoing hematopoietic stem cell transplantation (HSCT), yet it remains inconsistently integrated into clinical practice. This consensus chapter establishes principles and recommendations for the systematic incorporation of pediatric palliative care within HSCT programs. It emphasizes early integration, shared decision-making, and alignment of care with patient and family values throughout the transplant trajectory, regardless of prognosis. Key domains addressed include eligibility criteria, functional and prognostic assessment, communication strategies, ethical and legal considerations, and multidisciplinary collaboration. The chapter also reviews existing institutional models of palliative care integration and highlights adaptable frameworks suited to diverse resource settings. By standardizing approaches and clarifying roles, this consensus seeks to reduce variability in care, improve quality of life, and promote ethically sound, patient-centered decision-making. Integrating palliative care as a core element of pediatric HSCT policy is critical to improving both quality-of-life and end-of-life outcomes for patients and families.