Education And Debate

Ethics of using preimplantation genetic diagnosis to select a stem cell donor for an existing person

BMJ 2001; 323 doi: http://dx.doi.org/10.1136/bmj.323.7323.1240 (Published 24 November 2001) Cite this as: BMJ 2001;323:1240
  1. Robert J Boyle, clinical genetics fellow (BobBoyle@doctors.org.uk),
  2. Julian Savulescu, professor of medical ethics
  1. Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Victoria 3052, Australia
  1. Correspondence to: R Boyle, Department of Paediatrics, Hillingdon Hospital, Hillingdon UB8 3NN
  • Accepted 30 October 2001

Preimplantation genetic diagnosis (PGD) involves genetic analysis of artificially fertilised embryos to select an embryo with a desired genotype before it is implanted. 1 2 Since the 1980s, over 2500 cycles of PGD have been performed worldwide.3 The technique has been used to test for disorders caused by a single gene (cystic fibrosis, thalassaemia, sickle cell disease, muscular dystrophy) and chromosomal abnormalities (Down's syndrome, trisomy 18).4 The procedure is regulated in the United Kingdom by the Human Fertilisation and Embryo Authority, which says it should be used only for detecting “very serious, life threatening conditions”5 and not for minor genetic abnormalities. 4 6

The technique has been used to detect genes for adult onset disorders such as Huntington's disease and for familial predisposition to cancer, such Li-Fraumeni syndrome (which involves mutations in p53 cancer suppressor genes).3 It has been used in Australia by fertile couples without a history of sex linked disorders to select the sex of their child.7

Summary points

A common objection to using preimplantation genetic diagnosis (PGD) to choose an embryo that may produce a child who would provide stem cells for an existing person is that children conceived for the benefit of their siblings are not valued in their own right

The uptake of this procedure will have few social consequences and is likely to be a reasonable use of limited health resources

Using PGD to choose a stem cell donor is unlikely to cause harm to anyone and is likely be beneficial to some

In countries where PGD is already permitted, using PGD solely for choosing a HLA compatible embryo to provide stem cells for treating an existing person should also be permitted

PGD for the benefit of a relative

Children have been conceived to provide stem cells for their siblings. In the most publicised case, the Ayala case, …

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