The Future (R)evolution of Preimplantation Genetic Diagnosis/Human Leukocyte Antigen Testing: Ethical Reflections

Abstract

There has been increasing support for combining preimplantation genetic diagnosis (PGD) for specific diseases with a test for human leukocyte antigens (HLA) because the generation of HLA-matched umbilical cord blood cells may save the life of a diseased sibling. To date, this procedure has taken place in the context of conceiving another child-PGD/HLA testing type 1. However, it may well become possible to perform PGD/HLA testing outside this context, that is, to select matched embryos from which embryonic stem cells could be derived and used in cell therapy-PGD/ HLA testing type 2. A proactive ethical analysis is needed and is presented in this article. Although PGD/HLA testing type 1 can be morally justified, the risks, pitfalls, and practical limitations of this procedure make it necessary to develop alternative strategies. PGD/HLA testing type 2 may provide an alternative strategy. From an ethical point of view, the controversial issue is that this procedure creates embryos purely for instrumental use. However, given the dominant view that the preimplantation embryo has only limited moral value, this alternative may be as morally justified as PGD/HLA testing type 1.

Human embryonic stem cell lines derived from single blastomeres of two 4-cell stage embryos

“…Currently, preimplantation genetic diagnosis (PGD) is used to obtain a human leukocyte antigen (HLA)-matched child as a donor for cord blood HSC to transplant and save a sibling with bone marrow failure syndromes or other hematological diseases (Bielorai et al ., 2004; Grewal et al ., 2004). This so-called PGD/HLA testing type 1 (de Wert et al ., 2007) is morally accepted in most countries on the condition that the parents intend to care for the donor child to the same extend as they do for their other children and because the newborn is not harmed when collecting the cord blood. However, this approach is limited by several factors including implantation rate and the duration of the pregnancy for those cases requiring urgent transplantation.…”

“…However, this approach is limited by several factors including implantation rate and the duration of the pregnancy for those cases requiring urgent transplantation. An alternative option for the parents would be not to transfer the HLA-matched embryo but to derive a hESC line for the in vitro generation of HSC for cell therapy (PGD/HLA testing type 2) (de Wert et al ., 2007). Using the conventional hESC derivation methodology starting from blastocyst ICM cells, the embryo would be destroyed.…”

Preimplantation genetic diagnosis: State of the ART 2011

“…SNP arrays will identify unexpected predispositions that may require appropriate counselling. PGD for HLA matching and late onset disorders has resulted in much ethical debate (Pennings and de Wert 2003;de Wert et al 2007). The discussions will be ongoing as it is possible to diagnose non-disease-causing traits.…”

“…The current techniques used for PGD have been relatively uncontroversial, except for social sexing (Pennings and de Wert 2003;Sharp et al 2010), PGD for HLA (Pennings and de Wert 2003;de Wert et al 2007) and PGD for inherited cancers where penetrance in not 100% and late onset diseases, such as Huntington disease, where the parents do not wish to know if they are carriers (Quinn et al 2009). However, PGD analysis will very likely become more controversial as there is an increase in the types of genes and diseases that can be diagnosed.…”

Eleven years of preimplantation genetic diagnosis for human leukocyte antigen matching: is there room for improvement?

“…Main issues have included the parental motives in creating and selecting a child to be 'used' in order to save a sibling, the risks imposed to the mother who will possibly need to undergo several ART cycles, any potential risks to the child to be born and the psychological impact on all family members [2,13]. Today, it is acknowledged that PGD-HLA represents a valuable treatment option for all involved (the parents, the healthy baby born and sick child cured), and although difficult, it is well worth the effort when it succeeds.…”