CMDA's The Point

The Three-Parent Child

October 13, 2016
The Three-Parent Child October 13, 2016

by Robert E. Cranston, MD, MA (Ethics)

Imagine the heartache of learning that your new baby will die slowly and painfully before the age of seven, or much sooner, with the same disabling, degenerative disease that killed your last two children.

Now, imagine all of this could be prevented by a newly developed technique that a world-renowned physician is willing to perform on your eggs to ensure your child’s good health.

Does this sound too good to be true?

Well, this is just what happened to a Jordanian couple recently. The mother had already miscarried four times and delivered two children who died of the severe neurological disease, Leigh Syndrome. Dr. John Zhang, medical director at the New Hope Fertility Centre in New York City, recently performed a nuclear implant with a new technique called spindle nuclear transport, from the mother’s egg into the donor mother’s healthy egg. Then, fertilized by the father’s sperm, the embryo was inserted into the mother’s uterus. The first successful procedure of this kind for prevention of Leigh Syndrome was heralded by many in the fertility community as a phenomenal breakthrough. The family is ecstatic, and their child, now five months old, appears healthy in all regards.

Leigh Syndrome is a severe neurodegenerative disease that is caused by defective maternal mitochondrial DNA. Dr. Zhang and others have been working for years to perfect a technique to insert spindle cells from mothers with defective mitochondria into healthy eggs, fertilize them with the father’s sperm and grow them in the mother, or potentially a surrogate mother.

But ethical questions abound:

  1. This procedure, currently banned in the U.S., was performed in Mexico to avoid U.S. government interference in the process. Why was the U.S. government opposed to this procedure?
  2. Did Dr. Zhang think that he knew better than the government as to what is ethical in the field of reproductive ethics? Will other renegade physicians opt to perform their forbidden procedures abroad so as to escape U.S. regulations? Many already do.
  3. How many embryos “failed” (died) in an attempt to get one viable embryo? That answer is four, at least that we know of in Dr. Zhang’s lab, just in reference to this pregnancy.
  4. How many other embryos in how many other labs died or were destroyed in unsuccessful attempts to produce these results? No one knows.
  5. How much did this cost? Roughly $500,000.
  6. Why does the reproductive industry in America have so few restrictions and general regulations? Remember “Octo-Mom?” We regulate hair salons more strictly than we do reproductive technology.
  7. In an age where millions of orphans live around the world without parents, does it make any sense to spend unbelievable financial and other resources so one family can have their own healthy child?
  8. What are the potential long-term consequences to the child? We don’t know.

In some ways, many of these questions pertain to surrogate pregnancies as well, but the questions raised here underscore the seriousness of the procedures and the potential complications associated with these issues.

Technology must be assessed ethically prior to widespread implementation. The entire reproductive endocrinology industry needs much greater oversight. Physicians like Dr. Zhang who purposely defy and skirt legal limits should be controlled. No one is entirely above the law.

About Robert E. Cranston, MD, MA (Ethics)

Robert E. Cranston, MD, MA (Ethics), MSHA, FAAN, CPE, is a board certified neurologist, with additional training and experience in palliative medicine, executive coaching and medical leadership. He is completing his 30th year serving at Carle Health, (formerly Carle Foundation Hospital) in Urbana, Illinois, as an attending neurologist, and (Past Chair—14 years) of the Carle Ethics Committee. He is a clinical professor of medicine (neurology) at Carle Illinois College of Medicine in Urbana-Champaign and is on the clinical faculty of University of Illinois, Urbana-Champaign. He is a member of the CMDA Ethics Committee. He and his wife Tammy are grateful for their five grown children, their daughters- and sons-in-law and their 11 grandchildren.

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