Chapter 2 - Ethics of Mitochondrial Gene Replacement Therapy

Abstract

In 2015, the United Kingdom became the first country to legalize novel reproductive technologies known as mitochondrial donation or mitochondrial replacement therapy, enabling women with mitochondrial disease to have healthy, genetically related children. This chapter explores the situation in the United Kingdom and the extensive review process that preceded legalization amid global concerns about human genetic modification. As the technique uses part of a donated egg to replace disease causing faulty mitochondria, the child would inherit DNA from a “third person”—the mitochondrial donor—whose genes could be inherited by a future generation. The chapter considers ethical issues: whether the donor is a “parent” and the implications for identity, genetic modification, and the “slippery slope,” the potential risks for the donor, and differences between the two techniques: maternal spindle transfer and pronuclear transfer. The chapter concludes by explaining why mitochondrial disease presents challenges for genetic counseling and considers alternatives to mitochondrial donation.