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Preventing Mitochondrial Disease

A Path Forward

Adashi, Eli Y., MD, MS; Cohen, I. Glenn, JD

doi: 10.1097/AOG.0000000000002486
Contents: Current Commentary

In a possible first, the heritable transmission of a fatal mitochondrial DNA disease (Leigh syndrome) may have been prevented by replacing the mutation-bearing mitochondria of oocytes with donated mutation-free counterparts. The procedure, carried out by a U.S.-led team, took place in Mexico in circumvention of a statutory U.S. moratorium on mitochondrial replacement. This development calls into question the regulatory utility of a national moratorium in a globalized world wherein cross-border care is increasingly prevalent. This development also calls to account the moral defensibility of a moratorium that acquiesces in the birth of gravely ill children whose afflictions could have been prevented. In this Current Commentary, we outline a potential path forward by analyzing the dual imprint of the moratorium, examining its legislative shortcomings, exploring its motivational roots, considering its national effect, and proposing its unlinking from the related yet distinct ban on editing the genome of the human embryo.

The birth of neonates afflicted with preventable mitochondrial diseases proceeds unabated in the United States as a result of an ill-defined statutory moratorium, the redress of which is herein delineated.

The Warren Alpert Medical School, Brown University, Providence, Rhode Island; and Harvard Law School, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, Massachusetts.

Corresponding author: Eli Y. Adashi, MD, MS, the Warren Alpert Medical School, Brown University, 272 George Street, Providence, RI 02906; email:

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he has met the journal's requirements for authorship.

© 2018 by American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.