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August 18, 2004

Preimplantation Testing to Produce an HLA-Matched Donor Infant—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(7):803. doi:10.1001/jama.292.7.804-b

In Reply: Drs Fasth and Wahlstrom believe PGD with HLA typing is futile because the children needing the transplant will die before the potential donor is born. In the report of Verlinsky et al, all the sick children were alive when the potential donor was born, and the 1 transplant attempted thus far has been successful.

Dr Wagner and colleagues point out that the genetics of DBA are complicated, and that the risks of recurrent disease cannot presently be reduced to zero by genetic screening. These are problems for parents considering procreation in this setting regardless of whether they conceive in the old-fashioned way or by using in vitro fertilization with or without PGD. Their statement that "preimplantation HLA testing to create a donor may inadvertently result in a child affected by [DBA]" suggests that preimplantation testing may somehow increase the risk of having an affected child. In this series, all couples were planning another child anyway. It is possible that they would not have reproduced without the availability of PGD, but that is speculative. I know of no evidence that PGD per se, or HLA matching, increases the risk for DBA. Many parents choose to procreate despite the risk of recurrent disease. In the report of Verlinsky et al, an apparently healthy child has been born with a successful transplantation.