Ethical Questions on Egg Donation
June 24th, 2015
Ana Lita, Ph.D.
Global Bioethics Initiative
Executive Director
GLOBAL BIOETHICS INITIATIVE (GBI)
GBI is a non-profit organization co-founded in 2011
by Ana Lita, Ph.D, and Charles Debrovner, M.D.
777 UN Plaza, 5th Floor
New York, NY 10017
www.globalbioethics.org
alita@globalbioethics.org
MISSION AND VISION
Global Bioethics Initiative (GBI) is dedicated to
fostering public awareness and understanding of
bioethical issues, and to exploring solutions to bioethical
challenges.
Focus Issues
• Organ Transplantation and Trafficking
• Reproductive Rights
• Population Aging/End of Life Health Care
International Bioethics Summer School
For more details, check our program’s website:
www.summerschool.globalbioethics.org
VIDEO CLIPS
Basics of Egg Donation
Egg donation is a product of in vitro fertilization (IVF)
technology
(a) Women's ovaries are stimulated with
hormones or hormone-mimicking drugs to
produce multiple mature eggs
b) Eggs are retrieved from ovarian
follicles via a transvaginal needle
aspiration under ultrasound guidance
Video Clip— Egg Retrieval:
https://www.youtube.com/watch?v=i4vLRZPF8GQ
Differences Between Egg Donation
and Sperm Donation
Egg donation, compared to sperm donation, is:
• medically more complicated
• significantly more invasive
• less amenable to storage than sperm are,
although a number of human egg banks
have recently sprung up in the U.S. and
U.K.
• compensates on a much larger scale (up to
hundreds of thousands of dollars per
donation cycle)
What are the risks of Egg
Donation?
Complications are uncommon
and usually limited to standard
surgical risks of infection,
bleeding, and damage to
surrounding tissues.
The most serious risk is
ovarian hyperstimulation
syndrome (OHSS).
Ovarian Hyperstimulation Syndrome
• occurs after using injectable hormone medications to stimulate
egg development during the preparation period for egg donation
• ovaries become swollen and painful, fluid collects in the
abdomen
• other symptoms include rapid weight gain, abdominal pain,
vomiting and shortness of breath
• OHSS will usually resolve itself on its own, but can be aided by
draining fluid from the abdomen and administering painkillers
Who benefits from egg donation?
•
•
•
•
Women with a variety of genetic diseases, various illnesses,
damaged ovaries, or born with no ovaries at all
Gay couples
Women older than typical child-bearing age
Biomedical Research
Advertised Compensation for Egg
Donation in the United States
1. The country you are in:
• In the United States, egg donors are legally
allowed to be compensated for the time
spent donating, travel arrangements, and
potential damage
• Prices can range from a few thousand
dollars to more than $250,000 as was
advertised in a classified ad found in a
Princeton campus newspaper a few years
ago (right, a similar ad run at Columbia
University)
In the USA
2. It Depends on the region you are in
• Within the U.S., there is regional variation in prices
• New York, Chicago, Los Angeles, Houston, Washington DC,
Boston and Seattle pay egg donors more than smaller ones like
Birmingham and Louisville.
• In Ohio, some egg donor programs pays between $3000 and
$7000 per cycle.
• In Boston, Massachusetts, donor programs pay $5,000 per cycle.
• A Houston IVF clinic pays between $5,000 and $8,000 per cycle.
Advertised Compensation for Egg
Donation in the United States
Advertised Compensation for Egg
Donation in the United States
• Free medical exam, genetic and infectious
disease screening.
• Health Insurance provided for procedure.
• Repeat eligible donors may donate up to six
times with medical clearance.
• College or some college education required. If
you are between the ages of 21-32, legal to
work in the United States, and able to
commute to our clinic on a daily basis you
may be eligible!!
In the USA
3. Does the egg donor agency abide by the ASRM code of ethics?
• The ASRM (American Society for Reproductive Medicine) sets
guidelines for how much egg donors should be paid. In their
ethics code, they state that:
“Although there is not consensus on the precise payment that oocyte
donors should receive, at this time sums of $5,000 or more require
justification and sums above $10,000 go beyond what is appropriate.”
• Donating eggs through an ASRM-affiliated egg donor program
or IVF clinic essentially means that the egg donor will make
between $5,000 and $10,000, regardless of other factors.
“The United States is the Wild West of reproductive
technologies”
– Art Caplan
Egg Donation in Other Countries
• Norway and Germany – banned donating eggs, but not
sperm
• Sweden – requests a stable relationship for at least a year
to receive IVF
• Switzerland – only married couples may receive IVF
• Austria and Italy – banned egg and sperm donation
• Czech, Slovak, Spain, France, Israel, Belgium, Ghana –
allowed
• New Zealand and Romania – egg donation is done for free,
without any monetary compensation. This is sometimes
called “egg sharing.”
Egg Donation in Other Countries
• Czech Republic
– Price: 4.500 EUR
– GYNEM - Fertility Clinic – Prague
• Israel
– Price for 6 mature eggs is 6.000 EUR
• Romania
– No compensation/”egg sharing”
– 30 Israelis Arrested Over Human Egg
Trafficking
In the UK
•
The Human Fertilisation and Embryology Authority
(HFEA) is the UK's independent regulator overseeing
the use of gametes and embryos in fertility treatment
and research.
•
The HFEA licenses fertility clinics and centres
carrying out in vitro fertilisation (IVF), and other
assisted conception procedures and human embryo
research.
In the UK
•
•
•
•
•
Since 2006, anyone who donates either sperm or eggs has
received travel expenses & compensation for loss of
earnings of up to £61.28 a day.
Limited compensation: No more than £250 in total for each
cycle of donation.
In 2012 IVF waiting lists went down as egg donors got 'pay'
rise
Donor compensation is limited to £750 per cycle for egg
donors, “due to recession”
Paying sperm donors £35 for each visit to a clinic.
Objections To Egg Markets
Developments in biotechnology have a profound effect on
women, particularly as they relate to the growing market for
human eggs.
Three potential objections (with rejoinders where possible)
(a) the potential for economic coercion
(b) the potential for commodification
(c) the problem of unquantified risk
Objection 1: Economic Coercion
• Such large amounts of money could inappropriately compel
financially vulnerable women into donating their eggs when they
otherwise would not (i.e. collegiate women with exorbitant
educational loans)
Age Biotechnology
EconomicCutting
Coercion
in Poorer Countries
• Limited economic opportunities make
financial compensation an appealing
incentive
• GlobalARTusa, for example, was a
private fertility clinic based in Romania
that had internationalized the egg
donation market
• Couples from anywhere in the world
selected donors for physical and
personality characteristics, educational
background, health status, etc.
• The cost was significantly reduced for international customers (only a few
thousand dollars per cycle of eggs), and the monetary compensation was
very low for Romanian women who donated their eggs (about $250 per
harvest)
Rejoinder 1: Paternalism and
Reproductive Freedom
• There is an underlying belief that egg donors are forced to make decisions
that are ultimately against their best interests. This unnecessary paternalism
unduly limits the reproductive (and, in this case, financial) freedom of
women—especially poor women
• If high monetary “compensation” to egg donors constitutes coercion, then
many bright young adults are being “immorally” coerced into becoming
lawyers, doctors, bankers, and other types of well-paid professionals
• Egg donation is a viable option for many women who have few options
However…
Large amounts of money, in combination with limited decision-making
abilities, create a situation in which it is unethical not to offer these women
protection and put egg donation and its impact on women’s health under real
scrutiny.
Objection 2: Commodification
Generally, commodification arguments say something to the effect of:
1. If we allow financial compensation to accompany, albeit indirectly, the
donation of body parts, then we are essentially treating those parts like
commodities
1. Treating body parts like commodities is a gross affront to the intrinsic value
of human beings, which leads to treating women as means to an end (not as
ends in themselves)
1. The latter is unacceptable, and thus financial compensation is unacceptable
when associated with the transfer of body parts
1. Therefore, financial compensation for egg donation is unacceptable
***In addition, proponents of this argument posit slippery slopes if financial
compensation ever becomes standard practice for body parts.
Rejoinder 2: Commodification
• The argument assumes that being human is essentially defined by one's
body parts
• What makes somebody human is intrinsically aligned with “who they
are,” their personalities, social roles, conscience, etc.
• Women who have had their ovaries removed feel that they are still
women—despite the fact that they can no longer produce eggs
• If so, it is unclear why financial compensation for egg donation should
pose such threat to the intrinsic value of women as human beings
***Worries of commodification are relevant but do not outweigh the
interests of childless, infertile couples.
Objection 3:Unquantified Risks vs.
Benefits
Benefit for infertile couples:
• The chance to have children
and thus establish a family
Risks for donors:
• Dangers associated with the
surgical removal of eggs
• Dangers associated with ovulation induction, i.e. ovarian
hyperstimulation syndrome (OHSS)
Unquantified Risks and
Informed Consent
1. Although the risks associated with ovulation induction have
been covered in medical literature, but perhaps there is a lack of
such coverage in popular literature. This:
(a) imposes limits on the potential egg donors' abilities
to understand the procedure
(b) allows fertility clinics to skirt their obligations to
obtain informed consent
2. Providing donors with information about risks of ovulation induction is essential to obtaining
informed consent
***The ethical responsibility of IVF clinics to ensure informed consent is made especially
crucial if the recruitment of egg donors occurs among populations already vulnerable for socioeconomic and other reasons.
Informed Consent
•
Informed consent from egg donors would mean they are
aware of the associated dangers of ovulation induction and
surgical removal of eggs
•
Obtaining informed consent for any medical procedure has
been inadequate for decades
•
It continues to be a problem that plagues the medical
profession
Current Situation in the US
•
•
There is no consistent oversight of fertility clinics operating
on U.S. soil
Professor Art Caplan, chairman of the Department of
Medical Ethics at New York University Langone Medical
Center, has dubbed the United States the “Wild West of
reproductive technology.”
Current Situation in the World
•
There is no agency in the U.S. comparable, for example, to the UK
Human Fertilisation and Embryology Authority, which oversees
licensure, accreditation and operating practices of British fertility
clinics.
(http://www.hfea.gov.uk/)
• Several Western nations such as Italy, Norway, Canada, and the UK,
have enacted strict legislation prohibiting some, or all, forms of
gamete donation
• There is a lack of international standards regarding practices and
policies on egg donation
• This situation elicits fears about whether women are being treated
with respect and dignity and calls into question the fertility industry
as a whole
Reproductive Tourism—
A Cousin of Transplant Tourism
• “Reproductive tourism”
the practice of traveling to another country to receive specific
fertility treatment because of legal restrictions in home country, or
to obtain the sought procedure or gametes at a lower price
(Pennings 2004)
• “Reproductive exile”
refers to women forced to leave their home countries to access
safe, effective, affordable, and legal fertility care. Their choice
to
use assisted reproductive technologies is voluntary, but their
travel abroad is not
• “Transplant tourism”
is the practice of traveling to another country to obtain organ
transplantation through commercial transactions because of organ
shortages/long waiting-lists in home country
Health Risks of Egg Donation
The Need for a Donor Registry
•
There is currently no egg donor registry in the U.S.
Consequently, there can be no long-term follow up of:
• possible health effects, or long-term risks of egg
donation
•
There is a national registry for kidney donation
• donors can participate in research studies and it is
therefore possible to determine long-term risks and
effects
Future Directions for Egg Donation
• To adopt international standards to govern egg donation, which could
eliminate disparities
• To increase the available data on the effects of ovary-stimulating
drugs
• To decrease unquantified risks associated with egg donation and
promote informed consent
• To codify what does and does not constitute commodification
***At the very least, the mere exercise of developing such standards will
draw much needed attention to this important area of biotechnology and
bring the consequent issues to the forefront of public attention
In the US: Donors increasing
in number during
recessionhttp://www.youtube.
com/watch?v=DRxTCRD-yM&feature=related
Romanian mother at
66http://www.youtube.com/w
atch?v=Q9rtWZrBeV4
Woman gives birth to
quadruplets at 65
https://www.youtube.com/wat
ch?v=Nl2fwy16xiM
Thank You for Your Attention