Sunday, February 18, 2007

Donating Eggs for Science

Today's Guardian has this news report that the UK's Human Fertility and Embryology Authority (HFEA) is expected to approve a policy that would permit women to be paid £250 to donate their eggs for scientific research. This issue is a very contentious and difficult issue. I haven't been able to find HFEA's Ethics and Law Committee report on why they have arrived at this decision but perhaps it will be posted on the web later this week when the announcement is made. So I look forward to reading their report.

This issue is a great example of the challenges we face when trying to find a reasonable balance between two laudable aims. On the one hand, we want to minimise the risks of preventable harm that women are exposed to. On the other hand, we want to promote scientific research (like stem cell research) into treatments that could lead to cures for a variety of medical conditions. And if these advances prove to be successful this would mean we could thus reduce a variety of harms and risks of harm. So the question is really one of what would constitute a fair and sensible risk-management policy. Those in favour of permitting voluntary egg donation for science will likely argue that the risk of harm from such a procedure is minimal and the potential benefits (e.g. of stem cell research) could be enormous. Those taking the opposite position will likely argue that the potential risks of harm from egg donation, while minimal, are demonstrable and potentially severe. Given the potential harms are demonstrable, and the scientific gains only speculative, voluntary egg donations for science should not be permitted.

While those critical of permitting voluntary egg donations for science might highlight the risks of egg donation, it is important to bear in mind that we permit women to voluntarily expose themselves to these same risks when they undergo IVF. So women can take these risks for something that has no direct medical benefit to themselves. Furthermore, we permit women to expose themselves to these risks even when the potential non-medical benefits (i.e. having a child they are biologically related to) are not guaranteed. The success rate of artifical reproductive technologies varies depending on the age of the women, the cause of infertility, and the number of embryos transferred. According to this report from the U.S, the national average success rate of artificial reproductive technologies is 28%. So it is important to bear this mind when considering permitting voluntary egg donations for science. If we permit women to expose themselves to these same risks for the chance (not certainty) to have children they are biologically related to, should we not permit them to voluntarily expose themselves to these same risks for the chance to benefit medical science? Furthermore, we permit healthy volunteers to consent to participating in clinical trials, trials that expose them to some risks of harm. So I think it is natural to ask: should we not permit women, who would be informed of the risks of egg donation, to decide if they are willing to tolerate such risks for the chance to benefit medical science?

I think the really central issue comes down to the likelihood and severity of the potential risks and the likelihood and magnitude of the potential benefits such donations could make to science. There is uncertainty and disagreement about both of these issues. The lower the risk of the harm from egg donation, and the greater the likelihood that such donations will reap tangible scientific benefits, the greater the case for permitting voluntary egg donations for science.

One interesting component of the proposed policy that I think should relieve some of the concerns of its critics is that potential donors must demonstrate they are acting for altruistic reasons. For example, that they wish to help scientists develop a treatment for a condition that inflicts a close relative. If this policy can actually be implemented in a way that permits regulators to distinguish between those who wish to donate for genuine altruistic reasons vs those who are doing so primarily for the money, then I think this further tips things in favour of the policy. So does the fact that the amount of money involved here is modest. It would be different if the money being offered was thousands of pounds. So these features of the policy reduce the likelihood that it will result in the exploitation of women.

The BBC has an interesting video report on these issues here (on the right hand side). And News@Nature had a special report on these issues back in August. You can download that report here.