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Ethicists and biologists ponder the price of eggs

Nature volume 442, pages 606607 (10 August 2006) | Download Citation

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A Nature Special Report investigates the ethics and economics of donating eggs for stem-cell research. In this, the first part Erika Check investigates whether paying donors would increase supply. In the second part Helen Pearson asks what is known about the long-term health risks faced by donors.

Should women be paid for the time, discomfort and health risks involved in donating eggs for research? The world's largest group of stem-cell scientists is grappling with the question, and has now asked the public for its views.

Stem-cell researchers want eggs so they can work on somatic cell nuclear transfer, or 'therapeutic cloning'. They hope to derive embryonic stem cells matched to patients' DNA, by transferring the nucleus of one of the patient's cells into a human egg and developing it into an embryo from which cells can be derived. The technique has great medical potential — but researchers are far from achieving it, and the main limiting factor in the research is the availability of human eggs to practise on.

So far, scientists have relied on women already undergoing fertility treatment donating their extra eggs for research. But the supply is meagre. To help persuade them, several labs are increasingly offering financial rewards, such as cheaper fertility treatment. Others are starting to ask healthy women to donate — triggering a debate about how such women should be compensated.

Some ethicists argue that women should receive compensation for the discomfort and effort involved. Others are worried that this will create an undue incentive that will coerce women — especially poorer ones — into giving up their eggs. The fact that so little is known about the long-term health risks of the procedure further complicates the picture (see 'Health effects of egg donation may take decades to emerge', opposite).

Scientists in many parts of Europe, Asia, the Middle East and North America ask women to donate eggs for research, but they all treat the practice differently. Scientists at the North East England Stem Cell Institute announced on 27 July that they had got permission from the UK Human Fertilisation and Embryology Authority to pay part of the cost of in vitro fertilization treatments for women who donate eggs for research (see Nature 442, 498; 200610.1038/442498a).

But other European countries that accept egg donation for research, such as Sweden, prohibit payment for anything other than direct expenses. Japan bans egg donation altogether because of the risk of complications, whereas China, along with several other countries, does not specifically address the question.

Mixed blessing? Donating eggs is a time-consuming and uncomfortable business. Image: H. MORGAN/SPL

In the United States, a National Academies panel recommended last year that women should be reimbursed only for direct expenses. This approach has been adopted by the California Institute for Regenerative Medicine, and by the state of Massachusetts, home of the Harvard Stem Cell Institute (see Nature  doi:10.1038/news060605-6; 2006). Both institutes are asking healthy women to donate eggs for research. But even their policies differ — for instance, California law would allow paying the travel expenses of women who come from out-of-state to donate eggs, whereas it's not clear how Harvard will handle this question. “At the moment we're confining the search to this area,” says spokesman B. D. Colen.

Scientists want international guidelines so that they can share materials without worrying about how they were derived. So a task force of the International Society for Stem Cell Research (ISSCR) is considering the compensation question as part of a larger effort to draw up guidelines. The task force, made up of scientists, ethicists and lawyers from 14 countries, was convened last year after the revelation of scientific misconduct by South Korean stem-cell researcher Woo Suk Hwang: as well as faking evidence of 11 human embryonic stem-cell lines derived by therapeutic cloning, he lied about paying hundreds of women for eggs, and obtained eggs from his female subordinates.

On 30 June, the ISSCR task force released draft guidelines at its annual meeting in Toronto. The guidelines embrace most of the principles proposed by the National Academies last year. But they differ on the issue of egg donation. The task force leaves the door open for a more liberal policy on compensation by stating simply that stem-cell research projects should be reviewed by a local oversight body, which must ensure “there are no undue inducements or other undue influences for the provision of human materials”. What constitutes 'undue' is left to the local oversight bodies.

George Daley, a biologist at Harvard Medical School who chaired the task force, says that this is the best consensus the task force was able to achieve, because scientists and ethicists on the task force disagree so sharply about how egg donors should be treated (see 'Research volunteers or organ donors?).

Box 1: Research volunteers or organ donors?

Much of the disagreement on compensation has arisen from the question of how egg donors should be viewed. Laurie Zoloth, a bioethicist at Northwestern University in Evanston, Illinois, who was on the ISSCR task force, argues that egg donation is similar to organ donation, and should therefore be free of financial considerations.

“One is asking the donor to undergo hyperstimulation, anaesthesia and minor surgery, then in a very real sense participate in the act of creation of an embryo that will be destroyed for research,” she says. “This is a serious moral gesture, and I think it ought to be directed by a serious and reflective moral decision.”

The eggs are to be used for research rather than medicine — but, Zoloth argues, so were the first organ donations. If scientists start paying for eggs now, she says, it will be difficult to stop payments once the technique moves to the clinic.

But bioethicist Insoo Hyun of Case Western Reserve University in Cleveland, Ohio, who was also on the task force, argues that egg donors should be treated as research volunteers, like those who donate bone marrow for research (see Commentary, page 629). Such participants are generally reimbursed for their time and discomfort.

Meanwhile, Kevin Eggan of the Harvard Stem Cell Institute, who was not a member of the task force, has another concern. Although avoiding compensation may reduce the risk that women could be coerced into donating eggs, it would also restrict the practice to wealthy donors, who can afford child care or to take time off work. The eggs upon which research is carried out would therefore represent only the most privileged groups, and not the population as a whole. “I think it's very hard to hold the line that reimbursing for minimal expenses is the right thing to do for the women involved,” he says.

E.C.

The guidelines are seen as an important first step nonetheless, and are now open to public comment until 1 September, when the ISSCR will finalize the document.

“These are going to be seen as the rules set by scientists themselves, from the inside out,” says Kevin Eggan of the Harvard Stem Cell Institute. “It's very useful for scientists to show that they have thought about these issues.”

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