April 21, 2007

Deborah Spar on Paying for Eggs

Harvard’s Debora Spar has a commentary in a recent New England Journal of Medicine article that calls for an improved debate over egg donation and payment policies. Spar highlights a central inconsistency in American egg donation policy—we allow women to sell eggs for reproductive purposes, but not for research, even though the risks and benefits to donors are the same in both cases. Both donors undergo the same set of medical risks, and both receive roughly the same direct benefits—basically nothing. Yet in one case we allow women to sell their eggs for whatever the market will bear, with no informed consent requirements whatever, and in the other we prohibit any direct payment except for expenses, variously defined.

Spar notes that much opposition to egg sales stems from fears of exploitation and “commodification”, but argues that these concerns apply equally to both reproductive and research donors. There’s already a thriving market in eggs, fueled by would be parents who are willing to pay whatever it takes, to the extent of mortaging houses and liquidating retirement accounts. Spar notes this market is getting steadily larger—her back of the envelope calculations indicate that roughly 13,000 IVF cycles with donated eggs were performed in 2003, almost all of which were paid for, at an average price of around $5,000. Paid egg donors get no substantial benefit from the procedure beyond the pay—the purchasing couple takes the eggs and there’s frequently no contact between donors and purchasers. Unlike organ donation, which comes with a mandated informed consent procedure, there are no such requirements for egg donation— brokers or fertility clinics can tell donors as much, or as little, as they feel like.

Why this transaction is less exploitive or commodifying than donating eggs for research really isn’t clear. There’s no compelling reason why blonde, leggy volleyball players who go to Harvard should be able to sell their eggs for $50,000 to wealthy infertile couples and women wishing to donate eggs for research can’t get paid anything. Other countries with egg donation policies frequently limit or prohibit payment for eggs, but treat both reproductive and research donors the same way.

Spar argues that current no-payment-for-research policies makes volunteers the only substantial source of oocytes for research. Anti-payment advocates have focused more on why women shouldn’t get paid and less on why they should—or will—volunteer to undergo a medical risk for free, or why anyone who can sell their eggs for reproductive purposes should be willing to donate them for research for nothing. Allowing payment for some donations but not for others seems almost certain to insure a shortage of eggs for research.

It should be noted Spar is not alone in these views. Judith Daar and Russell Korobkin of UCLA have argued here that financial incentives are ubiquitous—and both legal and ethical-- in a market economy and that bans on payment for eggs presumes that women are incapable of making informed decisions. Our own Bonnie Steinbock has offered a different defense of payment in the Mt Sinai J Medicine [2004 Sep;71(4):255-65].

The major obstacles to consistent treatment of egg donors are political rather than substantive. Proposals to ban payment for reproductive donors would produce howls of protest from those who profit from the assisted reproduction process, and proposals to pay research donors with public money would likely be considered dead on arrival. Spar’s proposals to understand and mitigate the risks of egg donation, insure that all consent to donation is informed, and have a serious debate on whether any women should be allowed to sell eggs are all sensible, but don’t look for any progress anytime soon.
Jim Fossett AMBI/Rockefeller Institute of Government
Bioethics and Federalism Initiative

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