Skene, Loane --- "Should Women be Paid for Donating Their Eggs for Human Embryo Research?" [2009] UMelbLRS 40

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This paper was first published in the Monash Bioethics Review, Volume 28, No. 4, 2009

In Australia, the UK and Canada, the tradition in medical research has been that all tissue used in research should be donated gratuitously, including human eggs and embryos. Payments are not permitted beyond reasonable expenses,1 such as reimbursement of the donors’ medical expenses and compensation for loss of earnings due to the donation. Similarly, European countries disapprove of ‘commercialisation’ of human tissue or obtaining financial gains from the donation of human reproductive materials. In the US, on the other hand, there is no federal legislation governing the sale of human eggs. They may be sold for a ‘fair price’ for use in fertility programs, except in states that have legislative restrictions on the sale of eggs for use in research.2 Recently, New York became the first American state to allow scientists to use public research funds to pay women for donating their eggs for use in research, or certain types of research. This may lead to questions about whether Australia should reconsider the prohibition of payment for human eggs for use in research, especially as the federal legislation on human cloning and embryo research will be reviewed next year. This paper considers the arguments that might be advanced in favour of paying women who donate eggs for research and some responses to counter-arguments.

1. Human embryo research may provide important information for human health care

There are several ways in which human embryo research may be useful in human health care. Perhaps the most controversial is the derivation of pluripotent stem cells from the embryo to study, to test drugs and to try to differentiate the cells into other types of cells to treat patients with spinal injuries, Alzheimer’s disease, diabetes and other conditions (Skene 2009). Despite some scepticism in the community about the likely effectiveness and safety of human stem cell treatments, it should be remembered that one type of stem cell transplant (bone marrow) has been used to treat leukemia for more than thirty years with increasing success. More recently, there have been many experiments showing ‘proof of concept’ for other stem cell treatments, both in animal models and in humans. An Australian example is the use of a patient’s own stem cells taken from the cornea of one eye to treat macular degeneration in the other eye (Macrae 2009).

Other research on early human embryos is necessary to understand their early development, to improve fertility treatment procedures and possibly even to develop ‘treatments that can correct growth defects before a child is born’ (Sample 2009).

2. Research on human embryos will still be needed despite recent advances with induced pluripotent stem (IPS) cells

It might be thought that human embryonic stem (hES) cell research is not needed after human stem cells have been derived from human induced pluripotent stem (hIPS) cells. Also, ‘cell reprogramming’ is widely predicted to be the most likely form of treatment for the future (this involves ‘turning the clock back’ on adult human cells to give them the versatility of embryonic cells).

It is certainly true that hIPS cell research is currently receiving more attention and funding than hES cell research.3 However, in the US, significant hES cell research is still being undertaken and, in time, hES cells may provide the best opportunities for clinical treatment. Professor Kevin Eggan, who is doing ground-breaking research at Harvard on deriving matched neurons from the skin cells of patients with Lou Gehrig's disease, reportedly described embryonic research as the ‘gold standard’ for stem cell research (Eggan 2008; CBC News 2009). Embryonic stem cells multiply indefinitely and can be transformed into all other cells. They are more adaptable than stem cells derived from body cells and they reproduce indefinitely. Earlier this year, the first clinical trial to transplant stem cells from human embryos into patients with acute spinal cord injuries was approved by the US Food and Drug Administration (the Geron trial). Although the trial has been delayed, it could start at any time and, if it is successful, it may challenge people's attitudes to human embryonic stem cell research.

In addition, as discussed earlier, there are other reasons to continue research on human embryos as well as hES research. Embryo research will help scientists to understand the early development of a human embryo, to improve fertility treatment procedures and possibly even to develop treatments for genetic conditions. This type of embryo research will be valuable whatever happens with hIPS cell research.

3. Not all embryo research can be conducted using human eggs donated from fertility programs; embryos must sometimes be created for research

Some human embryo research can be undertaken on human embryos that have been donated for research when they are no longer needed in fertility treatment programs;4 and many frozen embryos are available for research.5 However, if embryos are specifically created for research rather than donated from fertility treatment programs,6 it may be possible to derive new stem cells that are tissue-matched to a particular person, or that all carry the same mutation for study or drug testing. The ‘cloning’ of hES cells is currently clouded by the prosecution of South Korean stem cell researcher, Dr Hwang, for bioethical violations and fraud after he claimed he had produced human stem-cell lines using cloned embryos derived from patients suffering from spinal-cord injury and other disorders (Cyranoski 2009), but in future this research may be successful and useful.

4. Many donated human eggs will be needed if research is done that requires the creation of human embryos for research

If human embryos are created for research, large numbers of human eggs will be needed. According to an Australian newspaper report, 227 sheep eggs were used to create Dolly and 304 monkey eggs to create the first reported ‘cloned’ primate (Martin 2008).7

One obstacle for scientists undertaking human embryo research has been a shortage of human eggs for research. Women in fertility programs can donate eggs they do not need but many women want to have all their eggs fertilised and frozen for later use, in case they don't become pregnant on the first attempt. Other women in fertility treatment programs don't want their eggs to be used in research. Women who are not in fertility programs could also be donors, for example if they want to help research into genetic conditions in their families, or to help research in general. However, they may be deterred by the time and effort of donation and the potential risks.

6. Women may be more willing to donate their eggs if they are paid for their time and the invasiveness of the procedure

American researchers have found that willing egg donors have been deterred by the time and invasiveness of the procedure. Professor Eggan and his collaborators began recruiting egg donors for their research with advertisements in local papers and disease-advocacy magazines. Eggan said ‘We’ve had hundreds of calls from women who are interested in donating, but when they find out about the time, effort, and pain involved, they simply can't take the time to go forward’ (Eggan 2007). Eggan blames the dearth of donors on Massachusetts regulations that prohibit researchers from paying women for their eggs. The law is meant to prevent coercion of poor women who might undergo the procedure out of financial need. But women who undergo the same procedure to donate eggs to infertile women for assisted reproductive technology (ART) receive payments from $3,000 to $10,000. ‘If we feel comfortable compensating women who donate eggs for ART – and infertility is a terrible disease – why aren't we comfortable compensating women for donations that could aid other serious diseases?’ Eggan asks (Eggan 2007).

7. Paying women for donating eggs is reasonable to compensate them for the time taken and the invasiveness of the procedure. This is not ‘commodification’ of bodily material

Donation of human eggs is invasive and has risks, some of which may not be known. It therefore seems reasonable for women to be compensated for more than just medical expenses and time off work. People may condemn such payments as a ‘sale’ of human bodily material and undesirable commodification of the human body. But women are not in fact selling their eggs. They are being compensated for subjecting themselves to the process of taking drugs to produce more eggs and then a surgical procedure for retrieving the eggs for research. Women should also be compensated for future medical costs (direct and indirect) arising as a result of the donation to be fully covered, with the benefit of the doubt going to the donor.

Competent adult women should be permitted to decide freely whether to donate their eggs for research. Prohibiting them from being paid is an unwarranted restriction of their autonomy – the hand of the nanny state. We allow people to work in risky jobs and to be paid for doing so: film stunts, bridge construction – even prostitution. The state protects workers’ safety as much as possible but it does not discourage them by prohibiting payment. Indeed, women who donate eggs for research may be better protected by allowing payment with open procedures and proper regulation than by prohibiting payment.

9. Possible exploitation of ‘vulnerable’ women can be avoided by proper disclosure of what is involved and the potential risks; and the requirement of ethical oversight

There may be concerns about payment for egg donation leading poor and ‘vulnerable’ women to risk their health in order to make money, or being subject to unfair inducement or exploitation. However, women could be protected by the usual processes of medical research, especially oversight by institutional ethics committees according to specific ethical guidelines. These ethics committees would scan the recruitment procedures and the information and consent forms. Donors could be limited to women who have had children (in case egg retrieval affects future fertility). It would be mandatory to mention any known risk and the fact that other risks may not be known. The number of eggs and the occasions on which eggs may be donated could be restricted. The amount for payment could be limited so as not to threaten the woman’s ability to provide free and voluntary informed consent for donation (Macklin, 1981); or to appreciate the risks of the procedure (Bentley and Thacker 2004). Mandatory detailed record keeping could be required, with proper long-term monitoring of donors.

If there is concern that eggs may be imported for research from other countries that have less stringent protection for donors, then legislation could be passed to prohibit the importation of gametes and stem cell lines that have not been procured in accordance with procedures similar to those required by the local laws governing monetary payments and consent.

10. Allowing payment for eggs would not set a precedent for payment for other types of tissue donation because egg donation is in a different category

People may be concerned about payment for egg donation setting an unfortunate precedent. If it led to payment for other donated human tissue, that would contravene the Australian tradition of altruistic donation and research participation. Blood donors – and even organ donors – cannot be paid. However, organs are rarely donated to a stranger (unlike eggs donated for research); and a live person cannot donate an organ for research. Blood can be donated for research, which must be altruisitic; but egg donation is much more invasive than blood donation. The women have to take drugs to stimulate ovulation and the eggs must be removed surgically. Egg donation should therefore be treated differently from other types of human tissue donation for research.

The arguments set out in this paper are intended to provoke discussion. The Australian federal legislation will be reviewed in 2010 and this may be an issue that is raised. As explained in the paper, the need for human embryo research is not limited to hES cell research, which may be less urgent with advances in hIPS cell research. There are other reasons for doing research on human embryos – to learn more about their early development, improve fertility procedures and the like. Some of that research could be done on embryos donated from fertility treatment programs, without creating new embryos specifically for research (subject to obtaining a licence from the federal embryo research licensing committee). Other embryo research may involve creating human embryos specifically for research. If that research increases, more human eggs will be needed and paying women for donating their eggs may increase the supply of eggs for research. The interests of women who donate eggs could be protected by appropriate regulation and ethical oversight.

1 Australia: Prohibition of Human Cloning for Reproduction Act 2002 (Cth) s 23; UK: Policy of the Human Fertilisation and Embryology Authority (HFEA) – Seed Review, 2004; Canada: Assisted Human Reproduction Act 2004 (Can); Canadian Institutes of Health Research, Guidelines for the use of stem cells. March 2001 (the guidelines have been updated several times, with the latest revision published on 29 June 2007).
2 California, for example, prohibits the purchase or sale of an ovum, zygote, embryo, or fetus for the purpose of cloning human beings.
3 Substantial funding is available for human IPS cell research; see, for example Johns Hopkins Medicine (2009); ‘only a handful’ of projects to which the California Institute for Regenerative Medicine recently awarded $230 million in disease team awards was for embryonic stem cell research: California hands out $230 million to move stem cells into the clinic (The Great Beyond 2009). See also (CIRM 2009).
4 Human embryos created for fertility treatment cannot be retained indefinitely. Couples who have completed their family or who no longer wish to continue the treatment have three options. They can donate the embryos to another couple, donate them for research or direct that they be removed from storage.
5 Frozen embryos could probably be used in the type of research that Geron has FDA clearance to do: see text above.
6 In Australia, it is lawful to form a human embryo for research by somatic cell nuclear transfer (SCNT) but not by fertilising a human egg with human sperm. SCNT means that the embryo is formed by inserting the nucleus of a person's body cell into a donated egg that has had its nucleus removed.
7 In Chinese research reported in 2009, creating patient-specific ES cells, ‘a total of 135 oocytes were obtained from 12 healthy donors (30–35 years)’ (CellNEWS 2009).

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Skene, Loane. 'Should women be paid for donating their eggs for human embryo research?'. Monash Bioethics Review. 2009.; Monash University ePress: Victoria, Australia. http://www.epress.monash.edu.au/. : 28.1–28.8. DOI:10.2104/mber0928

University of Melbourne Law School Research Series

Skene, Loane --- "Should Women be Paid for Donating Their Eggs for Human Embryo Research?" [2009] UMelbLRS 40