25 October 2010
ByAppeared in BioNews 581
Dr Sue Avery, director of assisted conception at Birmingham Women's Hospital, opened the discussion. She said participation in egg sharing - a programme designed to address the shortage of egg donors - has dropped by 80 percent at her centre since more NHS-funded IVF has become available. This suggests women are less likely to donate eggs once their financial concerns are removed.
Egg sharing involves an exchange. Women who have used their NHS-funded quota of fertility treatment or don't qualify for NHS funding can undergo a cycle of IVF free-of-charge in exchange for donating their eggs. Dr Avery said egg sharing is not morally comfortable for everyone because it begs the question of what constitutes compensation and where you draw the line between compensation and payment.
The debate's chair Tony Rutherford, a consultant gynaecologist and chairman of the BFS, raised the question of payment. He asked whether the £250 compensation currently available to women who donate their eggs is enough because they must go through appointments that take them away from work, frequent injections, and a small operative procedure.
Laura Witjens, chair of the National Gamete Donation Trust (NGDT) and a mother and altruistic donor, proposed a £700 payment for egg donors. This represented 'a gesture of appreciation, but not enough for women who donate to take an unnecessary risk', she said. 'It's also not enough to clear your credit card debt or student loan', she added, hoping to persuade the audience that £700 would not represent an inducement to donate.
Dr Avery defined compensation as an amount of money that should 'put you back in the position you were in before starting the process', and wondered where the line between compensation, payment and exploitation lies. She quoted from the European Union's 2004 Tissues and Cells Directive, which states: 'donors may receive compensation, which is strictly limited to making good expenses and inconveniences related to the donation'.
It is the use of 'compensation' in the directive, which makes any use of the word 'payment' in discussing egg donation problematic. The moral test for exploitation involves distinguishing between coercion and persuasion, said Professor Raanan Gillon, chair of the Institute of Medical Ethics.
'There is a huge difference between coercion and persuasion', said Professor Gillon, who gave the dictionary definition of coercion as to constrain or restrain by force, or the threat of force. He said: 'payment simply doesn't constitute coercion under that definition'. Professor Gillon likened the situation to employment we might not undertake without being paid, saying: 'Of course payment can persuade people to do what they otherwise might not do'.
'Large payments, or other inducements, only become undue inducements if they attempt to persuade someone to do something wrong or illegal', he said. Unless compensated egg sharing 'where women in effect are paid several thousand pounds in reduced cost of IVF' is shown to be wrong or illegal, he said payment or other financial incentives do not constitute undue inducement.
Professor Brian Lieberman, medical director of Manchester Fertility Services, voiced misgivings about payment. He talked about potential health risks faced by donors, including ovarian hyperstimulation syndrome, pelvic infection, damage to the bowel and ovarian abscesses. But Professor Lieberman said the retrieval procedure itself is low risk.
Egg sharers can experience psychological damage too, according to an audience member. The donor may find it too much to bear if someone else becomes pregnant using their eggs while their own IVF cycles fail. A Cambridge University researcher challenged this view. Her research showed donors' main feelings were not distress, but 'at least I tried' and that some benefit and worth had come from their unsuccessful procedure.
The psychological risks to children born from paid egg donation triggered more debate. Professor Brenda Almond, president of the Philosophical Society of England, said donor-conceived children may feel a 'loss of genetic connection' to 'mother, siblings or half-siblings, grandparents and other relatives'. She said: 'I think there is a special difficulty when a child comes to know the circumstances of their birth and finds their genetic mother sold them to a stranger for financial gain'.
This issue of 'what to tell the children' was raised more than once by members of the audience. One audience member painted a reassuring picture of an imaginary exchange between parent and donor-conceived child: the child was wanted so badly by their non-biological parent(s) that 'special measures' were taken to bring them into the world. The issue of money played second fiddle to the result: a child brought up with love and affection.
One audience member was at pains to point out not all naturally-conceived children are raised in loving and healthy families purely by dint of their genetic relationship. His own daughter was donor-conceived and, at a tender age, he had begun to explain her unique situation in a basic way. He did not feel she was psychologically traumatised by this knowledge.
Perhaps the most emotionally evocative speech came from Laura Witjens, the panelist with the most personal experience of egg donation. 'Knowing I made a difference was payment enough for me', she said, although she supported offering donors a £700 payment to encourage participation. This suggestion was met with some scepticism from the audience who remarked on its similarity with 'compensation' figures offered in countries like Spain.
Spain's approximately €900 compensation is a somewhat unfair comparison since the donor anonymity law removed in the UK in 2005 still exists there. However, rates of donation increased fairly dramatically as the recent economic recession begun to take full effect in Spain, reiterating the point that any amount of money would act as an inducement to some women seeking to better their financial situation.
Altruistic egg donors may be rare, but they do exist. There are women in the UK who donate their time and eggs without even claiming the compensation to which they are entitled. Some would be offended to be offered payment. Perhaps our energies and resources should be spent recruiting women to egg donation programs who see making a difference to others lives as payment enough.