To: Bob Cook-Deegan
From: Amber Johnson
Date: February 22, 2000
Re: Stricter Guidelines for Recruitment of College-Age Women
for Egg Donation
Statement of Issue: The current shortage of healthy donor
oocytes, as well as the rising demand for infertility treatment, has led
to increased recruitment of young, college women for egg donation.
Most campus advertisements use financial incentives to attract students
for this procedure, which carries documented surgical risks and long-term
effects. These young women will more likely regret their decision
and suffer harm than donors who already have children and are more likely
to donate for altruistic reasons.
Policy Options: Although other countries, including
the UK, Israel, Denmark, and Canada, have guidelines discouraging the use
of financial incentives for donors, the United States has no such policy.
Ovarian hyperstimulation during donation increases the risk of malignant
tumors and other serious conditions, including ovarian hyperstimulation
syndrome, ovarian trauma, infection, infertility, and lacerations.
7% of all donors will develop a long-term side effect.
Donors with financial motivations recruited from university settings
have the highest levels of postdonation regret, and may have higher
levels of family trauma and sexual abuse than the general donor pool. -
This increases the risk of psychological harm to the donor and litigation
towards the clinic and recipient.
High financial incentives hamper the donor’s ability to make clear,
informed consent. According to the International Federation
of Gynecology and Obstetrics, this constitutes commercial exploitation
and should be prohibited.
Best Policy Action: A limit on allowable compensation
to egg donors will eliminate financial motivation for the most high risk
donors, while still allowing infertile couples to benefit from donor oocytes.
Although not a cure-all, this is a necessary, attainable first step in
regulation. Other small changes, such as a “cooling off” period in the
consent process and increased risk education, could be incorporated into
the policy with little opposition and ensure more informed donation.
This policy also combats the rising problem of egg auctions, which compromise
optimal donor and recipient matches in favor of high profits.
National ban on monetary compensation for voluntary, non-patient egg donors.
This would prohibit the recruitment of egg donors using financial incentives,
and limit donor payment to reimbursement of medical expenses. Similar
to the current UK policy, this would confine the donor pool to altruistic
non-patient donors and infertile women undergoing ovarian hyperstimulation
who are willing to share eggs.
Advantages: Ensures that only women with highest chance
for postdonation satisfaction and informed consent become donors.
Eliminates problem of donors hiding potentially damaging information to
gain eligibility. Supported by some medical ethicists who oppose
all forms of payment.
Disadvantages: Increases shortage of available eggs,
reducing access to care for infertile couples. Documented medical
risks associated with the procedure may be worthy of compensation.
Must rely on social recruitment campaigns similar to blood donation which
have proven ineffective for gamete donors. Opposed by infertility
lobbyists, practitioners who would lose business, and some medical ethicists
who feel invasive procedure justifies some compensation.
Limited “inconvenience allowance” with stricter guidelines for donor recruitment.
This would set a cap on allowable compensation for donors, allowing for
medical expenses and a limited payment for participation. The auctioning
of eggs would be outlawed, and private donation services would be more
Advantages: Does not significantly limit donor pool
but eliminates strongly financially motivated women most unfit for donation.
Allows some payment for documented medical risk, which decreases likelihood
of litigation. Encourages egg-sharing among infertile women, which
does not expose a third-party to medical risks. More likely support
from infertility lobby, medical practitioners, and some medical ethicists.
Disadvantages: Does not alleviate shortage of donor
oocytes. Opposed by some private donation agencies, as well as infertile
couples from high socioeconomic levels. Exact amount of proper “inconvenience
allowance” difficult to quantify.
“Ovum donation: move slowly.” Lancet. July 16, 1994;
344 (8916): 142.
Johnson, MH. “The medical ethics of paid egg sharing in the UK.”
Human Reproduction. February 1999; 14(2): 1912-8.
Klock, Susan et al. “Predicting anonymous egg donor satisfaction:
A preliminary study.” Journal of Women’s Health.
March 1998; 7(2):
Ahuja, K.K. et al. “Anonymous egg donation and dignity.”
Reproduction. June 1996; 11(6): 1151-4.
Ahuja, K.K. et al. “Egg sharing and egg donation: attitudes of
British egg donors and recipients.” Human Reproduction.
December 1997; 12(12):
“The donation of genetic material for human reproduction.” International
Journal of Gynecology and Obstetrics. February
1994; 44(2): 185.
Craft I, et al. “Should egg donors be paid?” British
Medical Journal. May 10, 1997; 314(7091): 1400-3.
Ahuja, K.K., et al. “Money, morals, and medical risks: conflicting
notions underlying the recruitment of egg donors.” Human
February 1999; 71(2): 219-21.