What Are the Ethical Concerns Regarding Egg Donation?

Egg donation raises questions regarding all four of the basic principles of medical ethics:  autonomy, justice, beneficence, and non-maleficence.  Infertility specialists, donor recruitment agencies, donors, medical ethicists, patients, and health insurers must consider these conflicts of interest when formulating and evaluating policies regarding egg donation.

Medical ethicists often question the quality of consent involved in the egg donation process.  For donors who receive payment for their participation, high financial incentives may provide pressure or coercion which hampers ability to make clear, informed decisions.  While most egg donors in the US receive around $4,000 as compensation, current advertisements offer up to $100,000 for young, healthy donors with "desirable" characteristics.  Studies show that women who donate for financial reasons suffer more emotional harm from the procedure and are more likely to regret their decision than women with altruistic motivations.  Also, with the highly technical nature of ARTs, donors may be incapable of fully understanding all the potential risks and treatment options without substantial background in biology and medicine.  Clearly, potential exists for coercion and uninformed consent with regards to egg donation.

Because of the current shortage of qualified egg donors, infertility treatments are subject to distributive injustice.  Approximately 1,000 women conceive each year with the use of donor eggs, while many more must postpone treatment until an acceptable donor becomes available.  Women who can afford higher payments for advertising, compensation, and agency fees are more likely to receive treatment than women from lower socioeconomic levels, leading to ethical conflicts.

Injustice may also occur in the management of needs, rights, and obligations involved in egg donation.  Infertility specialists are required by the principle of justice to provide appropriate treatment to their patients, which implies they will do all they can to ensure a successful pregnancy for an infertile woman.  With a shortage of egg donors, doctors may be unable to provide optimal treatment to their infertile patients, making donor recruitment necessary.  A conflict of interest emerges then, in the doctor's need to serve her patients by encouraging donation by young women and her responsibility for protecting the health of these donors who would otherwise not be involved in the medical risks of the procedure.  

Beneficence and Non-maleficence
These last two principles require that egg donation procedures are performed for the purpose of improving the health of the patient and preventing harm.  However, there is an inherent aspect of maleficence in respect to donors, who undergo the risks of an invasive surgical procedure without clinical benefit.  Doctors and legislative bodies must decide whether placing a young, fertile donor at risk for harm is justifiable for the benefit of an older, infertile patient.

This concept of harm-avoidance is especially problematic because the side effects of ovulation enhancing drugs on donors are not completely known.  The use of these drugs began fairly recently, and longitudinal studies about their effects in later life have yet to be performed, although the American Society for Reproductive Medicine recognizes the need for further study.  Of concern is the increasing frequency of clinical reports linking ovarian stimulation regimes with ovarian cancer.  Other documented risks include ovarian hyperstimulation syndrome, lacerations, ovarian trauma, infection, infertility, and lacerations.  The precautionary principle, a concept of medical ethics encouraging limited use of technologies in the absence of conclusive information about long-term effects, would seem to discourage the practice of egg donation among healthy young women.  Especially for this procedure, with no clear benefit to the donor and many potential risks, serious ethical questions may be raised.

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