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This article was downloaded by: [Case Western Reserve University] On: 06 November 2014, At: 10:53 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK The American Journal of Bioethics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/uajb20 Can We Broker Eggs Without Making Omelets? Jeffrey Kahn Published online: 07 Dec 2010. To cite this article: Jeffrey Kahn (2001) Can We Broker Eggs Without Making Omelets?, The American Journal of Bioethics, 1:4, 14-15 To link to this article: http://dx.doi.org/10.1162/152651601317139216 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

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Page 1: Can We Broker Eggs Without Making Omelets?

This article was downloaded by: [Case Western Reserve University]On: 06 November 2014, At: 10:53Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registered office: MortimerHouse, 37-41 Mortimer Street, London W1T 3JH, UK

The American Journal of BioethicsPublication details, including instructions for authors and subscriptioninformation:http://www.tandfonline.com/loi/uajb20

Can We Broker Eggs Without Making Omelets?Jeffrey KahnPublished online: 07 Dec 2010.

To cite this article: Jeffrey Kahn (2001) Can We Broker Eggs Without Making Omelets?, The American Journal ofBioethics, 1:4, 14-15

To link to this article: http://dx.doi.org/10.1162/152651601317139216

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”)contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensorsmake no representations or warranties whatsoever as to the accuracy, completeness, or suitabilityfor any purpose of the Content. Any opinions and views expressed in this publication are the opinionsand views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy ofthe Content should not be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings,demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arisingdirectly or indirectly in connection with, in relation to or arising out of the use of the Content.

This article may be used for research, teaching, and private study purposes. Any substantial orsystematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distributionin any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found athttp://www.tandfonline.com/page/terms-and-conditions

Page 2: Can We Broker Eggs Without Making Omelets?

14 ajob Fall 2001, Volume 1, Number 4

� 2001 by The MIT Press

Open Peer CommentariesOpen Peer Commentari es

CanWe Broker EggsWithout Making Omelets?Jeffrey Kahn, University of Minnesota

A unique environment has evolved in reproductive medi-cine in the United States. Nowhere else in medicine arehuman tissues bought and sold in such overtly commercialtransactions as we increasingly see with gametes—humaneggs in particular.

It’s not entirely true to say we don’t buy and sell othertissues; blood is bought from donors at plasma centers thatturn it into pooled products for research and treatment,and there has been some recent disclosure of what appearto be markets for cadaveric skin and bone. But neitherhave quite the feel of the overt commercialization that hasovertaken the way human eggs are donated, in whatGurmankin (2001) and others refer to as the “egg market.”Paid blood donors receive relatively little compensationand undergo minimal risk, and their blood can only beused in limited ways based on concerns over the safety ofthe blood supply. Any transactions around cadaveric tis-sues, such as skin, involve only third parties, with no pay-ment going to donors’ families. This, at least in part, is be-cause payment for solid organs from living or dead donorsremains illegal under the federal National Organ Trans-plant Act.

So why has egg donation followed a different path,with increasingly large sums being offered to women will-ing to donate eggs for women who need them to conceive?The factors include the limited supply and increasing de-mand for donated ova, the lack of third-party reimburse-ment—and therefore a lack of third-party oversight—formost reproductive medicine services, and the perceptionthat reproductive medicine does not provide life-savingmedical care, so it is acceptable for access to services to becontrolled by market forces.

The trend toward competitive recruitment and highersums for egg donors is worrisome for reasons that manyhave argued—potential exploitation of donors and theinequity created by allocating eggs based on ability to payfor them. Gurmankin’s study offers preliminary insightsinto an additional reason to be concerned about egg dona-tion: the process of informed consent is woefully inade-quate, as it has been shown to be in many other areas ofmedical care and research.

There is substantial evidence that potential researchsubjects do not fully understand, for a variety of reasons,the protocols into which they are being recruited. Mostimportant for thinking about egg donation, and consistentwith Gurmankin’s pilot study �ndings, numerous analyseshave found that the informed-consent process in clinicalresearch too often underestimates the risks and overesti-

mates the potential bene�ts of research participation (Ad-visory Committee on Human Radiation Experiments1996; Sugarman et al. 1999). To complicate matters, po-tential subjects often have dif�culty understanding thefrequently complex and detailed information presented inthe informed-consent process. These well-known short-comings in informed consent in research bear on how weshould think about the process of egg donation, which isparallel in many respects—it entails participation in riskymedical procedures for the bene�t of someone else, withsome compensation offered in return. But unlike in the re-search context, the process of egg donation doesn’t gothrough mandatory prospective oversight before subjectscan be recruited.

For all these reasons we certainly must do better at in-formed consent in the context of egg donation, especiallyif we stake so much of the justi�cation for recruitment ofdonors (or research subjects) on autonomous decision-making. But even with perfect informed consent there arestill plenty of reasons to argue for policy changes related tothe practice. The problem of exploitation only becomesmore serious as the rate of payment for egg donation in-creases. We know that everybody has a price, and it is inmy view unethical to create situations in which womenoverlook the risks of donation to themselves and their fam-ilies (pain, disability, long-term effects, and even the pos-sibility of death) for monetary inducements. And manywomen report that they are concerned about the psycho-logical impact of having genetically-related childrensomewhere in the world created from their eggs (McKin-ley 1998). Further, we have decided as a society that it isunfair to base access to a scarce healthcare resource on abil-ity to pay. Even with adequate access to healthcare, sellingeggs puts in vitro fertilization out of the reach of many andallows the rich to outbid others and jump whatever queuesmight exist.

To address these issues, we should limit payment toegg donors to a standard and consistent monetary incen-tive that will encourage altruism but not lead to exploita-tion. This approach would follow the lead of the UnitedKingdom’s Human Fertilisation and Embryology Author-ity, which is phasing out all payment to gamete donorsother than “reasonable expenses” (Johnson 1997). Wher-ever the limit is set, it will be far less than the $50,000now offered for women with the “right” characteristics.We need to avoid paying donors to overlook the risks oftheir donation, both physical and psychological, and thehigher the pay, the more likely that is to happen.

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Page 3: Can We Broker Eggs Without Making Omelets?

Finally, the reproductive medicine community musttake responsibility for controlling the burgeoning marketin eggs. They are the front door to the process, as well asthe only legitimate avenue for the use of donated gametes.If the profession doesn’t regulate itself, it will be up to thegovernment to assert authority over what are increasinglycommercial transactions that threaten to become merce-nary at best and exploitative at worst. Whatever donationsresult should not be allocated on the basis of market forcesbut distributed according to medical need and waitingtime. We can choose another course, but the price to bepaid by the potential exploitation of donors and turningbody parts into commodities is even higher than the priceof a shortage of eggs. n

References

Advisory Committee on Human Radiation Experiments. 1996. The

human radiation experiments. New York: Oxford University Press.

Gurmankin, A. D. 2001. Risk information provided to prospective

oocyte donors in a preliminary phone call. American Journal of

Bioethics 1(4): 3± 13.

Johnson, J. 1997. Payments to gamete donors: Position of the Hu-

man Fertilisation and Embryology Authority.Human Reproduction

12(9): 1839± 1846.

McKinley, J. 1998. The egg woman. New York Times Sunday Mag-

azine, 17 May.

Sugarman, J., D. C. McCrory, D. Powell, et al. 1999. Empirical re-

search on informed consent. An annotated bibliography. Hastings

Center Report 29(1): S1± S42.

Donation, Disclosure, and DeceptionRebecca Dresser, Washington University

Andrea Gurmankin’s (2001) pilot study supplies valuableinformation about the initial disclosure of risks to womenconsidering oocyte donation. Her �ndings are relevant notonly to oocyte donor recruitment practices, but to the re-cruitment of research participants as well. According towidely accepted ethical principles, people must give in-formed and voluntary consent before they may be exposedto risks for the bene�t of others. Initial communicationsthat emphasize �nancial bene�ts and omit information onpotential harms can mislead prospective oocyte donors andresearch participants, thus compromising their ability tomake informed and voluntary decisions.

Gurmankin is not the �rst to argue that women areowed truthful information about oocyte donation risks atall stages of the recruitment process. In 2000 the EthicsCommittee of the American Society for ReproductiveMedicine (ASRM) issued a report entitled “Financial In-centives in Recruitment of Oocyte Donors.” The reportrecommends that:

1. Programs give women accurate and meaningful infor-mation about oocyte retrieval and donation, includingpossible negative physical and psychological conse-quences;

2. When couples themselves recruit potential donors,programs ensure that such donors go through the samedisclosure and counseling process as other prospectivedonors; and

3. Advertisements citing �nancial bene�ts to donors alsoacknowledge the existence of risks and burdens.

A further issue concerns the proper disclosure standardfor recruitment materials and contacts. What is an ethi-cally appropriate method of presenting preliminary riskinformation? Should advertisements and program recep-tionists furnish information about speci�c health risks andburdens? The ASRM Ethics Committee recommendedthat advertisements simply note the presence of risks andburdens, without speci�cally describing them. Becauseproblems could arise if receptionists or other untrained in-dividuals attempted to discuss speci�c medical informa-tion, they too should simply state that risks exist and thatrisks will be discussed in detail when prospective donorstalk with professional clinicians.

Risks should also be acknowledged in early communi-cations with prospective research participants. But re-search recruitment appears to present problems similar tothose seen in recruitment of oocyte donors. For example,in their review of research advertisements appearing in theWashington Post, Miller and Shorr (1999) found that spon-sors stressed the free examinations, evaluations, and medi-cations available to patients enrolling in studies. Not oneadvertisement mentioned any research risks or the possi-bility that participants would be assigned to a placebocontrol group.

From a broader perspective, prospective oocyte donorsand study volunteers would be less vulnerable to mislead-ing advertisements if media and other public informationsources offered more accurate background informationabout these activities. Many people form an impression ofoocyte donation and research participation before they en-

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