Stem Cell

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Outcomes

While the contributing factors regarding the risks of participating egg donors are varied, the subsequent outcomes of egg-harvesting for the purpose of advancing stem-cell research are the exploitation of women, women undergoing procedures with insufficient information regarding procedures, and the effects of taking powerful hormones.

The factors which contribute to increasing the risk to participants of egg-harvesting are:

1. Exploitation of women

With the growing international human egg trade, the exploitation of women appears inevitable (Beeson & Lippman 2006). Studies state that women are paid cash incentives for their oocytes (eggs). Financially vulnerable Romanian factory workers repeatedly sell their eggs for $US 250 and in other parts of the world, they are paid a minimum of $4000 to $5000 per cycle (Steinbrook 2006; Beeson & Lippman 2006; Galpern 2006). Compensation for treatment is said to average from US$2000 to US$3000 (Kalfoglou & Gittelsohn 2000). There are conflicting views regarding payment of participants, with countries such as Canada rejecting all payments, and with some areas such as Massachusetts and California also prohibiting payment to donors and others allowing payment as compensation (Beeson 2006). The attempt to lure in donors through offering too much money can be considered a manipulative process which leads to patients making decisions they may later regret (Steinbrook 2004).

Deception during treatment is morally concerning with some donors being placed under the impression that the reason a large number of eggs have been extracted is due to being 'super-fertile' (Steinbrook 2004). Steinbrook (2004) reveals that it is not uncommon for 'fertility doctors to flatter patients' in order to encourage repeat donations. Super-fertility is far from the truth with patients deterred from the idea of hormonal treatments being responsible for the excess number of eggs.

2. Undergoing procedures with insufficient or misleading information.

Kalfoglou & Gittelsohn (2000) state that there were a number of participants who reported requesting information on several occasions regarding the risks of donation and were given insufficient information about the risks involved, the time required for the procedure and the discomfort. On another occasion, one participant is said to have requested information to be sent to her and it never arrived. In addition, upon commencing treatment, Kalfoglou & Gittelsohn (2000) state that upon commencing treatment, participants were provided the necessary drugs and these drugs lacked a package insert instruction or such instructions were in a foreign language.

Kalfoglou & Gittelsohn (2000) reported that a number of participants were concerned that they were given insufficient information regarding the long term risks; others felt that the lack of information was due to egg donation for research having no financial incentive and thus participants were of little importance in comparison to their eggs.

However, Ahuja & Simons & Edwards (1999) state that if all possible risks were outlined to participants, too many patients would decline treatment. At the same time, with this risk in mind, participants must be provided with facts in order for donors to give 'informed' consent.

3. Effects of hormonal treatments on participants

Participants may face a serious and immediate risk of ovarian hyperstimulation syndrome (OHSS) due to the unnatural manipulation of a woman's body to produce multiple eggs for harvesting through administration of powerful hormones (Beeson & Lippman 2006). Such a serious condition may lead to hospitalization or even death. BBC(2005, cited in Beeson 2006) identifies that five cases in the UK resulted in death as of June 2005. Therefore, at the cost of egg-harvesting, participants may often be placed in a vulnerable position where their health and well-being is at risk.

Inadequate data based on the long-term effects of hormonal treatment is also an ethical concern. The lack of follow-up with participants results in less knowledge in this field and thus greater potential risks for women. Beeson & Lippman (2006) present such a case where long-term effects such as vaginal cancer in young offspring of users of the drug, DES (diethylstilbestrol), were only realised twenty years after the drug was administered to five to ten million women worldwide. In addition to this, Lupron, also a hormonal drug commonly used during the process of egg harvesting, currently has more than 6000 complaints on file with the Food and Drug Administration (FDA) and 25 fatalities that have been reported; however, there has been insufficient investigation or analysis of these incidents which could potentially provide participants and researches with greater understanding (Norsigian 2005; Lazar 1999, cited in Beeson & Lippman 2006). As is evident, the short and long term side effects presented reveal the underlying risks involved for participants and present this as an issue of worldwide ethical significance.

Recommendations:

1. Informed Consent

Measures should be taken to ensure participants are provided with adequate informed consent on which to base importance to researchers. Mertes and Pennings (2007) propose the condition that all donors should receive adequate education regarding the process of egg-harvesting. In addition, Ahuja et al. (1999) supports this view adding that it is the obligation of practitioners to ensure patients are advised of any risks being known or unknown.

2. Further research of long term effects

Donors' health should be of paramount importance for researchers. Scientists should weigh the risks and benefits of their research through documenting cases and using this data to reduce the risk posed on patients ((Mertes & Pennings 2007)). Follow-up projects regarding the long term effects of egg-harvesting on participants need to be in place with researchers encouraged to participate and gather information (Mertes & Pennings 2007). In addition, patients should be 'guaranteed free follow-up care' through insurance coverage (Mertes & Pennings 2007).

3. International standardisation of compensation

As a possible solution, Steinbrook (2006) suggests that an international consensus regarding the ethics of payment to participating egg donors