The British Medical Association (BMA)'s Medical Ethics Committee (MEC) recently had a long and fascinating debate about egg donation for research. The debate was much broader than the Human Fertilisation and Embryology Authority (HFEA)'s consultation document, looking also at related issues such as payment for donation of other human material for research. Also, in view of the proposed merger of the HFEA and the Human Tissue Authority (HTA), the committee questioned what, if any, impact the HFEA's approval of compensated egg sharing would have on the question of payment, in money or kind, for the donation of organs for treatment.
Interestingly the main topic of the HFEA's consultation - non-patient donation of eggs for research - was the most straightforward and the issue on which there was most agreement within the committee. There are, and must be, limits to what a competent adult can give consent to. An adult could not, for example, consent to donate his or her heart for the treatment of others or for research. But, provided they are properly informed and not coerced, we allow competent adults to donate one of their kidneys for transplantation and, of course, for many years women have been donating eggs for the treatment of others. Subject to research ethics committee approval, people also take risks for research - as was vividly illustrated by the ill-fated phase one TGN1412 clinical trial at Northwick Park. With egg donation the procedure is intrusive and there are some known and established risks (and, possibly, some unknown long-term risks from the drugs used to stimulate the ovaries). When considering whether there are grounds to prohibit women from donating eggs to research, we need to consider whether the risks are so great that it goes beyond what is reasonable for a competent, informed individual to consent to. The clear view from the BMA's Medical Ethics Committee is that the risks associated with egg donation do not raise this type of concern or justify preventing women from donating to research if that is their wish and they are not subjected to pressure causing them to act contrary to their own better judgement. Of course, how many women will be willing to undergo this procedure without any incentive (such as payment, in money or in kind) remains to be seen.
As with all procedures, in order to be valid the consent must be voluntarily given and free from pressure. Because of the risk of actual or perceived coercion, there is already guidance recommending caution where the participants are in a dependent relationship with the researcher and the BMA and others advise against the use of students or junior laboratory staff from the same department as the researcher. As with other areas of research, any actual or perceived conflict of interest needs to be declared and addressed and safeguards need to be put in place to ensure that participants have adequate accurate information and that their consent is valid. Subject to those safeguards, the MEC took the view that there should be no barrier to women donating eggs to research where that was their wish.
For understandable reasons, the HFEA has looked at this issue in isolation, but surely we need to consider the bigger picture. People who donate blood or other tissue for research can be paid, why should research using gametes be any different from donation of other material for research? The vagaries of the HFE Act mean that women who donate eggs for research that does not involve the creation of embryos can be paid but those who donate to licensed research cannot. What is the moral justification for making such a distinction? Should egg donation for research be treated in the same way as donation of other material for research, or should it be treated in the same way as donation of eggs for treatment? With donation for treatment, the HFEA also appears to have looked at the issue in isolation. But for those, like the BMA, who oppose payment for the donation of organs, blood and tissue for treatment, the question arises of whether there are any reasons for taking a different approach to payment (in kind) for egg donation. When, as proposed, the HFEA merges with the HTA, how can the new body justify allowing compensated egg sharing for IVF treatment (which is essentially a form of payment) but resist considering requests from those individuals or organisations who would support payment for kidney donation or perhaps for some form of 'organ sharing'? Surely nobody would seriously consider that patients who need a heart or liver transplant should be offered the opportunity go to the top of the waiting list if, at the time of their transplant operation, they agree to donate a healthy kidney to someone else. It is these broader implications of the HFEA's decisions, and the need to ensure consistency in our approach to these different areas, that is proving most difficult.