Page URL: https://www.progress.org.uk/ncobbodies4

This policy document is part of a response submitted by the Progress Educational Trust (PET) to the Nuffield Council on Bioethics' Consultation on Human Bodies in Medicine and Research.


What do you consider the costs, risks or benefits (to the individual concerned, their relatives or others close to them) of providing bodily material?

Egg donation involves some health risks, which should be clearly explained to and understood by prospective egg donors. These include the side-effects of fertility drugs (which can include hot flushes, irritability and headaches) and the risk of developing ovarian hyperstimulation syndrome while undergoing ovulation induction (this can be a life-threatening complication).

Additionally, unlike sperm (which can usually be obtained via ejaculation), eggs must be obtained via a surgical procedure. As with any surgical procedure (including procedures undergone by organ donors), there are potential risks of infection, discomfort, bleeding and injuries to internal tissues and organs (in the case of egg donation, these might include the bowels, the bladder or blood vessels).

Some argue that there are broader psychological risks associated with gamete (sperm and egg) and embryo donation. We believe that these risks have been overstated, as has the emotional significance of gamete donation. Although it is true that many people ascribe an automatic emotional significance to their genetic relatives, this is not always the case, and it may not be as common a sentiment in future.

As non-traditional families become increasingly commonplace, so the assumption that genetic relationships are coterminous with family relationships may cease to be automatic. Our vocabulary may undergo corresponding changes, so that - for example - donor-conceived individuals can more easily distinguish between their father (who raised them) and their sire (who donated sperm for their conception).

Before the removal in 2005 of entitlement to donor anonymity in the UK, it was argued that donor-conceived individuals with no knowledge of their genetic provenance experienced difficulties of psychology and identity. Even now that the entitlement to donor anonymity has been removed, some argue that there should be more stringent requirements imposed upon gamete donors, such as providing more information about themselves. The argument is that this would attract a higher standard of gamete donor who takes their responsibilities seriously, thus contributing to the welfare of the child conceived as a result of donation.

We disagree with this argument, as we feel that it (wrongly) seeks to impose the responsibilities of parenthood upon donors. While recipients of gametes should have access to all available donor information, it does not necessarily follow from this that donors should be encouraged to give all of this information. Certainly, donors should not be coerced into giving more than the rudimentary information.

Even if there is no explicit coercion, there is a slippage that can occur between good or best practice, guidelines, and mandatory requirements, where the classification of a practice in one category becomes the justification for promoting it to the more binding category. It would be a mistake for the authorities to make or encourage any pejorative assumptions about the amount of information that a donor gives. For one thing, there may be good reasons for not giving certain information. For another thing, even where there are no such good reasons, the judgement as to whether comprehensiveness of donor information is an indicator of donor suitability should rest (at best) with the gamete recipient or (at worst) with the fertility clinic, not with the authorities.

The importance that a recipient attaches to donor information can be broken down into two categories - utilitarian and emotional. It is right to presume that recipients will ascribe utilitarian (pragmatic and medical) importance to donor information, which is (among other reasons) why it is right that rudimentary information is available from all donors. However, it is not right to presume that recipients either will or will not ascribe emotional importance to donor information. Both attitudes should be accommodated, and the authorities should remain neutral in the matter.

Since the entitlement to donor anonymity was removed, psychological concerns have also been raised about the donor themselves, specifically about their trepidation at the possible impact upon them and their family, if a child born as a result of their donation should contact them 18 years later. Additionally, all individuals conceived from a donor's gametes - whether via donation or as part of the donor's own family - have the option to contact one another (effectively, to locate their genetic half-siblings) via voluntary registers such as UK DonorLink or the Human Fertilisation and Embryology Authority's Donor Sibling Link resource.

One concern that has been raised concerning gamete donors is specific to egg donors who participate in egg sharing schemes. These schemes enable women to receive fertility treatment sooner and/or at reduced cost if they donate some of their eggs for use in the treatment of other fertility patients. Studies have indicated that in a scenario where a woman's fertility treatment is unsuccessful, and that woman has participated in an egg sharing scheme, she may feel anxiety at the thought that her biological child is being raised by others (see the journal article 'An Assessment of the Motives and Morals of Egg Sharing Donors: Policy of "Payment" to Donors Requires a Fair Review', Kamal Ahuja et al, Human Reproduction, October 1998).

Another type of human bodily material we wish to address here is umbilical cord blood stem cells. There is a tension between the optimum method of obtaining cord blood stem cells, and the aim of minimising health risks to mother and child. This tension is more pronounced in relation to private cord blood banking, where procuring the optimum number of cells is a more urgent priority than it is in public cord blood banking.

In order to collect the optimum number of nucleated cells necessary for a cord blood transplant, it is recommended that the cord is clamped early and the cells collected whilst the placenta remains in utero. These practices involve potential health risks to mother and child, which should be clearly communicated to the pregnant woman before collection. There is also a risk to those who collect the cord blood stem cells - the risk of potential liability if anything goes wrong (see the journal article 'Tying the Cord Around the Midwife's Neck: The Problem with Umbilical Cord Blood Collection', Karen Devine, Journal of Professional Negligence, 1 July 2010).

For gamete donors, cord blood donors and other donors of human bodily material, the principal benefit of donation is altruism - satisfaction at having helping others to create a family or having contributed to biomedical research. Furthermore, although explicit remuneration for gamete donation is prohibited in the UK, egg sharing schemes are permitted. These give participants the opportunity to receive fertility treatment sooner and/or at reduced cost.