According to recent U.S Food and Drugs Administration statistics, the use of donor eggs for women who do not have the ability to otherwise conceive is increasing in the United States .. Vitro fertilization (IVF) with donor is the most common third-party reproduction method in use today. In this method of fertilization, a woman who cannot conceive using her own oocytes (the recipient) uses the oocytes of another woman (the donor). This way, she achieves pregnancy. The donor is always a woman in a healthy condition and receives compensation for the donation. She undergoes medical procedures to retrieve the egg. According to a media release by the Centers for Disease Control and Prevention in 2006, almost 12% of the assisted reproductive technology cycles were the ones from egg or embryo donation. The fresh embryos from donor oocytes show the highest success rates in fertilization. The implantation of the egg depends on the age of the woman. As the woman gets older, the probability of implantation reduces (CDC 2006”). The issue of donation has raised different ethical issues to different stakeholders.
Ethical Concerns in Egg Donation
The major ethical issue in egg donation is the conflict of interest. A conflict of interest arises between the recipient, the donor and those who provide infertility care. The infertility providers in most cases claim that their main role is caring for the recipients, because they pay the physicians. The donors do not pay the physicians, and instead receive compensation. According to Kalfoglou and Geller in 2000, the donor cannot be the consumer, since she takes no responsibility for the professional fees. The professional has a motivation to always keep the consumer happy, in this case the recipient. The conflict of interest arises when the professional does not have the best interests of the donor due to lack of an incentive. Some medical theorists argue that the conflict of interest can interfere with the legal representation and the informed consent of the donor (Seibel & Crockin 1996).
The relationship between the physician and the patient affects the well-being of the patient. The relationship between the donor and the physician is quite shallow, since the physician may ignore her well-being and only focus on the recipient. To avoid this ethical issue, the physicians should take into consideration the importance of the donor in the IVF process. The donor is a voluntary woman who takes the medical risks of the process. The nurses should, therefore, consider the potential of a conflict of interest. They should try and treat the donor and the recipient equally. The donor should also seek legal representation before the IVF process to ensure that they do not experience negligence from the physicians after the donation (Affordable Care Act 2012).
The other ethical concern in the IVF cycle and the egg donation process in general is the informed consent of the donor and recipient. The high financial incentives available for potential donors may blind them. A donor may make rash decisions involving egg donation due to the coercion or pressure from the availability of a huge financial benefits. The average amount of compensation for donors is around 4000 US dollars for a healthy donor. There are advertisements which offer up to 100,000 US dollars for a healthy, young donor with desirable characteristics. The American Society for Reproductive Medicine has tried to regulate the amount up to a high of $10,000. There are no federal or constitutional provisions governing the compensation amount. This means that a person can receive any amount of money considering the traits the recipient desires (Harris 2010).
For example, a recipient can offer high payment for a woman donor with specific hair color, intelligence and the looks in general. This creates a scenario where some people refer to as ‘designer baby donors’. A woman with these characteristics can make a decision without considering the risks especially when in economic difficulties. The best way to handle this ethical issue is to provide full communication to a woman before the donation. The woman should know the protocols, procedure, risks and other unique aspects of the IVF cycle. The physician should then allow the donor to make the decision without persuasions or pressure. The donor should also know the time requirement of the IVF cycle and have a schedule to accommodate it. The physician should also inform the donor of the financial penalties in case of a contract breach. This will ensure that the donor will make the consent with full information of risks and benefits ( Connolly, Keller, & Leever 2009).
The other ethical concern that arises regarding the egg donation is distributive justice in the availability of the procedure. The shortage of qualified donors is the main issue that puts infertility treatment in the category of distributive injustice. Recent statistics show that approximately a thousand women conceive annually with the use of the IVF procedure. Approximately the same number of women has to wait for donors to volunteer. The ethical conflict presents itself due to the fact that the procedure will favor those in a higher economic status. The women who can afford the payments for compensation, advertising and agency cost have a higher probability of finding a donor than those who cannot. Women from lower socioeconomic levels cannot access the service which makes it a luxury.
The injustice issue also occurs in the administration of the process. A patient who is infertile consults a doctor for treatment. The doctors have an obligation to ensure that they do all they can in their power to cure their patients. This means that the doctor has an obligation to ensure pregnancy for the infertile woman. With shortage in the egg donors, treating the infertile patients becomes more difficult. The doctor will revert to donor recruitment efforts; therefore, end up encouraging women to donate eggs without necessarily considering their opinions and consent. On the other hand, this turns to be unjust to the side of the donor. The conflict of interest will emerge, whereby the physician will focus more on the recipient other than the health protection of the donor (Butts & Rich 2005).
The other ethical issue is the non-maleficence and beneficence of the egg donation procedure. These require that the main aim of the IVF procedure is to improve the health of the patients and at the same time prevent any harm. The issue of maleficence comes up due to the fact that the donors do not have any clinical benefits after the surgical procedures. The donor takes risks in volunteering to undergo the surgical procedure without any biological benefits. Several legislators have raised concerns on whether the harm the donation process exposes on the donor is indeed medically ethical. The donation process places a young, fertile woman to health risks for the sake of an older, infertile woman. It is upon the physicians and legislators to determine whether this process is ethical (Schenker 2011).
During donation, the donor takes ovulation-stimulating drugs. The donors do not know the specific side effects of these drugs. This poses a great problem in avoiding harm in the procedure. Different researchers have raised the need for more studies on the effects of the drugs on the later life of a donor. Clinical studies and reports state that there is a big relationship between ovarian cancer and ovulation-enhancing drugs. According to the American Society for Reproductive Medicine, there are other risks attached to the use of these drugs. These include lacerations, ovarian hyperstimulation syndrome, ovarian infection, trauma and infertility. There is need for further tests to provide enough proof to these propositions. Medical practitioners are bound by a code of ethics that prohibits them from undertaking a medical procedure without concrete knowledge of the consequences and effects. It, therefore, raises ethical concerns of the undertaking of a procedure which risks the life of the donor (Meyer 1997).
The other ethical issue is the subjection of the donor to different psychological risks. The oocyte donation process may subject the donor to psychological problems in future. The donor may have concerns of the attachment of the eggs they donate to future offspring. They may also fear that the child may want to have a relationship with them in future, since they are the original source of the offspring. This may result to stress to the donor. According to Kenney and McGowan (2010 p. 8), psychological problems often arise especially in cases where the donor has personal relationships with the recipient. The donor might be a friend, a neighbor or even a close relative to the recipient. The recipient will always try and set boundaries between the offspring and the donor with the fear of maternal attachment. They also make sure that the contract stipulates the boundaries in roles and relationship between the donor and the offspring, which usually lacks an ethical justification, since the attachment is purely natural.
Another ethical concern is the availability of all the information about the donor’s genetic composition. Before the donation, the physician must take all the necessary genetic tests and procedure to ensure that the donor is viable. This might present information of undesirable genetic traits to the donor. The physician has to give this information to the donor and explain to them why they do not qualify. This raises the question of the ethical justification in giving information about specific genetic composition to an individual. Information such as being a carrier of some diseases or disorders such as color blindness or albinism, pose great psychological risks to the donor (Lew 2009). This information would be useless otherwise, since it does not mean that the woman suffers from any abnormalities. The physician will then inform the woman’s insurance company which further stresses the woman and renders her unhealthy. According to Hammarberg (2008), a donor will tend to question the process and may even end up in depression due to the disclosure of her genetic information.
Different human rights groups argue that the uncertainty of the future relationship and disclosure of the information between the donor and the recipient may bring about misunderstanding to the offspring. There is an ethical question on some limitations the offspring will have in the future considering the true origin as both the donor and the recipient would not want the possibility of consanguineous relationships afterwards. It is upon the parent to decide whether to tell her children about the donation or not (ASRM 2009). The innocent offspring may face some problems in future due to lack of information. Many questions arise on whom to provide information to the offspring regarding genetic health history. The recipient may end up blaming the donor for undesirable traits of the offspring such as improper behavior. The recipient may also develop negative attitude towards the offspring on the ground of lack of the desirable traits. This raises a key ethical concern of the abuse of the offspring’s innocence (Lachman 2006).
The American Society for Reproductive Health (ASRM) has put in place different measures to regulate the ethical standards of the egg donation process. According to a professor of clinical psychiatry at Columbia University Robert Kitzman, these standards have played a big role in ensuring that physicians and recipients do not exploit the donors. ASRM has set that a donor should be at least twenty one years of age. Any donor younger than this age, but above the majority age should receive psychiatric evaluation before donation and receive special follow-up programs (Soifer 2009). The donors should also receive compensation for their time; the compensation, however, is not based on such factors as past successful donations or donors’ college grades. The main challenge in adhering to these guidelines is the lack of legal authority. The process is rather voluntary and ASRM cannot sanction anyone who denies compliance. The agency, therefore, points out that it is for the good of the donor to question the clinic responsible for the procedure whether they follow these recommendations. This will ensure that the donors avoid a significant number of ethical concerns.
It is not necessarily the case that all the citizens and stakeholders share these ethical concerns. Different groups give justifications for the process and offer arguments to support their involvement. These are mostly recipient agencies and IVF clinics. They point out that the IVF process is not a necessity, and those against it should not consider it a medical imperative. They point out that the variation in the price of eggs is due to the wealth disparities among recipients. They compare this to general medical care or the quality of education. They, therefore, argue that government agencies and legislators should leave the ‘egg market’ to enjoy the freedom and control of market forces. However, this will pose great risks in the process and even give room for more ethical concerns. The authority should collaborate with the medical practitioners and other groups to come up with solutions on these ethical issues (Erickson 2010).
It is the role of the nurses working with the women who take part in IVF to ensure that both the donors and the recipients are aware of the consequences of the whole process. They can ensure that the donors are aware of the benefits as well as the risks of egg donation. They should also ensure that they bring out all the concerns attached to egg donation; present the conflicts of interest to the donors and recipients to allow them make their own decisions regarding the procedure. This involves completeness of informed consent, legal representation of the donor and the follow-up support. Different interest groups such as the American Society for Reproductive Medicine should take up the initiative to influence legislation that sets the whole procedure clear. The legislations should provide clear guidelines on how to undertake the process. The ethical concerns will remain a contentious issue in the egg donation procedure until the interest groups in the medical field take the responsibility to oversee the whole process for the good of the donors, the recipients and medical practitioners.