New York's stem cell board approves payments to egg donors for research
New York's stem cell board approves payments to egg donors for research
"You kill somebody [selling] their eggs…the public outcry would be enormous"
The board that oversees New York state's $600 million stem cell research program will allow researchers to pay compensation to women who donate eggs for research — a decision believed to be the first in the U.S. to allow state research money for this purpose.
It's also a move that will put decisions about such recruitment offers to women — How much? How often? With what warnings about risks? — squarely in front of IRBs in New York.
And some believe it could lead authorities in other states to revisit their long-standing decisions not to allow payments to egg donors for research purposes.
"My understanding is that other states are definitely re-evaluating and reconsidering their position on this issue," says Robert Klitzman, MD, a member of the Empire State Stem Cell Board's (ESSCB) ethics committee. Klitzman is an associate professor of clinical psychiatry at Columbia University in New York City, where he co-founded the university's Center for Bioethics.
Other states have rules prohibiting payments to women who donate eggs for research purposes. The National Academy of Science's 2005 Guidelines for Human Embryonic Stem Cell Research recommended that women who undergo hormonal induction to generate eggs for research be compensated only for "direct expenses incurred as a result of the procedure."
"No cash or in-kind payments should be provided for donating oocytes for research purposes," according to the NAS guidelines.
Disagreement on payments
But the guidelines also acknowledged disagreement on this issue, including arguments from some that other research subjects can receive financial inducements and that denying them to women who donate eggs is paternalistic.
And Klitzman notes that women already are routinely paid to provide eggs in reproductive clinics for infertile couples. As a result, he says, it has been nearly impossible for researchers to recruit egg donors for research without being able to compensate them.
"I know at Harvard for instance, they tried for years to recruit women and finally were able to get one woman," he says. "The others, when they were told they wouldn't get paid, decided not to do it.
"Basically, it's impaired stem cell research."
Klitzman says the ESSCB's ethics committee also cited ethical reasons for opening up the possibility of paying women who undergo the difficult process of hormonal induction to produce eggs for research. He says it takes an estimated 56 hours of a woman's time to donate eggs, including hormonal treatments and the egg retrieval procedure itself.
There also are risks associated with the procedure, including ovarian hyper-stimulation syndrome, which occurs when swollen ovaries leak fluid into a woman's belly and chest. Most cases involve mild discomfort and bloating but in rare, severe cases, women can experience life-threatening complications such as blood clots and kidney failure.
Klitzman says these factors help explain the payments made to IVF egg donors, which can go as high as $10,000.
"If you figure out the amount per hour of time (associated with the procedure) and given that this is an invasive procedure and there are risks — this is not just doing an attitudinal study with a survey and you get $10," he says.
He says it is unfair to compensate a woman who donates eggs for research purposes less than one who donates for reproductive purposes.
IRBs among safeguards
In making the decision to allow payments to egg donors for stem cell research, the ESSCB included a number of safeguards, including requiring approval by both IRBs and embryonic stem cell research oversight committees (ESCROs), as well as payments in accordance with guidelines developed by the American Society of Reproductive Medicine.
However, the action continues to have its critics. Arthur Caplan, PhD, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia, says that the first time a woman is injured or even dies as a result of being paid to donate eggs for research, the reaction would likely put a halt to all such arrangements.
"This is a very volatile supply source," he says. "If you kill somebody having them sell their eggs, I think the public outcry would be enormous against it."
And Caplan is not convinced the practice will spread to other states, given the controversy already attached to embryonic stem cell research. He notes that New York's situation is unusual, given that an appointed commission made the decision.
"I think in most states you'd have to push this through the legislature," he says. "I think politically, it's a much tougher sell."
Caplan suggests that there are alternative ways of procuring eggs for stem cell research, including post-mortem donations of eggs from deceased women and donations of ovaries that potentially could be induced to create eggs outside the body.
Klitzman notes there is strong public support for stem cell research in general. He says that NAS guidelines are not binding, so other states are free to make the same decision that New York did.
"Even though NAS guidelines may or may not change, states may nonetheless feel that ethically they should permit compensation."
The board that oversees New York state's $600 million stem cell research program will allow researchers to pay compensation to women who donate eggs for research a decision believed to be the first in the U.S. to allow state research money for this purpose.Subscribe Now for Access
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