Correspondence

More on Compensating Egg Donors

N Engl J Med 1993; 329:278-279July 22, 1993

Article

To the Editor:

Seibel and Kiessling (March 11 issue)1 invoked equal worth of the sexes and the nationwide practice of paying sperm donors to justify their proposal to pay oocyte donors. The risks and benefits associated with paying donors are not mentioned. Although oocyte donation has not been demonstrated to transmit infectious disease, hepatitis and human immunodeficiency virus (HIV) are transmissible through sexual intercourse, artificial insemination, and organ and tissue transplantation. Transfusion from paid blood donors is associated with a higher risk of transmitting infectious disease from donors to recipients than transfusion from donors who do not receive monetary reimbursement or incentives.

This increased risk is not balanced by a demonstrated need to pay egg donors to ensure their availability. Nationwide programs involving voluntary donors of bone marrow who are unrelated to the recipients have succeeded without paying the donors. Many were skeptical that people would volunteer to donate marrow to nonrelatives; yet, over 700,000 have registered with the national program as potential donors. In the St. Paul, Minnesota, program, the time spent on the donation of bone marrow to an anonymous recipient is comparable to the time spent on oocyte donation.

Perhaps it is time to develop community programs of anonymous oocyte donation by volunteers to meet the needs of patients with infertility, as has been done for bone marrow and blood donations.

D. Ted Eastlund, M.D.
David E. Stroncek, M.D.
American Red Cross Blood Services, St. Paul, MN 55107

1 References

1. 1

   Seibel MM, Kiessling A. Compensating egg donors: equal pay for equal time? N Engl J Med 1993;328:737-737
   Full Text | Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: Drs. Eastlund and Stroncek raise an important point in suggesting that a registry of unpaid volunteers for anonymous oocyte donation be compiled as has been done for bone marrow and blood donations. Perhaps this concept should be considered at the national level. The prospect of a national registry, however, has been made difficult by a moratorium by the National Institutes of Health on sponsoring research in assisted reproduction.

Oocyte donation differs from blood donation in many respects. Blood and marrow donors are identified in the open forum of a drive for donations, and their identity is known. Oocyte donation does not solve a problem of life and death. The donation does not remain in the recipient; it becomes a child. When the donor allows another woman to have a baby, complex issues of parenthood arise for the donor, the recipient, and the child. The identities of some oocyte donors are known, but as in sperm donation, the opportunity for confidentiality remains essential for optimal protection of all parties.

The number of recipients of donated eggs is increasing rapidly, as women wait longer to have children and the number of babies available for adoption dwindles. In addition, 3.5 million women a year are reaching menopause, and some will want to continue childbearing. Egg donation could become as common as adoption or sperm donation. At present, the number of acceptable oocyte donors is marginally sufficient.

Not all oocyte donors are paid. Historically, anonymous sperm donors were paid. The same approach was applied to anonymous oocyte donors. In our program, about 50 percent of oocyte donors remain anonymous. Altruism is an important criterion for acceptance. Potential donors motivated by financial reasons alone are refused. Applicants undergo intensive psychological screening as well as testing for HIV infection, hepatitis, and other infectious diseases. Not all applicants are emotionally well suited to donate oocytes.

In our original letter, we took issue with the contractual agreements with insurance companies that currently limit patient access, affect standards of care, and determine treatment policy. Perhaps adequate numbers of acceptable, unpaid volunteers for oocyte donation do exist. This letter could serve as a call for a national meeting on the topic of a registry, the contrast between oocyte donation and other organ donations, and the opportunity to standardize care. But today there is no registry. Compensating oocyte donors is the norm, in accordance with the ethical guidelines of the American Fertility Society. The medical community, not the insurance industry, should make these decisions.

Machelle M. Seibel, M.D.
Ann A. Kiessling, Ph.D.
Faulkner Centre for Reproductive Medicine, Boston, MA 02130