Letter to the editor |
Mirror exchange of donor gametes should also accommodate scientific research
1 National University of Singapore and 2 Genome Institute of Singapore, Genome, Singapore
3 To whom correspondence should be addressed at: National University of Singapore, 5 Lower Kent Ridge Road, 119074 Singapore. E-mail: denhenga{at}nus.edu.sg
Sir,
We read with great interest the article by Pennings (2005)
who proposed a system of mirror exchange in gamete donation. The proposed scheme, however, fails to take into account the overwhelming demand for donor gametes in scientific research; particularly, somatic cell nuclear transfer (SCNT) for the derivation of patient-specific stem cells (Hwang et al., 2004, 2005), which have opened up new avenues of therapy for various human diseases. Although no clinical trials have yet been carried out with nuclear transfer stem cells, studies with animal models have yielded extremely promising results that can readily be extrapolated to the human model (Rideout et al., 2002; Lanza et al., 2004). Nevertheless, a major impediment against further rapid advances in this field is the severe shortage of donor oocytes for scientific research.
No doubt, it may be argued that mirror exchange donor oocytes may be better utilized for infertile recipients in clinical assisted reproduction rather than scientific research. Nevertheless, it is imperative that provisions should also be made for the personal wishes of the oocyte donors themselves. They should be given an additional choice to contribute to scientific research, instead of being restricted to only helping infertile women to conceive.
It is envisioned that the majority of patients would prefer to donate their oocytes for SCNT research rather than have a potential biological offspring in an unknown family. Moreover, the abolishment of gamete donor anonymity in several countries (Lebech, 1997; Johnston, 2002; Fortescue, 2003) could makes the situation less comfortable for mirror exchange oocyte donors, who may already feel pressurized to donate in return for donor insemination. Serious ethical and moral issues are bound to arise, if mirror exchange oocyte donors themselves fail in assisted conception, but are subsequently contacted by their biological offsprings several years later.
Under such circumstances, it is imperative that the available choices for mirror exchange oocyte donors be extended to include SCNT research, instead of being restricted only to assisted conception. This is ethically justifiable, because donation to scientific research can also be seen as a positive reciprocal contribution to society, in return for donor insemination. In any case, mandatory counselling should be given to enable the prospective donor to make an informed decision on their choice.
Additionally, it is also proposed that mirror exchange oocyte donation should be in the context of sharing the prospective donor’s cohort of oocytes retrieved from a treatment cycle, rather than subjecting her to an additional stimulation cycle exclusively for oocyte donation. This would reduce the medical risk of ovarian hyperstimulation syndrome (Budev et al., 2005). Because of likely imbalances in mirror exchange gamete donation arising from an unequal ratio of oocyte and sperm donors, as well as the unequal effort expected from female partners compared with male partners (Pennings, 2005), an equal split of the patient’s cohort of oocytes for donation may not be justified in this case. Perhaps, a threshold number of retrieved oocytes from the prospective donor should be set for each treatment cycle that if not exceeded would completely excuse her from donation. Any excess supernumerary oocytes above this threshold number can be donated either to infertile women or for scientific research, according to the personal wishes of the patient. Perhaps, a total of 10 retrieved oocytes from the prospective donor can be considered a suitable threshold number, since the chances of conception are unlikely to be impaired (Stojkovic et al., 2005).
References
Budev MM, Arroliga AC and Falcone T (2005) Ovarian hyperstimulation syndrome. Crit Care Med 33 (Suppl. 10),S301–S306.[CrossRef][Medline]
Fortescue E (2003) Gamete donation – where is the evidence that there are benefits in removing the anonymity of donors? A patient’s viewpoint. Reprod Biomed Online 7,139–144.[Medline]
Hwang WS, Ryu YJ, Park JH, Park ES, Lee EG, Koo JM, Jeon HY, Lee BC, Kang SK, Kim SJ et al. (2004) Evidence of a pluripotent human embryonic stem cell line derived from a cloned blastocyst. Science 303,1669–1674.
Hwang WS, Roh SI, Lee BC, Kang SK, Kwon DK, Kim S, Kim SJ, Park SW, Kwon HS, Lee CK et al. (2005) Patient-specific embryonic stem cells derived from human SCNT blastocysts. Science 308,1777–1783.
Johnston J (2002) Mum’s the word: donor anonymity in assisted reproduction. Health Law Rev 11,51–55.[Medline]
Lanza R, Moore MA, Wakayama T, Perry AC, Shieh JH, Hendrikx J, Leri A, Chimenti S, Monsen A, Nurzynska D et al. (2004) Regeneration of the infarcted heart with stem cells derived by nuclear transplantation. Circ Res 94,820–827.
Lebech AM (1997) Anonymity and informed consent in artificial procreation: a report from Denmark. Bioethics 11,336–340.[Medline]
Pennings G (2005) Gamete donation in a system of need-adjusted reciprocity. Hum Reprod 20,2990–2993.
Rideout WM III, Hochedlinger K, Kyba M, Daley GQ, Jaenisch R (2002) Correction of a genetic defect by nuclear transplantation and combined cell and gene therapy. Cell 109,17–27.[CrossRef][ISI][Medline]
Stojkovic M, Stojkovic P, Leary C, Hall VJ, Armstrong L, Herbert M, Nesbitt M, Lako M and Murdoch A (2005) Derivation of a human blastocyst after heterologous nuclear transfer to donated oocytes. Reprod Biomed Online 11,226–231.[ISI][Medline]
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